Unilateral acoustic neuroma in childhood

Pediatric vestibular schwannomas: case series and a systematic review with meta-analysis

OBJECTIVE

Sporadic unilateral vestibular schwannomas are rare in the pediatric population. Little has been reported in the literature on the presentation, tumor size, response to surgical treatment, and recurrence rates in these younger patients. The authors' goal was to describe their institutional experience with pediatric sporadic vestibular schwannomas and to conduct a meta-analysis of the existing literature to provide further insight into the presentation, tumor characteristics, and surgical outcomes for these rare tumors to help direct future treatment strategies.

METHODS

The authors performed a retrospective review of all patients 21 years of age or younger with unilateral vestibular schwannomas and without neurofibromatosis type 2 who underwent resection by the senior authors between 1997 and 2019. A systematic review of the literature and meta-analysis was also performed by entering the search terms "pediatric" and "vestibular schwannoma" or "acoustic neuroma," as well as "sporadic" into PubMed. Presentation, treatment, clinical outcomes, and follow-up were analyzed.

RESULTS

Fifteen patients were identified at the authors' institution, ranging in age from 12 to 21 years (mean 16.5 years). Common presenting symptoms included hearing loss (87%), headache (40%), vertigo (33%), ataxia (33%), and tinnitus (33%). At the time of surgery, the mean tumor size was 3.4 cm, with four 1-cm tumors. Four patients had residual tumor following their first surgery, 3 (75%) of whom had significant radiographic regrowth that required further treatment. The literature review identified an additional 81 patients from 26 studies with patient-specific clinical data available for analysis. This resulted in a total of 96 reported patients with an overall average age at diagnosis of 12.1 years (range 6-21 years) and an average tumor size of 4.1 cm.

CONCLUSIONS

Pediatric vestibular schwannomas present similarly to those in adults, although symptoms of mass effect are more common, as these tumors tend to be larger at diagnosis. Some children are found to have small tumors and can be successfully treated surgically. Residual tumors in pediatric patients were found to have a higher rate of regrowth than those in their adult counterparts.

Sporadic acoustic neuroma in pediatric patients

OBJECTIVE

Sporadic acoustic neuroma, usually occur between the ages of 40 and 70 years, are very rare in children. We review the experiences of 10 cases of sporadic (non-NF2) acoustic neuromas in pediatric patients.

METHOD

During last 26 years 2000 skull base procedures were performed in the Otorhinolaryngology Unit of the Ospedali Riuniti di Bergamo. Among these almost 900 cases were acoustic neuromas. Only 10 were at or under the age of 18 years.

RESULTS

The age of the youngest patient in our series was 12 years. Deafness were the commonest presentation and were seen in eight patients. It varied between 10 and 65 dB sensorineural hearing loss. Among these eight cases, two patients have sudden onset of hearing loss. Two patients presented with dizziness. The duration of complaints were between 2 months and 5 years in these patients. The diameter of the tumors varied widely with minimum of 10 mm to maximum up to 60 mm. Five patients each underwent resection of the tumor by translabyrinthine and retrosigmoid approach, respectively. The minimum postoperative follow-up was 3 years and maximum was 22 years in our series. Postoperatively seven cases the facial nerve recovered to grade I, and one each to grade II and grade VI of House-Brackmann classification. All five cases who underwent retrosigmoid approach had moderate (40 dB) to total sensorineural hearing loss postoperatively. The youngest patient with largest tumor diameter of 60 mm developed transient hemiparesis in the immediate postoperative period and he recovered fully in due course.

CONCLUSION

We found preservation of facial nerve function is more easier than hearing in this group of patients.

Management of vestibular schwannomas in young patients-comparison of clinical features and outcome with adult patients

OBJECTS

Vestibular schwannomas (VS) in young patients are rare. They are regarded to have different biological characteristics. Our objective is to analyze a series of such patients, with respect to their clinical presentation, treatment, and outcome and to compare the results to a matched series of adult patients.

MATERIALS AND METHODS

Retrospective analysis of 20 patients under 21 years of age. All patients underwent surgery via the retrosigmoid approach. The analysis included: age, gender, tumor size, clinical, and neurological pre- and postoperative status including cochlear and facial nerve function, and complications. Statistical comparison of the young patient's data with a series of 200 adult patients previously published by the authors.

CONCLUSIONS

The current study demonstrates that the outcome after surgical management in patients harboring VS does not show any significant difference between young and adult patients.

Vestibular schwannomas in children

OBJECTIVE

This article highlights the clinical presentation and management issues of unilateral vestibular schwannomas in children. We demonstrate how the presentation differs from neurofibromatosis type 2 (NF2) and from adult unilateral vestibular schwannomas.

STUDY DESIGN

This article is composed of a series of three cases and a literature review.

SETTING

The study was performed at a university hospital (tertiary referral center).

PATIENTS

Three children, aged 9, 11, and 13 years, with histologically confirmed vestibular schwannomas were studied. All children under 16 years of age in the world literature with unilateral vestibular schwannomas were reviewed.

INTERVENTION

Analysis of presentation and surgical management of these three children and those children reported in the literature.

MAIN OUTCOME MEASURE

Pattern of presentation relative to children with NF2 and people with adult unilateral vestibular schwannomas.

RESULTS

Two patients had multiple cranial nerve weakness and recurrence, and one patient had successful removal of the tumor with preservation of all functions of the cranial nerves, including the facial nerve.

CONCLUSION

Vestibular schwannomas in children are very uncommon. It is likely that it is the first manifestation of NF2, but it may also be a variant of sporadic vestibular schwannomas. A presentation of three cases and a review of 36 other cases in the literature demonstrates how the presentation is different from adult sporadic vestibular schwannomas and NF2 because it lacks primary audiological symptoms. The study also provides evidence of non-NF2 vestibular schwannomas presenting in children and suggests that it is likely that these are a variant of unilateral sporadic vestibular schwannomas. The search for the features of NF2 in these cases remains mandatory.