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Di Micco R, Salcher R, Lesinski-Schiedat A, Lenarz T. Long-Term Hearing Outcome of Cochlear Implantation in Cases with Simultaneous Intracochlear Schwannoma Resection. Laryngoscope 2024; 134:1854-1860. [PMID: 37676060 DOI: 10.1002/lary.31025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/13/2023] [Accepted: 08/14/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES The aim was to analyze the long-term hearing results after simultaneous microsurgical extirpation via enlarged cochleostomy and cochlear implantation in intracochlear schwannoma as compared with non-tumor single-side deafness patients. METHODS Microsurgical extirpation via enlarged cochleostomy with simultaneous cochlear implantation was performed in 15 cases of intracochlear schwannoma between 2014 and 2021. Speech recognition tests in German language and impedance performances were collected over 36 months of observation and compared with an internal cohort of 52 age matched non-tumor single-side deafness patients. Retrospective cohort study in a tertiary referral center. RESULTS The surgery proved feasible and uneventful in all cases. In the case of intracochlear schwannoma, the hearing rehabilitation results were highly satisfactory and comparable to those of the non-tumor single-side deafness cohort. The speech recognition performance improved steadily in the first 12 months; afterward, it remained stable, providing indirect evidence against tumor recurrence during the follow-up. One patient required implant revision surgery related to device failure, but no recurrence was registered in the 36 months of observation. CONCLUSIONS Cochlear implantation is the strategy of choice for hearing rehabilitation in case of intracochlear schwannomas in the long term. In particular, the combination of tumor extirpation via cochleostomy with a cochlear implantation in the same surgical time offers a viable therapy for intracochlear schwannoma, granting a sufficient degree of radicality without compromising the cochlear integrity. This technique allows for revision surgery if required. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1854-1860, 2024.
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Affiliation(s)
- Riccardo Di Micco
- Department of Otorhinolaryngology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Rolf Salcher
- Department of Otorhinolaryngology, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Thomas Lenarz
- Department of Otorhinolaryngology, Medizinische Hochschule Hannover, Hannover, Germany
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Holger S, Conrad R, Rayoung K, Scholtz LU, Pfeiffer CJ, Peter G, Ingo T. A new device for the removal of cochlear schwannoma: A temporal bone study. Front Surg 2023; 10:1077407. [PMID: 36816011 PMCID: PMC9928970 DOI: 10.3389/fsurg.2023.1077407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023] Open
Abstract
Background Intralabyrinthine schwannoma (ILS) is a rare, mostly unilateral disease that causes deafness. Different intralabyrinthine sites of ILS can occur and can be removed by different surgical approaches. Cochlear ILSs are frequently partially hidden by the modiolus and therefore difficult to extirpate. Surgical techniques can be traumatic, offer limited surgical control during removal, and are time-consuming. The aim of this present study was to demonstrate the performance and handling of a newly developed device for the removal of cochlear intralabyrinthine schwannoma in the temporal bone. Methods In a temporal bone study with a prepared posterior tympanotomy, an enlarged round window approach, and additional second turn access, a stiffened device with silicone rings was inserted and extracted gradually from the second turn access until the rings were visible in the second turn access. Results Insertion and extraction of the second cochlear access were easily performed. Pulling and pushing the silicone rings through the modiolus and hidden parts of the basal turn was possible and worked like a pipe cleaner. Conclusion This newly developed tissue removal device in combination with the proposed surgical handling offers a new and less traumatic way to remove cochlear ILS.
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Curatoli L, Pontillo V, Quaranta N. Intralabyrinthine schwannomas: a two-case series and literature review with a focus on hearing rehabilitation. Eur Arch Otorhinolaryngol 2023; 280:2073-2079. [PMID: 36648549 PMCID: PMC10066102 DOI: 10.1007/s00405-023-07823-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE Intralabyrinthine schwannomas (ILSs) are an uncommon finding. Diagnosis is challenging and no gold standard treatment exists yet. In this article, we present a two-cases series and review the latest available literature to assess the best diagnostic and therapeutic scheme. METHODS We reviewed the latest available literature assessing most frequent and relevant sets of symptoms, clinical features of the disease, diagnostic tests and imaging, possible treatments and after-surgery hearing rehabilitation techniques. We then compared literature data to our own series ones. RESULTS ILSs clinical presentation and development may overlap with other, more common otological conditions. Full audiometric battery test, electrophysiological study of VEMPS and MRI with contrast enhancement all appear to be critical to correctly diagnose these tumors. Several treatments exist: radiological follow-up, radiation therapy, full or partial surgical excision. Hearing rehabilitation is mostly accomplished through simultaneous cochlear implantation. CONCLUSIONS Our case-series data matches the available literature. ILSs are a rare type of vestibular schwannomas. Diagnosis in challenging and delayed in time as all the diagnostic tests, yet sensitive, are not specific for ILSs. The most suitable treatment seems to be surgical excision of these tumors followed by simultaneous cochlear implantation to restore hearing.
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Affiliation(s)
- Luigi Curatoli
- Translational Biomedicine and Neurosciences Department, University of Bari, Bari, Italy.
| | - Vito Pontillo
- Translational Biomedicine and Neurosciences Department, University of Bari, Bari, Italy
| | - Nicola Quaranta
- Translational Biomedicine and Neurosciences Department, University of Bari, Bari, Italy
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Laborai A, Ghiselli S, Cuda D. Cochlear Implant in Patients with Intralabyrinthine Schwannoma without Tumor Removal. Audiol Res 2022; 12:33-41. [PMID: 35076488 PMCID: PMC8788267 DOI: 10.3390/audiolres12010004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/27/2021] [Accepted: 01/04/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Schwannomas of the vestibulocochlear nerve are benign, slow-growing tumors, arising from the Schwann cells. When they originate from neural elements within the vestibule or cochlea, they are defined as intralabyrinthine schwannomas (ILSs). Cochlear implant (CI) has been reported as a feasible solution for hearing restoration in these patients. (2) Methods: Two patients with single-sided deafness (SSD) due to sudden sensorineural hearing loss and ipsilateral tinnitus were the cases. MRI detected an ILS. CI was positioned using a standard round window approach without tumor removal. (3) Results: The hearing threshold was 35 dB in one case and 30 dB in the other 6 mo after activation. Speech audiometry with bisillables in quiet was 21% and 27% at 65 dB, and the tinnitus was completely resolved or reduced. In the localization test, a 25.9° error azimuth was obtained with CI on, compared to 43.2° without CI. The data log reported a daily use of 11 h and 14 h. In order to not decrease the CI’s performance, we decided not to perform tumor exeresis, but only CI surgery to restore functional binaural hearing. (4) Conclusions: These are the sixth and seventh cases in the literature of CI in patients with ILS without any tumor treatment and the first with SSD. Cochlear implant without tumor removal can be a feasible option for restoring binaural hearing without worsening the CI’s performance.
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Casselman JW, Vanden Bossche S, De Foer B, Bernaerts A, Dekeyzer S. Temporal Bone. Clin Neuroradiol 2022. [DOI: 10.1007/978-3-319-61423-6_90-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Poillon G, Horion J, Daval M, Bouccara D, Hautefort C, Housset J, Levy D, Purcell Y, Savatovsky J, Toupet M, Attyé A, Eliezer M. MRI characteristics of intralabyrinthine schwannoma on post-contrast 4 h-delayed 3D-FLAIR imaging. Diagn Interv Imaging 2021; 103:171-176. [PMID: 34688591 DOI: 10.1016/j.diii.2021.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to describe the MRI characteristics of intralabyrinthine schwannoma (ILS) on post contrast three-dimensional (3D) fluid-attenuation-inversion-recovery (FLAIR) images obtained four hours after intravenous administration of a gadolinium-based contrast agent (4h-3D-FLAIR). MATERIALS AND METHODS This IRB-approved retrospective multi-center study included patients presenting with typical ILS from January 2016 to October 2020. All medical charts were systematically collected. All MRI examinations, including 4h-3D-FLAIR images, were reviewed by two board-certified neuroradiologists. Main outcome measures were location, signal intensity and associated anomalies of ILS. RESULTS Twenty-seven out of 8730 patients (0.31%) referred for the investigation of a cochleovestibular disorder had a final diagnosis of ILS. There were 13 men and 14 women with a mean age of 52 ± 17 (SD) years (age range: 20-86 years). The most common clinical presentation was unilateral progressive sensorineural hearing loss (16/27; 59%). All ILS were unilateral and 15 (15/27; 55%) were intracochlear. All ILS presented as a hypointense filling defect within the labyrinth on T2-weighted images that enhanced on post-contrast T1-weighted images. On 4h-3D-FLAIR images, all ILS presented as a hypointense filling defect, associated with diffuse perilymphatic hyperintensity. Two patients (2/27; 7%) presented with ipsilateral endolymphatic hydrops. CONCLUSION ILS displays consistent features on post-contrast 4h-3D-FLAIR images. ILS should not be confused with endolymphatic hydrops and requires a systematic analysis of the corresponding T2-weighted images.
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Affiliation(s)
- Guillaume Poillon
- Department of Neuroradiology, Fondation Adolphe de Rothschild Hospital, Paris 75019, France.
| | - Julien Horion
- Department of Neuroradiology, Rouen University Hospital, Rouen 7600, France
| | - Mary Daval
- Department of Head and Neck Surgery, Fondation Adolphe de Rothschild Hospital, Paris 75019, France
| | - Didier Bouccara
- Department of Head and Neck Surgery, Georges Pompidou Hospital, AP-HP, Paris 75015, France
| | - Charlotte Hautefort
- Department of Head and Neck Surgery, Lariboisière University Hospital, AP-HP, Paris 75010, France
| | - Juliette Housset
- Department of Head and Neck Surgery, Lariboisière University Hospital, AP-HP, Paris 75010, France
| | - Daniel Levy
- Department of Head and Neck Surgery, Fondation Adolphe de Rothschild Hospital, Paris 75019, France
| | - Yvonne Purcell
- Department of Neuroradiology, Fondation Adolphe de Rothschild Hospital, Paris 75019, France
| | - Julien Savatovsky
- Department of Neuroradiology, Fondation Adolphe de Rothschild Hospital, Paris 75019, France
| | - Michel Toupet
- Centre d'Explorations Fonctionnelles Otoneurologiques, Paris 75015, France
| | - Arnaud Attyé
- Department of Neuroradiology, Grenoble University Hospital, Grenoble 38000, France
| | - Michael Eliezer
- Department of Neuroradiology, Lariboisière University Hospital, AP-HP, Paris 75010, France; Université de Paris, Faculté de Médecine, Paris 75010, France
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Quality Control after Intracochlear Intralabyrinthine Schwannoma Resection and Cochlear Implantation. Brain Sci 2021; 11:brainsci11091221. [PMID: 34573240 PMCID: PMC8466831 DOI: 10.3390/brainsci11091221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The combination of intralabyrinthine schwannoma (ILS) removal and cochlear implantation is the standard of care after surgical resection for audiological rehabilitation. Intracochlear ILS is not only the most frequent tumor in this group of schwannomas, but it is also, to some degree, surgically the most challenging because of its position behind the modiolus. Recent developments in the knowledge of implant position, implant magnet choice, and magnetic resonance imaging (MRI) sequences make an MRI follow-up after surgical removal possible. Thus far, no results are known about the surgical success and residual rate of these kind of tumors. The aim of the present study was to perform an early MRI follow-up for the evaluation of residual or recurrent intracochlear ILS after surgical removal and cochlear implantation. Methods: In a retrospective study, we evaluated seven patients after an intracochlear ILS removal and single-stage cochlear implantation with a mean period of 13.4 months post surgery with a 3T T1 GAD 2 mm sequence for a residual ILS. Patients were operated on using an individualized technique concept. Results: In six out of seven cases, 3 T T1 GAD 2 mm MRI follow-up showed no residual or recurrent tumor. In one case, a T1 signal indicated a tumor of the upper inner auditory canal (IAC) at the MRI follow up. Conclusion: MRI follow-up as a quality control tool after ILS removal and cochlear implantation is highly important to exclude residual tumors. Long-term MRI evaluation results are needed and can be obtained under consideration of implant position, implant magnet, and MRI sequence choice. A preoperative MRI slice thickness less than 2 mm can be recommended to visualize possible modiolar and IAC expansion.
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Weiss NM. Rare Diseases of the Middle Ear and Lateral Skull Base. Laryngorhinootologie 2021; 100:S1-S30. [PMID: 34352901 PMCID: PMC8354576 DOI: 10.1055/a-1347-4171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Otalgia, otorrhea and hearing loss are the most common ear-related symptoms that lead to the consultation of an otolaryngologist. Furthermore, balance disorders and affections of the cranial nerve function may play a role in the consultation. In large academic centres, but also in primary care, the identification of rare diseases of the middle ear and the lateral skull base is essential, as these diseases often require interdisciplinary approaches to establish the correct diagnosis and to initiate safe and adequate treatments. This review provides an overview of rare bone, neoplastic, haematological, autoimmunological and infectious disorders as well as malformations that may manifest in the middle ear and the lateral skull base. Knowledge of rare disorders is an essential factor ensuring the quality of patient care, in particular surgical procedures. Notably, in untypical, complicated, and prolonged disease courses, rare differential diagnoses need to be considered.
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Affiliation(s)
- Nora M. Weiss
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie
„Otto Körner“ der Universitätsmedizin Rostock,
Deutschland
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Plontke SK, Fröhlich L, Cozma S, Koitschev A, Reimann K, Weiß R, Götze G, Seiwerth I, Kösling S, Rahne T. Hearing rehabilitation after subtotal cochleoectomy using a new, perimodiolar malleable cochlear implant electrode array: a preliminary report. Eur Arch Otorhinolaryngol 2021; 278:353-362. [PMID: 32504199 PMCID: PMC7826316 DOI: 10.1007/s00405-020-06098-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/27/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE We here report about the first surgical experience and audiological outcome using a new, perimodiolar malleable cochlear implant electrode array for hearing rehabilitation after subtotal cochleoectomy for intralabyrinthine schwannoma (ILS). METHOD Based on a cochlear implant with MRI compatibility of the magnet in the receiver coil up to 3 T, a cochlear implant electrode array was developed that is malleable and can be placed perimodiolar after tumor removal from the cochlea via subtotal cochleoectomy. Malleability was reached by incorporating a nitinol wire into the silicone of the electrode array lateral to the electrode contacts. The custom-made device was implanted in four patients with intracochlear, intravestibulocochlear or transmodiolar schwannomas. Outcome was assessed by evaluating the feasibility of the surgical procedure and by measuring sound field thresholds and word recognition scores. RESULTS After complete or partial tumor removal via subtotal cochleoectomy with or without labyrinthectomy, the new, perimodiolar malleable electrode array could successfully be implanted in all four patients. Six months after surgery, the averaged sound field thresholds to pulsed narrowband noise in the four patients were 36, 28, 41, and 35 dB HL, and the word recognitions scores for monosyllables at 65 dB SPL were 65, 80, 70, and 25% (one patient non-German speaking). CONCLUSION The surgical evaluation demonstrated the feasibility of cochlear implantation with the new, perimodiolar malleable electrode array after subtotal cochleoectomy. The audiological results were comparable to those achieved with another commercially available type of perimodiolar electrode array from a different manufacturer applied in patients with ILS.
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Affiliation(s)
- Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Laura Fröhlich
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Sebastian Cozma
- ENT Department, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Assen Koitschev
- Department of Otorhinolaryngology, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Katrin Reimann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Rainer Weiß
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Gerrit Götze
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Ingmar Seiwerth
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Sabrina Kösling
- Department of Radiology, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle (Saale), Germany
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
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Fröhlich L, Curthoys IS, Kösling S, Obrist D, Rahne T, Plontke SK. Cervical and Ocular Vestibular-Evoked Myogenic Potentials in Patients With Intracochlear Schwannomas. Front Neurol 2020; 11:549817. [PMID: 33192980 PMCID: PMC7655125 DOI: 10.3389/fneur.2020.549817] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022] Open
Abstract
Objective: To evaluate ocular and cervical vestibular evoked myogenic potentials (oVEMPs and cVEMPs) in patients with solely intracochlear localization of an intralabyrinthine schwannoma (ILS). Study Design: Retrospective analysis of a series of cases. Setting: Monocentric study at a tertiary referral center. Patients: Patients with intracochlear schwannoma (ICS) and VEMP measurements. Outcome Measures: Signed asymmetry ratio (AR) of cVEMPs and oVEMPs to air conducted sound with AR cut-offs considered to be asymmetrical when exceeding ±30% for cVEMPs and ±40% for oVEMPs with respect to the side affected by the tumor (reduced amplitudes on the affected side indicated by negative values, enhanced amplitudes by positive values); VEMP amplitudes and latencies; tumor localization in the cochlear turn and scala. Results: Nineteen patients with a solely intracochlear tumor (ICS patients) [10 males, 9 females, mean age 57.1 (SD: 13.4) years] were included in the study. On the affected side, cVEMPs were absent or reduced in 47% of the patients, normal in 32%, and enhanced in 21%. Ocular VEMPs on the affected side were absent or reduced in 53% of the patients, normal in 32% and enhanced in 15%. Latencies for cVEMPs and oVEMPs were not significantly different between the affected and non-affected side. In all patients with enhanced VEMPs, the tumor was located in the scala tympani and scala vestibuli. Conclusions: As a new and unexpected finding, VEMP amplitudes can be enhanced in patients with intracochlear schwannoma, mimicking the third window syndrome.
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Affiliation(s)
- Laura Fröhlich
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Sabrina Kösling
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Diagnostic assessment of magnetic resonance imaging for patients with intralabyrinthine schwannoma: A systematic review. J Neuroradiol 2020; 49:41-46. [PMID: 32861774 DOI: 10.1016/j.neurad.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Recent advancements in high-resolution imaging have improved the diagnostic assessment of magnetic resonance imaging (MRI) for intralabyrinthine schwannoma (ILS). This systematic review aimed to evaluate the diagnostic performance of MRI for patients with ILS. METHODS Ovid-MEDLINE and EMBASE databases were searched for related studies on the diagnostic performance of MRI for patients with ILS published up to February 10, 2020. The primary endpoint was the diagnostic performance of MRI for ILS. The quality of the enrolled studies was assessed using tailored questionnaires and the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. RESULTS Overall, 6 retrospective studies that included 122 patients with ILS from a parent population of 364 were included. The sample size, parent population and its composition, reference standard, detailed parameters of MRI, and even the diagnostic methods varied between the studies. The studies had moderate quality. The sensitivity of combination of T2WI and CE-T1WI was over 90%. Relative sensitivity of T2WI comparative to CE-T1WI ranged from 62% to 100%, and the specificity were 100%. CONCLUSIONS MRI has acceptable diagnostic performance for ILS. There is a need for well-organized research to reduce the factors causing heterogeneity.
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MRI of endolymphatic hydrops in patients with intralabyrinthine schwannomas: a case-controlled study using non-enhanced T2-weighted images at 3 T. Eur Arch Otorhinolaryngol 2020; 278:1821-1827. [PMID: 32770410 DOI: 10.1007/s00405-020-06271-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Like other vestibular schwannomas developing in the internal auditory canal, intralabyrinthine schwannomas (ILS) may present with similar symptoms as in endolymphatic hydrops. Two different studies have described MR saccular hydrops in ~ 30% of internal auditory canal vestibular schwannomas, but this association has never been studied in ILS before. The aim of this work is to study the prevalence of a saccular dilation in ILS, on a T2-weigthed sequence at 3 T, compared to a control group. MATERIAL AND METHODS All patients presenting with typical ILS between January 2008 and October 2018 were included (n = 28, two patients with bilateral tumors) and compared to a control group (n = 53). All underwent a high-resolution T2-weighted 3D sequence (FIESTA-C). The height and width of the saccule were measured on a coronal plane by two radiologists. RESULTS The saccule was dilated on the side of the schwannoma in 47% of the cases (p = 0.0006 for the height, p = 0.0487 for the width). Bilateral saccular dilation was observed in 37% of the cases. There was a statistically significant correlation between the presence of a saccular hydrops and balance disorders (p = 0.02) as 50% of the patients with an intralabyrinthine schwannoma who presented with such symptoms had a saccular dilation. CONCLUSION Forty-seven percent of ILS are associated with homolateral saccular dilation, which is an MR sign of endolymphatic hydrops (bilateral in 37%) and it appears related to the presence of balance disorders. This opens new therapeutic potentialities with the possible use of anti-vertiginous drugs, which could have a beneficial effect on their clinical symptomatology.
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Labyrinthine enhancement on 3D black blood MR images of the brain as an imaging biomarker for cisplatin ototoxicity in (lung) cancer patients. Neuroradiology 2020; 63:81-90. [PMID: 32761280 DOI: 10.1007/s00234-020-02504-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Cancer patients treated with platinum-based chemotherapy can present with ototoxicity symptoms. The purpose of this work is to report the imaging features related to cisplatin ototoxicity. METHODS Between December 2015 and March 2019, a cohort of 96 consecutive patients with lung cancer was selected. Only patients who received cisplatin chemotherapy and underwent an imaging protocol consisting of a Gd-enhanced 3D-BB and 3D-T1W sequence, as well as T2W sequence to exclude metastases, were included. Labyrinthine enhancement was assessed, and all findings regarding the auditory and vestibular function were retrieved from the clinical files. RESULTS Twenty-one patients met the inclusion criteria. The Gd-enhanced 3D-BB images were used to divide them into the labyrinth enhancement group (LEG) and the labyrinth non-enhancement group (LNEG). None of these patients demonstrated enhancing regions on the 3D-T1W images. The labyrinthine fluid remained high on the T2 images in all patients, excluding metastases. The LEG consisted of 6 patients. The cochlea and semicircular canals were the most frequently affected regions. All the LEG patients that presented with hearing loss (4/6) had cochlear enhancement. Patients with normal hearing had no cochlear enhancement. Five patients (5/6) showed vestibular enhancement. Four of these patients had vestibular symptoms. CONCLUSION Labyrinthine enhancement as an imaging feature related to cisplatin ototoxicity is unreported. This study demonstrates a correlation between hearing loss and cochlear enhancement and also between vestibular impairment and vestibular/semicircular enhancement on 3D-BB images, which remained invisible on the 3D-T1W images. The labyrinthine enhancement on 3D-BB images in the presence of normal signal intensity of the intralabyrinthine fluid can be used as an imaging biomarker for cisplatin toxicity in daily clinical practice and should not be mistaken for intralabyrinthine metastases.
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Di Lullo AM, Paolucci A, Motta S, Cantone E, Barbieri E, Cicala D, Grassi R, Bruno F, Splendiani A, Tortora F, Cavaliere M, Brunese L. Diagnosis and management of intralabyrinthine schwannoma: case series and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:136-144. [PMID: 32945288 PMCID: PMC7944674 DOI: 10.23750/abm.v91i8-s.9976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
Intralabyrinthine schwannoma (ILS) is a rare benign tumor affecting cochlear and vestibular nerves, whose symptoms are generally unspecific and frequently responsible for a late diagnosis. Radiological examinations, with particular reference to magnetic resonance imaging (MRI), represent the only diagnostic technique to identify ILS. On computed tomography ILS can only be indirectly suspected by the presence of surrounding bone remodeling, whereas MRI provides direct visualization of the neoplasm as a filling defect within the labyrinth with vivid contrast enhancement. At the same time, MRI is also helpful in defining ILS anatomical extension into adjacent structures and in planning therapeutic management. Here we report three representative cases of ILS with new pictorial imaging features to improve ILS early detection and optimize subsequent therapeutic management.
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Affiliation(s)
- Antonella Miriam Di Lullo
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples “Federico II”, Naples, Italy, CEINGE- Advanced Biotechnology, Naples, Italy
| | | | - Sergio Motta
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples “Federico II”, Naples, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples “Federico II”, Naples, Italy
| | - Emiliano Barbieri
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Domenico Cicala
- Department of Neurosciences, “Santobono-Pausilipon” Pediatric Hospital, Naples, Italy
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila,Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila,Italy
| | - Fabio Tortora
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Michele Cavaliere
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples “Federico II”, Naples, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
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NF2-Related Intravestibular Schwannomas: Long-Term Outcomes of Cochlear Implantation. Otol Neurotol 2020; 41:94-99. [DOI: 10.1097/mao.0000000000002431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Withers S, Plontke SK, Boeddinghaus R, Kuthubutheen J, Atlas M. [Bilateral intracochlear schwannomas in a patient with no genetic or clinical features of neurofibromatosis type 2. German version]. HNO 2019; 68:534-538. [PMID: 31758201 DOI: 10.1007/s00106-019-00751-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Schwannomas of the eighth cranial nerve are benign tumours commonly found in the internal auditory meatus or in the cerebellopontine angle. In most cases, they arise from the inferior or vestibular portion of the vestibular nerve. Rarely, these tumours present in the inner ear and are then called intralabyrinthine schwannomas. Bilateral schwannomas are known in neurofibromatosis type 2 (NF2). Bilateral and ipsilateral, multilocular sporadic schwannomas of the eighth cranial nerve have been described as extremely rare findings. This report describes the first case of bilateral sporadic intracochlear schwannomas in a patient with no genetic or clinical features of NF2.
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Affiliation(s)
- S Withers
- Ear Science Institute of Australia, School of Surgery, University of Western Australia, 1/1 Salvado Road, 6008, Subiaco, Australien.
| | - S K Plontke
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - R Boeddinghaus
- Ear Science Institute of Australia, School of Surgery, University of Western Australia, 1/1 Salvado Road, 6008, Subiaco, Australien.,Perth Radiological Clinic, Perth, Australien
| | - J Kuthubutheen
- Ear Science Institute of Australia, School of Surgery, University of Western Australia, 1/1 Salvado Road, 6008, Subiaco, Australien
| | - M Atlas
- Ear Science Institute of Australia, School of Surgery, University of Western Australia, 1/1 Salvado Road, 6008, Subiaco, Australien
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Bilateral intracochlear schwannomas in a patient with no genetic or clinical features of neurofibromatosis type 2. HNO 2019; 68:60-64. [DOI: 10.1007/s00106-019-00752-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Cochlear Implantation After Partial or Subtotal Cochleoectomy for Intracochlear Schwannoma Removal-A Technical Report. Otol Neurotol 2019; 39:365-371. [PMID: 29283914 PMCID: PMC5821483 DOI: 10.1097/mao.0000000000001696] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
To describe the technique for surgical tumor removal, cochlear implant (CI) electrode placement and reconstruction of the surgical defect in patients with intracochlear schwannomas.
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20
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Plontke S, Kösling S, Pazaitis N, Rahne T. [Intracochlear schwannoma : Tumor removal via subtotal cochleoectomy and partial cochlear reconstruction with preservation of semicircular canal function. German version]. HNO 2019; 65:610-616. [PMID: 28477092 DOI: 10.1007/s00106-017-0347-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report about a patient who in 2005, aged 37 years, experienced sudden mild to moderate, mid-frequency sensorineural hearing loss in the right ear along with tinnitus and mild dizziness. MRI of the temporal bone revealed a very small (1 mm) contrast-enhancing lesion in the second turn of the right cochlea. Hearing gradually deteriorated with complete hearing loss in 2015. At this time, an MRI scan showed a lesion completely filling the cochlea.The tumor was removed via transmeatal subtotal cochleoectomy. The cochlea was partially reconstructed with cartilage and fascia. A cochlea implant dummy electrode was inserted as a placeholder in order to prevent complete fibrosis of the "neocochlea" during follow-up MRI examinations.Vestibular function tests 2 months postoperatively showed preserved caloric excitability and a normal vestibulo-ocular reflex (vHIT) in all three planes. The patient is free of vertigo.Intralabyrinthine schwannomas (ILS) are a rare differential diagnosis of sudden hearing loss, which should be specifically checked for in MRI. Surgical removal of an intracochlear ILS through partial or subtotal cochleoectomy with preservation of vestibular function is possible in principle.
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Affiliation(s)
- S Plontke
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
| | - S Kösling
- Klinik für Radiologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - N Pazaitis
- Institut für Pathologie; Universitätsmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - T Rahne
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
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21
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Choudhury B, Carlson ML, Jethanamest D. Intralabyrinthine Schwannomas: Disease Presentation, Tumor Management, and Hearing Rehabilitation. J Neurol Surg B Skull Base 2019; 80:196-202. [PMID: 30931228 PMCID: PMC6438793 DOI: 10.1055/s-0039-1678731] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 12/31/2018] [Indexed: 02/06/2023] Open
Abstract
Intralabyrinthine schwannomas (ILS) are rare tumors that frequently cause sensorineural hearing loss. The development and increased use of magnetic resonance imaging in recent years have facilitated the diagnosis of these tumors that present with otherwise nondiscriminant symptoms such as tinnitus, vertigo, and hearing loss. The following is a review of the presentation, pathophysiology, imaging, and treatment with a focused discussion on auditory rehabilitation options of ILS.
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Affiliation(s)
- Baishakhi Choudhury
- Department of Otolaryngology Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, United States
| | - Matthew L. Carlson
- Department of Otorhinolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel Jethanamest
- Department of Otolaryngology Head and Neck Surgery, NYU Langone Health, New York, New York, United States
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Extension patterns of vestibular schwannomas towards the middle ear: three new cases and review of the literature. Eur Arch Otorhinolaryngol 2019; 276:969-976. [PMID: 30747318 DOI: 10.1007/s00405-019-05332-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Middle ear extension of vestibular schwannomas is not a common occurrence, and only a few cases have been described so far in past publications. We report three new cases of vestibular schwannomas extending to the middle ear and reviewed the literature to specify the patterns of such an extension. MATERIALS AND METHODS We analysed databases of previously published articles to search for additional cases of middle ear extension of vestibular schwannomas and compared them to the cases we have documented. Extension patterns of the tumours were analysed, especially focusing on the extension through the round and oval windows. RESULTS AND CONCLUSION Middle ear vestibular schwannomas are uncommon tumours and only 13 cases have been published so far. The vestibular schwannoma (internal auditory canal or intralabyrinthine) has to invade the labyrinth first (complete invasion in 88% of the cases, n = 14), before reaching the middle ear. In the majority of cases (69%, n = 11/16), internal auditory canal vestibular schwannomas or intralabyrinthine schwannomas extended in the middle ear though the round window.
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23
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Different clinical presentation of intralabyrinthine schwannomas – a systematic review. Braz J Otorhinolaryngol 2019; 85:111-120. [PMID: 29980446 PMCID: PMC9442840 DOI: 10.1016/j.bjorl.2018.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/18/2018] [Accepted: 05/17/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Intralabyrinthine schwannoma is a rare, benign tumor that affects the most terminal portions of the vestibular and cochlear nerves. This tumor can be classified into 10 subtypes, according to its inner ear location. Objective To carry out a comprehensive review of the most frequent auditory manifestations secondary to the intralabyrinthine schwannoma, describing the possible underlying pathophysiological mechanisms. Methods Systematic review of the literature until October 2017 using the PubMed, Web of Science and Scopus databases. The inclusion criteria were clinical manifestations of the intralabyrinthine schwannoma. Three researchers independently assessed the articles and extracted relevant information. The description of a case of an intravestibular subtype intralabyrinthine schwannoma with multiple forms of clinical presentations was used as an example. Results Twenty-seven studies met our inclusion criteria. The most common intralabyrinthine schwannoma subtype was the intracochlear, followed by the intravestibular type. All the cases demonstrated hearing loss, usually progressive hearing loss. Conclusion The diagnosis of intralabyrinthine schwannomas is based on high-resolution magnetic resonance imaging and should be included in the differential diagnosis of patients with vestibulocochlear complaints. Although there are approximately 600 cases in the literature, we still lack a detailed description of the clinical evolution of the patients, correlating it with MRI findings of temporal bones and tumor subtype.
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24
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Ralli M, Nola G, Fusconi M, Sparvoli L, Ralli G. Ocular vestibular evoked myogenic potentials and intravestibular intralabyrinthine schwannomas. EAR, NOSE & THROAT JOURNAL 2018; 97:E21-E25. [PMID: 30036442 DOI: 10.1177/014556131809700703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Intravestibular intralabyrinthine schwannomas (ILSs) are uncommon benign tumors that arise from the saccular, utricular, and lateral and superior ampullary nerves. According to the literature, there is an average delay of 8 years between the onset of symptoms and diagnosis. The diagnosis is based on an audiovestibular examination and magnetic resonance imaging (MRI). We describe a case of intravestibular ILS in which we included the ocular vestibular evoked myogenic potentials (oVEMPs) test in the diagnostic workup. The oVEMPs test is a relatively new neurophysiologic diagnostic modality that evaluates the superior vestibular pathway and the ascending contralateral pathway through the vestibulo-ocular reflex. In our case, a 65-year-old man presented with progressive right-sided sensorineural hearing loss, dizziness, and tinnitus and fullness in his right ear. Audiovestibular examination and MRI detected an intravestibular ILS on the right. We found that oVEMPs were absent on the contralateral side, which contributed to the diagnostic process. The detection of oVEMPs can provide detailed information on the functionality of the macula of the utricle and the lateral and superior ampullary nerves, with a precise identification of the affected area. Based on our findings, we discuss the role of oVEMPs in the diagnosis of an intravestibular ILS.
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Affiliation(s)
- Massimo Ralli
- Department of Oral and Maxillo Facial Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00186, Italy.
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25
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Differentiation Between Intralabyrinthine Schwannoma and Contrast-enhancing Labyrinthitis on MRI: Quantitative Analysis of Signal Intensity Characteristics. Otol Neurotol 2018; 39:1045-1052. [DOI: 10.1097/mao.0000000000001901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Is an Intravenous Injection of Gadolinium Really Necessary for Intralabyrinthine Schwannomas MR Examination? Otol Neurotol 2018; 39:e579-e584. [PMID: 29957669 DOI: 10.1097/mao.0000000000001881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Our aim was to confirm the usefulness of T2-weighted (T2W) gradient-echo sequence for detection and topographic diagnosis of intralabyrinthine schwannomas (ILS) compared with T1W contrast-enhanced sequence as gold standard, to evaluate the necessity of intravenous gadolinium injection for ILS follow-up imaging. METHODS Thirty patients with ILS were retrospectively enrolled and compared to a control group of 30 patients with no inner ear pathology. All patients underwent a T2W gradient-echo steady-state free precession (SSFP) acquisition at 3T, which was visually analyzed by two radiologists and compared to contrast-enhanced T1W sequence. A quantitative analysis was also performed, with the measurement of the tumor and inner ear signal on T2W images and the measurement of the tumor length in cochlear schwannomas. RESULTS T2W FIESTA-C sequence correctly diagnosed ILS with a sensitivity (Se) of 95% and a specificity (Sp) of 100%, with matching results for their topographic evaluation (Se 92%, Sp 98%) compared with the gold-standard. The difference between the two sequences was only 2.5%, with excellent interobserver agreement. The tumor signal on T2W images was significantly lower than the normal bright signal of the normal inner ear fluids (mean signal ratio = 0.42 vs 0.98). CONCLUSION The positive and topographic diagnostic accuracy of T2W FIESTA-C sequence was excellent compared with the T1W contrast-enhanced sequence, even though the latter remains easier and faster to analyze for an untrained radiologist. The performances of T2W gradient-echo sequence at 3T make it a reasonable alternative strategy for following ILS after they are diagnosed.
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27
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Valesano JC, Carr CM, Eckel LJ, Carlson ML, Lane JI. MRI screening of the internal auditory canal: Is gadolinium necessary to detect intralabyrinthine schwannomas? Am J Otolaryngol 2018; 39:133-137. [PMID: 29273441 DOI: 10.1016/j.amjoto.2017.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Non-contrast MRI of the internal auditory canal (IAC) using high-resolution T2WI (T2 weighted image) has been proposed as the primary screening study in patients with sudden or asymmetric sensorineural hearing loss (ASNHL). However, there are concerns that non-contrast MRI may not detect labyrinthine pathology, specifically intralabyrinthine schwannomas (ILSs). The purpose of this study was to determine if non-contrast high-resolution T2WI alone are adequate to exclude these uncommon intralabyrinthine tumors. METHODS 31 patients with ILSs and 36 patients without inner ear pathology that had dedicated MRI of the IAC performed with both non-contrast T2WI and post-contrast T1WI (T1 weighted image) were identified. Three board-certified neuroradiologists reviewed only the T2WI from these 67 cases. When an ILS was identified, its location and size were recorded. Sensitivity, specificity, and accuracy were calculated using the post-contrast T1WI as the "gold standard." A consensus review of cases with discordant results was conducted. RESULTS The sensitivity, specificity, and accuracy were 1.0, 1.0, and 1.0 for Observer 1; 0.84, 1.0, and 0.96 for Observer 2; 0.90, 1.0, and 0.98 for Observer 3. The 5 ILSs with discordant results were correctly identified upon consensus review. The median size of the ILSs was 4.4mm (±2.9mm) and most (18/31) were intracochlear in location. CONCLUSION Non-contrast high-resolution T2WI alone can detect ILSs with 84-100% sensitivity, suggesting that gadolinium may be unnecessary to exclude ILSs on screening MRI. These findings have implications for reducing cost, time, and adverse events associated with gadolinium administration in patients presenting with sudden or ASNHL. LEVEL OF EVIDENCE 4.
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28
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Plontke SK. Diagnostics and therapy of sudden hearing loss. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2018; 16:Doc05. [PMID: 29503670 PMCID: PMC5818684 DOI: 10.3205/cto000144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article reviews recent aspects of diagnostics, differential diagnostics, and evidence in systemic and local therapy of idiopathic sudden sensorineural hearing loss (ISSHL). Since a number of disorders can be accompanied by sudden hearing loss, a meaningful and targeted diagnostic strategy is of utmost importance. An important differential diagnosis of sudden hearing loss are intralabyrinthine schwannomas (ILS). The incidence of ILS is probably significantly underestimated. This may be due to the lack of awareness or lack of explicit search for an intralabyrinthine tumor on MRI or an inappropriate MRI technique for the evaluation of sudden hearing loss ("head MRI" instead of "temporal bone MRI" with too high slice thicknesses). Therefore, the request to the radiologist should specifically include the question for (or exclusion of) an ILS. With special MRI techniques, it is possibly today to visualize an endolymphatic hydrops. The evidence in the therapy of ISSHL is - with respect to the quality and not quantity of studies - unsatisfying. The value of systemically (low dose) or intratympanically applied corticosteroids in the primary treatment of ISSHL is still unclear. In order to investigate the efficacy and safety of high dose corticosteroids as primary therapy for ISSHL, a national, multicenter, three-armed, randomized, triple-blind controlled clinical trial is currently performed in Germany (http://hodokort-studie.hno.org/). After insufficient recovery of the threshold with systemic therapy of ISSHL, intratympanic corticosteroid therapy appears to be associated with a significantly higher chance of an improved hearing threshold than no therapy or placebo. Both, hearing gain and final hearing threshold, however, appear to be independent from the onset of secondary therapy. Based on currently available data from clinical studies, no recommendation can be made with respect to the type of corticosteroid and specifics of the intratympanic application protocol.
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Affiliation(s)
- Stefan K. Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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29
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Aschendorff A, Arndt S, Laszig R, Wesarg T, Hassepaß F, Beck R. [Treatment and auditory rehabilitation of intralabyrinthine schwannoma by means of cochlear implants - German Version]. HNO 2017; 65:321-327. [PMID: 27573449 DOI: 10.1007/s00106-016-0216-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To date, the therapy of intralabyrinthine schwannoma consists mainly of a wait-and-see approach, completely ignoring auditory rehabilitation. Only a few single-case reports are as yet available on treatment with cochlear implants (CI). AIM OF THE STUDY This study aimed to assess the results of auditory rehabilitation after treatment with CI in a series of cases. MATERIALS AND METHODS The demographic findings, symptoms, and results of surgical therapy in 8 patients were evaluated in a retrospective analysis. RESULTS Prior to surgery, all patients presented with profound hearing loss and tinnitus. Episodic dizziness was reported by 3 patients. Among the patients, 4 had an intracochlear and 3 an intravestibular schwannoma, and a transmodiolar schwannoma was found in 1 patient. A total of 6 patients underwent treatment with CI. The results of auditory rehabilitation are favorable with open-set speech comprehension. DISCUSSION CI treatment following resection of an intralabyrinthine schwannoma is a promising option for auditory rehabilitation, even in single-sided deafness. This is a new treatment concept in contrast to the wait-and-scan policy. Expectant management appears justified only if the patient still has usable hearing.
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Affiliation(s)
- A Aschendorff
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Implant Centrum Freiburg, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - S Arndt
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Implant Centrum Freiburg, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - R Laszig
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Implant Centrum Freiburg, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - T Wesarg
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Implant Centrum Freiburg, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - F Hassepaß
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Implant Centrum Freiburg, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - R Beck
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Implant Centrum Freiburg, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
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30
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Jerin C, Krause E, Ertl-Wagner B, Gürkov R. Clinical features of delayed endolymphatic hydrops and intralabyrinthine schwannoma : An imaging-confirmed comparative case series. English version. HNO 2017; 65:41-45. [PMID: 27492473 DOI: 10.1007/s00106-016-0199-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to compare the clinical history and audiovestibular function test results of patients suffering from intralabyrinthine schwannoma or delayed endolymphatic hydrops (DEH). PATIENTS AND METHODS Five patients diagnosed with intralabyrinthine schwannoma by magnetic resonance imaging (MRI) and five patients diagnosed with DEH by locally enhanced inner ear MRI (LEIM) were retrospectively studied. RESULTS All patients with intralabyrinthine schwannoma or DEH initially presented with hearing loss. Vertigo occurred in two patients with intralabyrinthine schwannoma and in all patients with DEH. While audiometry achieved poorer results for patients with intralabyrinthine schwannomas, vestibular function tests revealed normal results in about half of the patients in both groups. CONCLUSION Patients with intralabyrinthine schwannomas may present with clinical symptoms similar to patients suffering from other inner ear disorders such as delayed endolymphatic hydrops and they may obtain similar findings in audiovestibular function tests. High-resolution magnetic resonance imaging with locally applied contrast agent may provide evidence of both underlying pathologies.
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Affiliation(s)
- C Jerin
- German Center for Vertigo and Balance Disorders, Grosshadern Medical Center, University of Munich, Marchioninistr. 15, 81377, Munich, Germany. .,Department of Otorhinolaryngology - Head and Neck Surgery, Grosshadern Medical Center, University of Munich, Munich, Germany.
| | - E Krause
- German Center for Vertigo and Balance Disorders, Grosshadern Medical Center, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.,Department of Otorhinolaryngology - Head and Neck Surgery, Grosshadern Medical Center, University of Munich, Munich, Germany
| | - B Ertl-Wagner
- Institute of Clinical Radiology, Grosshadern Medical Center, University of Munich, Munich, Germany
| | - R Gürkov
- German Center for Vertigo and Balance Disorders, Grosshadern Medical Center, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.,Department of Otorhinolaryngology - Head and Neck Surgery, Grosshadern Medical Center, University of Munich, Munich, Germany
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31
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Plontke SK, Rahne T, Pfister M, Götze G, Heider C, Pazaitis N, Strauss C, Caye-Thomasen P, Kösling S. Intralabyrinthine schwannomas : Surgical management and hearing rehabilitation with cochlear implants. HNO 2017; 65:136-148. [PMID: 28664238 PMCID: PMC5554299 DOI: 10.1007/s00106-017-0364-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Intralabyrinthine schwannomas (ILS) are a rare differential diagnosis of sudden hearing loss and vertigo. In an own case series of 12 patients, 6 tumors showed an intracochlear, 3 an intravestibular, 1 a transmodiolar including the cerebellopontine angle (CPA), 1a transotic including the CPA, and 1 a multilocular location. The tumors were removed surgically in 9 patients, whereas 3 patients decided for a "wait-and-test-and-scan" strategy. Of the surgical patients, 3 underwent labyrinthectomy and cochlear implant (CI) surgery in a single-stage procedure; 1 patient had extended cochleostomy with CI surgery; 3 underwent partial or subtotal cochleoectomy, with partial cochlear reconstruction and CI surgery (n = 1) or implantation of electrode dummies for possible later CI after repeated MRI follow-up (n = 2); and in 2 patients, the tumors of the internal auditory canal and cerebellopontine angle exhibiting transmodiolar or transmacular growth were removed by combined translabyrinthine-transotic resection. For the intracochlear tumors, vestibular function could mostly be preserved after surgery. In all cases with CI surgery, hearing rehabilitation was successful, although speech discrimination was limited for the case with subtotal cochleoectomy. Surgical removal of intracochlear schwannomas via partial or subtotal cochleoectomy is, in principle, possible with preservation of vestibular function. In the authors' opinion, radiotherapy of ILS is only indicated in isolated cases. Cochlear implantation during or after tumor resection (i. e., as synchronous or staged surgeries) is an option for hearing rehabilitation in cartain cases and represents a therapeutic approach in contrast to a "wait-and-test-and-scan" strategy.
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Affiliation(s)
- S K Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - T Rahne
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | | | - G Götze
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - C Heider
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - N Pazaitis
- Institute of Pathology, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle (Saale), Germany
| | - C Strauss
- Department of Neurosurgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle (Saale), Germany
| | - P Caye-Thomasen
- Department of Oto-rhino-laryngology, Head and Neck Surgery, and Audiology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - S Kösling
- Department of Radiology, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle (Saale), Germany
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Plontke SK, Rahne T, Pfister M, Götze G, Heider C, Pazaitis N, Strauss C, Caye-Thomasen P, Kösling S. Intralabyrinthäre Schwannome. HNO 2017; 65:419-433. [DOI: 10.1007/s00106-017-0361-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shupak A, Holdstein Y, Kaminer M, Braverman I. Primary Solitary Intralabyrinthine Schwannoma: A Report of 7 Cases and a Review of the Literature. EAR, NOSE & THROAT JOURNAL 2016. [DOI: 10.1177/014556131609501208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intralabyrinthine schwannomas (ILSs) are uncommon benign tumors that originate in the Schwann cell sheath of the intralabyrinthine distal branches of the vestibulocochlear nerve. They have no initial involvement in the internal auditory canal although that might develop later. These lesions can arise inside the cochlea, originate in the vestibule or, in rare cases, develop in the semicircular canals. From these sites, spread might take place via the anatomic connections between the perilymphatic spaces in the scala vestibuli and the anterior vestibule. Thus, ILSs centered in the cochlea might involve the vestibule, and those originating in the vestibular end organs would reach the cochlea. Presenting signs and symptoms include a progressive or sudden sensorineural hearing loss (which occurs in more than 95% of patients), as well as tinnitus and vertigo. Magnetic resonance imaging characteristics include sharp circumscription and hypointensity on thin, heavily T2-weighted 3D images and strong enhancement after gadolinium administration on TI-weighted images. We describe a series of 7 cases of primary ILS that were managed at two of our institutions. We also discuss the need for a comprehensive otoneurologic evaluation that encompasses the functional derangement and the tumor location as delineated by MRI, and we describe the treatment options.
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Affiliation(s)
- Avi Shupak
- Unit of Otoneurology, Lin Medical Center, Haifa,
Israel
- Department of Otolaryngology-Head and Neck Surgery,
Carmel Medical Center, Haifa
- Bruce Rappaport Faculty of Medicine, the Technion-
Israel Institute of Technology, Haifa
| | | | | | - Itzhak Braverman
- Unit of Otolaryngology-Head and Neck Surgery, Hillel
Yaffe Medical Center, Hadera, Israel
- Bruce Rappaport Faculty of Medicine, the Technion-
Israel Institute of Technology, Haifa
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Aschendorff A, Arndt S, Laszig R, Wesarg T, Hassepaß F, Beck R. Treatment and auditory rehabilitation of intralabyrinthine schwannoma by means of cochlear implants. HNO 2016; 65:46-51. [DOI: 10.1007/s00106-016-0217-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Jerin C, Krause E, Ertl-Wagner B, Gürkov R. Klinische Eigenschaften von „delayed endolymphatic hydrops“ und intralabyrinthärem Schwannom. HNO 2016; 64:911-916. [DOI: 10.1007/s00106-016-0198-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Olshan M, Srinivasan VM, Landrum T, Sataloff RT. Acoustic neuroma: An investigation of associations between tumor size and diagnostic delays, facial weakness, and surgical complications. EAR, NOSE & THROAT JOURNAL 2016; 93:304-16. [PMID: 25181660 DOI: 10.1177/014556131409300808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We conducted a retrospective case review to ascertain the clinical characteristics associated with acoustic neuromas and their treatment. Our study population was made up of 96 patients-41 men and 55 women, aged 17 to 84 years (mean: 54)-who had undergone treatment for acoustic neuromas and for whom necessary data were available. We compiled data on presenting symptoms, the interval from symptom onset to diagnosis, tumor size at diagnosis, facial weakness, the interval from diagnosis to surgery, the type of surgical approach, and surgical complications. Our primary goals were to determine if tumor size was correlated to (1) the interval from symptom onset to diagnosis, (2) the degree of preoperative facial weakness, and (3) surgical complications. We also sought to document various other clinical characteristics of these cases. The mean interval from the first symptom to diagnosis was 4.5 years; the time to diagnosis did not correlate with tumor size. Nor was tumor size correlated with the degree of preoperative facial weakness as determined by facial electroneurography. Surgical complications occurred in 15 of the 67 patients who underwent surgery (22.4%), and they did correlate with tumor size. The most common complications were postoperative facial weakness (13.4% of operated patients), cerebrospinal fluid leak (6.0%), and infection (3.0%). Since tumors typically grow about 2 mm per year and since larger tumors are associated with more severe symptoms and surgical complications, we expected that the time to diagnosis would correlate with tumor size, but we found no significant association.
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Affiliation(s)
- Marc Olshan
- Department of Internal Medicine, University of Miami-Jackson Memorial Hospital, Miami, FL, USA
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CÁMARA-ARNAZ JA, BENITO-OREJAS JI, RODRÍGUEZ-VELASCO M, MORAIS-PÉREZ D. Schwannoma intralaberíntico. Descripción de un caso. REVISTA ORL 2016. [DOI: 10.14201/orl20167.13550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
OBJECTIVE To describe the presentation of intralabyrinthine schwannomas (ILSs). STUDY DESIGN AND SETTING Retrospective multicenter study involving 12 European skull base surgery tertiary referral centers. PATIENTS One hundred ten patients with the diagnosis of ILS, either labyrinth confined or extending into the internal auditory meatus for less than 50% of their volume. MAIN OUTCOME MEASURES Data collected were age, sex, nature and timing of presenting symptoms, hearing (according to the AAO-HNS grading system), results of vestibular tests (caloric tests and cervical vestibular-evoked myogenic potentials [c-VEMPs]), and tumor localization. Presenting symptoms and laboratory test results were studied according to the extension of the lesion into the cochlea (C) and vestibule (V), on one hand, and according to unifocal (L1) or plurifocal (L2) extension into the labyrinth, on the other. RESULTS Intracochlear type was more common (50%) than vestibular (19.1%) and more diffuse forms (30.9%). The mean delay for diagnosis was long (72.5 mo; SD, 76.6). Mean age was 53.9 years (SD, 13.2). Deafness was the most common symptom (77.8 dB HL [SD, 33.6], with only 24.6% of patients keeping viable hearing. Caloric tests (65.5% of patients) were abnormal in 77.8% of cases. c-VEMPs were abnormal in 65.7% of the 36 cases analyzed. In V forms, hearing was significantly better (class A + B in 21.1% in C and 45.8% in V forms) (p = 0.03), and vestibular function was more altered (C: 57%, V: 100%, p = 0.0009*). L2 forms were diagnosed later (L1: 59.1 mo, L2: 104.5 mo; p = 0.004*) and were associated more frequently with a dead ear (L1: 13.1%, L2: 41.2%, p = 0.002*) than L1 forms. CONCLUSIONS This series, which is the largest in the literature, demonstrates that even very small and localized ILSs heavily compromise labyrinthine functions.
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Wagner F, Wimmer W, Leidolt L, Vischer M, Weder S, Wiest R, Mantokoudis G, Caversaccio MD. Significant Artifact Reduction at 1.5T and 3T MRI by the Use of a Cochlear Implant with Removable Magnet: An Experimental Human Cadaver Study. PLoS One 2015. [PMID: 26200775 PMCID: PMC4511764 DOI: 10.1371/journal.pone.0132483] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective Cochlear implants (CIs) are standard treatment for postlingually deafened individuals and prelingually deafened children. This human cadaver study evaluated diagnostic usefulness, image quality and artifacts in 1.5T and 3T magnetic resonance (MR) brain scans after CI with a removable magnet. Methods Three criteria (diagnostic usefulness, image quality, artifacts) were assessed at 1.5T and 3T in five cadaver heads with CI. The brain magnetic resonance scans were performed with and without the magnet in situ. The criteria were analyzed by two blinded neuroradiologists, with focus on image distortion and limitation of the diagnostic value of the acquired MR images. Results MR images with the magnet in situ were all compromised by artifacts caused by the CI. After removal of the magnet, MR scans showed an unequivocal artifact reduction with significant improvement of the image quality and diagnostic usefulness, both at 1.5T and 3T. Visibility of the brain stem, cerebellopontine angle, and parieto-occipital lobe ipsilateral to the CI increased significantly after magnet removal. Conclusions The results indicate the possible advantages for 1.5T and 3T MR scanning of the brain in CI carriers with removable magnets. Our findings support use of CIs with removable magnets, especially in patients with chronic intracranial pathologies.
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Affiliation(s)
- Franca Wagner
- University Department of Diagnostic and Interventional Neuroradiology, Inselspital Bern, Bern, Switzerland
- * E-mail:
| | - Wilhelm Wimmer
- University Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Lars Leidolt
- University Department of Diagnostic and Interventional Neuroradiology, Inselspital Bern, Bern, Switzerland
| | - Mattheus Vischer
- University Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital Bern, Bern, Switzerland
| | - Stefan Weder
- University Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital Bern, Bern, Switzerland
| | - Roland Wiest
- University Department of Diagnostic and Interventional Neuroradiology, Inselspital Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- University Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital Bern, Bern, Switzerland
| | - Marco D. Caversaccio
- University Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Pont E, Mazón M, Montesinos P, Sánchez MÁ, Más-Estellés F. Imaging Diagnostics: Congenital Malformations and Acquired Lesions of the Inner Ear. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2014.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bykowski J, Harris JP, Miller M, Du J, Mafee MF. Intratympanic Contrast in the Evaluation of Menière Disease: Understanding the Limits. AJNR Am J Neuroradiol 2015; 36:1326-32. [PMID: 25814661 DOI: 10.3174/ajnr.a4277] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/28/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Studies describing endolymphatic hydrops in Menière disease after off-label intratympanic gadolinium-based contrast have been limited by long acquisition times. We aimed to demonstrate the feasibility of post-intratympanic imaging on a 3T MR imaging system within a clinically tolerable acquisition time and to address potential pitfalls in acquisition or interpretation. MATERIALS AND METHODS FDA Investigational New Drug 115,342 and institutional review board approval were obtained for intratympanic injection of 8-fold diluted Gd-DTPA into the more symptomatic ear of 6 adults with Menière disease. 3T MR imaging was performed using a 3-inch surface coil before and up to 28 hours after injection using FLAIR to define the nonenhancing endolymphatic space within the enhancing perilymph. Variable FLAIR TI images were used to determine the impact of fluid-suppression on interpretation. Image quality was assessed for perilymphatic and extralabyrinthine contrast enhancement, definition of endolymphatic anatomy, and other anatomic variants or pathologic findings. RESULTS The surface coil afforded 0.375 × 0.375 mm in-plane FLAIR resolution in <4 minutes 30 seconds, sufficient to perceive the nonenhancing spiral lamina, interscalar septa, and endolymphatic structures. Coronal views highlighted a potential interpretation pitfall of vestibular endolymphatic distention overestimation due to partial volume averaging. Varying FLAIR TI resulted in visible changes in the perception of the cochlear endolymphatic space. CSF enhancement was detectable at the internal auditory canal fundus on the injected side in half of the patients, which may confound interpretation. CONCLUSIONS Using a surface coil preserves high resolution within a clinically acceptable acquisition time. Pitfalls remain regarding the interpretation of these images and optimizing protocols across platforms in the absence of a clear internal reference for standardization.
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Affiliation(s)
- J Bykowski
- From the Departments of Radiology (J.B., M.F.M., J.D.)
| | - J P Harris
- Otolaryngology (J.P.H.), University of California, San Diego Health System, San Diego, California
| | - M Miller
- Department of Otolaryngology (M.M.), University of California, San Francisco Medical Center, San Francisco, California
| | - J Du
- From the Departments of Radiology (J.B., M.F.M., J.D.)
| | - M F Mafee
- From the Departments of Radiology (J.B., M.F.M., J.D.)
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Gosselin É, Maniakas A, Saliba I. Meta-analysis on the clinical outcomes in patients with intralabyrinthine schwannomas: conservative management vs. microsurgery. Eur Arch Otorhinolaryngol 2015; 273:1357-67. [PMID: 25673023 DOI: 10.1007/s00405-015-3548-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Abstract
The objective of this review is to compare the symptomatological evolution following conservative management (CM) or microsurgery (MS) in patients with intralabyrinthine schwannomas (ILS). A thorough systematic review of the English and French literature from 1948 to February 2014 was performed using Ovid Medline. An ancestor search was also completed. The major inclusion criterion consisted of a diagnosis of ILS with magnetic resonance imaging. Patients with a classic vestibular schwannoma, cases of incidentaloma during surgery or an autopsy were the main exclusion criteria. Thirty-one studies met our selective criteria. Descriptive data were collected from the articles. Clinical outcomes regarding the hearing loss, tinnitus, vertigo, dizziness and aural fullness were stated as improved, unchanged or worse at the last follow-up. All data were then separated into two different groups according to the management option: CM and MS. The data were analyzed using a Pearson χ (2) test and Fisher's exact test. This meta-analysis suggests that MS has a statistically significant favorable outcome regarding symptom relief compared to CM in patients with ILS suffering from tinnitus, vertigo and dizziness. Hearing level was not compared between treatment groups, as MS leads to anacusis. An indicative bias was the main limitation of this study, as patients suffering from intractable vertigo with moderate-to-severe hearing loss were referred to MS. Therefore, in the presence of a serviceable hearing, we suggest that CM should be the treatment of choice.
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Affiliation(s)
- Émilie Gosselin
- Division of Otolaryngology Head and Neck Surgery, Montreal University Hospital Center (CHUM), Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke street east, Montreal, QC, H2L 4M1, Canada
| | - Anastasios Maniakas
- Division of Otolaryngology Head and Neck Surgery, Montreal University Hospital Center (CHUM), Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke street east, Montreal, QC, H2L 4M1, Canada
| | - Issam Saliba
- Division of Otolaryngology Head and Neck Surgery, Montreal University Hospital Center (CHUM), Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke street east, Montreal, QC, H2L 4M1, Canada.
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Pont E, Mazón M, Montesinos P, Sánchez MÁ, Más-Estellés F. Imaging diagnostics: congenital malformations and acquired lesions of the inner ear. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014; 66:224-33. [PMID: 25312404 DOI: 10.1016/j.otorri.2014.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/06/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Congenital malformations and acquired lesions of the inner ear are characterised by small structural changes in this region. In recent decades, treatment options have improved considerably. At the same time, there has been a great advancement in diagnostic methods, obtaining high-resolution labyrinth images. Currently, we use a 64-multislice computed tomography scanner in spiral mode (Brilliance 64 Phillips, Eindhoven, the Netherlands), with an overlap of 0.66 mm and an interval of 0.33 mm, 120 KV and 300 mA. The magnetic resonance images were taken with Signa HDxt 1.5 and 3.0 T units (GE Healthcare, Waukesha, WI, USA). We reviewed the radiological features of the lesions affecting the inner ear. They are classified as congenital (labyrinth malformation and statoacoustic nerve deficiencies) or acquired (otospongiosis, labyrinthitis, Ménière's disease, inner ear haemorrhage, intralabyrinthine schwannoma and endolymphatic sac tumour). CONCLUSION Magnetic resonance imaging and computed tomography play an essential role in diagnosing patients with inner ear pathology. The technique selected should be chosen depending on the clinical setting. In a generic way, tomography is the method of choice for the study of traumatic pathology or otospongiosis. When tumour or inflammatory pathology is suspected, magnetic resonance is superior. In cases of congenital malformation, both techniques are complementary.
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Affiliation(s)
- Elena Pont
- Servicio de Otorrinolaringología, Hospital General de Onteniente, Valencia, España.
| | - Miguel Mazón
- Sección de Neurorradiología y Radiología Cabeza-Cuello, Servicio de Radiología Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Pau Montesinos
- Servicio de Radiología, Hospital La Ribera, Alzira, Valencia, España
| | - Miguel Ángel Sánchez
- Sección de Neurorradiología y Radiología Cabeza-Cuello, Servicio de Radiología Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Fernando Más-Estellés
- Sección de Neurorradiología y Radiología Cabeza-Cuello, Servicio de Radiología Hospital Universitario y Politécnico La Fe, Valencia, España
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Schoeff S, Kesser BW, Mukherjee S. Minimal Growth of Intracochlear Schwannoma Over 7 Years. Otol Neurotol 2014; 37:e167-8. [PMID: 25118578 DOI: 10.1097/mao.0000000000000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Stephen Schoeff
- *From the Departments of Otolaryngology-Head and Neck Surgery †Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
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Bittencourt AG, Alves RD, Ikari LS, Burke PR, Gebrim EMS, Bento RF. Intracochlear schwannoma: diagnosis and management. Int Arch Otorhinolaryngol 2014; 18:322-4. [PMID: 25992114 PMCID: PMC4296998 DOI: 10.1055/s-0033-1364170] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/04/2013] [Indexed: 10/31/2022] Open
Abstract
Introduction Schwannomas of the eighth cranial nerve are benign tumors that usually occur in the internal auditory canal or the cerebellopontine angle cistern. Rarely, these tumors may originate from the neural elements within the vestibule, cochlea, or semicircular canals and are called intralabyrinthine schwannomas. Intracochlear schwannomas (ICSs) represent a small percentage of these tumors, and their diagnosis is based on high-resolution magnetic resonance imaging (MRI). Objectives To report the clinical and radiologic features and audiometric testing results of an ICS in a 48-year-old man after a 22-month follow-up period. Resumed Report A patient with an 8-year history of persistent tinnitus in his right ear, combined with ipsilateral progressive hearing loss and aural fullness. Audiometry revealed normal hearing in the left ear and a moderate to severe sensorineural hearing loss in the right ear, with decreased speech reception threshold and word recognition score, compared with the exam performed 5 years previously. MRI showed a small intracochlear nodular lesion in the modiolus, isointense on T1 with a high contrast enhancement on T1 postgadolinium images. During the follow-up period, there were no radiologic changes on imaging studies. Thus, a wait-and-scan policy was chosen as the lesion remained stable with no considerable growth and the patient still presents with residual hearing. Conclusions Once diagnosed, not all ICS patients require surgery. Treatment options for ICS include stereotactic radiotherapy and rescanning policy, depending on the tumor's size, evidence of the tumor's growth, degree of hearing loss, intractable vestibular symptoms, concern about the pathologic diagnosis, and the patient's other medical conditions.
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Affiliation(s)
| | - Ricardo Dourado Alves
- Department of Otolaryngology, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Liliane Satomi Ikari
- Department of Otolaryngology, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Schutt CA, Kveton JF. Cochlear implantation after resection of an intralabyrinthine schwannoma. Am J Otolaryngol 2014; 35:257-60. [PMID: 24321750 DOI: 10.1016/j.amjoto.2013.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/03/2013] [Indexed: 11/28/2022]
Abstract
Intralabyrinthine schwannomas are rare tumors of the distal ends of the cochlear and vestibular nerve. Their presence can be debilitating secondary to symptoms of hearing loss, vertigo, tinnitus, and imbalance. Currently, treatment to restore hearing in those who have become profoundly deaf is not attempted. Additionally, resection in patients with functioning hearing is rare, as the surgery assures deafness. We report the first case demonstrating the feasibility of resection of an intralabyrinthine schwannoma with immediate cochlear implantation. This technique addresses the patients hearing status by taking into account advancing technology, allowing for an improved quality of life.
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Affiliation(s)
| | - John F Kveton
- Yale Department of Surgery, Section of Otolaryngology, New Haven, CT, USA.
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Kim YH, Jun BC, Yun SH, Chang KH. Intracochlear schwannoma extending to vestibule. Auris Nasus Larynx 2013; 40:497-9. [DOI: 10.1016/j.anl.2012.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/21/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
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Van Abel KM, Carlson ML, Link MJ, Neff BA, Beatty CW, Lohse CM, Eckel LJ, Lane JI, Driscoll CL. Primary inner ear schwannomas: A case series and systematic review of the literature. Laryngoscope 2013; 123:1957-66. [DOI: 10.1002/lary.23928] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 11/12/2012] [Accepted: 11/12/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Kathryn M. Van Abel
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic School of Medicine; Rochester; Minnesota; U.S.A
| | - Matthew L. Carlson
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic School of Medicine; Rochester; Minnesota; U.S.A
| | | | - Brian A. Neff
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic School of Medicine; Rochester; Minnesota; U.S.A
| | - Charles W. Beatty
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic School of Medicine; Rochester; Minnesota; U.S.A
| | - Christine M. Lohse
- Department of Health Sciences Research; Mayo Clinic School of Medicine; Rochester; Minnesota; U.S.A
| | - Laurence J. Eckel
- Department of Radiology; Mayo Clinic School of Medicine; Rochester; Minnesota; U.S.A
| | - John I. Lane
- Department of Radiology; Mayo Clinic School of Medicine; Rochester; Minnesota; U.S.A
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