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Kroon VJ, Mes SW, Borggreven PA, van de Langenberg R, Colnot DR, Quak JJ. Efficacy of S53P4 Bioactive Glass for the Secondary Obliteration of Chronically Discharging Radical Cavities. OTO Open 2023; 7:e96. [PMID: 38034064 PMCID: PMC10685330 DOI: 10.1002/oto2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/27/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023] Open
Abstract
Objective Present the results of the secondary obliteration of chronically discharging radical cavities using S53P4 bioactive glass (BAG). Study Design Retrospective cohort study. Setting Single-center study. Methods A single-center retrospective cohort study was conducted of all patients that underwent secondary obliteration of persistently draining radical cavities using S53P4 BAG between 2011 and 2022. Patients with middle ear cholesteatoma were excluded. The main outcome was postoperative otorrhea, as indicated by Merchant grading. Results In total, 97 patients were included. The median postoperative follow-up time was 3.9 years (range 0.5-10.4). Average time between the original canal wall down surgery and the secondary obliteration was 25.3 years (SD 11.7, range 2-66). At the most recent follow-up visit, a Merchant grade of 0 to 1 was observed in 95% of the cases. There were no cases of sensorineural hearing loss or facial palsy, one case developed a retro auricular skin defect and 1 patient developed CSF leakage. Minor complications were seen in 10 patients (10%). Ossicular chain reconstruction with a titanium prosthesis was performed in 42 cases, resulting in a median improvement of 11.2 dB in air conduction thresholds. In 9/42 cases (21%), closure of the postoperative air-bone gap to ≤20 dB was achieved. Twenty-five percent of cases could be discharged from out-patient visits. Conclusion Revision of persistently draining radical cavities with BAG obliteration is feasible and results in a dry and safe ear in 95% of the patients, thereby enabling wearing of a conventional hearing aid. Out-patient visits could be ceased in 25% of the cases.
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Affiliation(s)
- Victor J. Kroon
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
- Amsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Steven W. Mes
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
- Department of OtolaryngologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Pepijn A. Borggreven
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
| | - Rick van de Langenberg
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
| | - David R. Colnot
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
| | - Jasper J. Quak
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
- Amsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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Kroon VJ, Mes SW, Borggreven PA, van de Langenberg R, Colnot DR, Quak JJ. Cholesteatoma surgery in the pediatric population: remaining challenges in the era of mastoid obliteration. Eur Arch Otorhinolaryngol 2023; 280:1713-1722. [PMID: 36208330 PMCID: PMC9988747 DOI: 10.1007/s00405-022-07669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To present the first pediatric study on the safety and efficacy of mastoid obliteration using S53P4 bioactive glass (BAG) for cholesteatoma surgery. METHODS A single-center retrospective cohort study was conducted. Inclusion criteria were pediatric cases (≤ 18 years) and at least at least one year of follow-up including non-echo planar diffusion-weighted MRI to assess cholesteatoma recidivism. Both canal wall up (CWU) and canal wall down (CWD) procedures were evaluated. RESULTS A total of 61 cases (56 patients) were included. Most cases had an otologic history before the development of the cholesteatoma. CWU procedure was performed in 18 cases (30%) and CWD procedure in 43 cases (70%). The cholesteatoma recidivism rate was 33% after a mean follow-up period of 58 months. Kaplan-Meier curve estimated a 5-year recidivism rate of 40%. Few complications were seen that were all minor and resolved spontaneously or after local or systemic treatment. Control of the infection (merchant grade 0-1) was achieved in 98% of the cases. Closure of the air-bone gap within 20 dB was achieved in 22% of the cases with complete audiometric evaluation. CONCLUSION In this MRI-controlled study, we show the safety and efficacy of S53P4 BAG for mastoid obliteration in a pediatric cholesteatoma cohort. Postoperative complications were both rare and minor, and a dry ear was achieved in almost all patients. Nevertheless, persistent hearing loss and the apparent high recidivism rate reflect the challenging nature of pediatric cholesteatoma.
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Affiliation(s)
- Victor J Kroon
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
- Faculty of Medicine, University Utrecht, Utrecht, The Netherlands.
| | - Steven W Mes
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
- Otolaryngology-Head and Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - Pepijn A Borggreven
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Rick van de Langenberg
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - David R Colnot
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Jasper J Quak
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
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Kroon VJ, Mes SW, Borggreven PA, van de Langenberg R, Colnot DR, Quak JJ. Mastoid Obliteration Using S53P4 Bioactive Glass in Cholesteatoma Surgery: A 10-Year Single-Center Experience in 173 Adult Patients with Long-Term Magnetic Resonance Imaging Controlled Follow-up. Otol Neurotol 2022; 43:1181-1188. [PMID: 36099589 PMCID: PMC9671595 DOI: 10.1097/mao.0000000000003685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To present the long-term outcomes of mastoid obliteration in cholesteatoma surgery using S53P4 bioactive glass (BAG) in an adult population. STUDY DESIGN Retrospective cohort study. SETTING Single-center study. PATIENTS All 173 adult patients who underwent primary or revision surgery for cholesteatoma with mastoid obliteration using S53P4 BAG with at least 1 year of follow-up including nonecho planar diffusion-weighted magnetic resonance imaging (MRI) (non-EP DWI MRI) and/or second-look surgery to evaluate recidivism. Both canal wall up (CWU) and canal wall down (CWD) procedures were included. INTERVENTIONS Patients underwent CWU or CWD mastoidectomy using S53P4 BAG. MAIN OUTCOME AND MEASURES Cholesteatoma recidivism, postoperative complications, Merchant grade, hearing outcome. RESULTS Cholesteatoma recidivism was assessed by MRI in 97% of all cases and second-look surgery look surgery in 3% of cases. After a mean follow-up period of 53 months, cholesteatoma recidivism was seen in 10% of the cases (n = 18). Using the Kaplan-Meier curve to extrapolate, a 5-year recidivism rate of 12% was estimated. Only minor complications occurred, all resolving spontaneously or after minor treatment. Merchant grade of 0 to 1 was achieved 95% of the patients, no persistently wet ears were observed. Closure of the air-bone gap within 20 dB was possible in 32%. CONCLUSION In this long-term (up to 10 yr) follow-up study, we demonstrated the safety of S53P4 BAG. Minimal and only minor postoperative complications were observed. The effectiveness of BAG was indicated by the low rate of recidivism, even when using non-EP DWI MRI, a sensitive and specific noninvasive technique to detect cholesteatoma recidivism.
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Affiliation(s)
| | - Steven W Mes
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht
| | - Pepijn A Borggreven
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht
| | | | - David R Colnot
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht
| | - Jasper J Quak
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht
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Filipovic B, de Ru JA, Hakim S, van de Langenberg R, Borggreven PA, Lohuis PJFM. Treatment of Frontal Secondary Headache Attributed to Supratrochlear and Supraorbital Nerve Entrapment With Oral Medication or Botulinum Toxin Type A vs Endoscopic Decompression Surgery. JAMA FACIAL PLAST SU 2019; 20:394-400. [PMID: 29801115 DOI: 10.1001/jamafacial.2018.0268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Importance Endoscopic surgical decompression of the supratrochlear nerve (STN) and supraorbital nerve (SON) is a new treatment for patients with frontal chronic headache who are refractory to standard treatment options. Objective To evaluate and compare treatment outcomes of oral medication, botulinum toxin type A (BoNT/A) injections, and endoscopic decompression surgery in frontal secondary headache attributed to STN and supraorbital SON entrapment. Design, Setting, and Participants Prospective cohort study of 22 patients from a single institution (Diakonessen Hospital Utrecht) with frontal headache of moderate-to-severe intensity (visual analog scale [VAS] score, 7-10), frontally located, experienced more than 15 days per month, and described as pressure or tension that intensifies with pressure on the area of STN and SON. A screening algorithm was used that included examination, questionnaire, computed tomography of the sinus, injections of local anesthetic, and BoNT/A in the corrugator muscle. Interventions Different oral medication therapy for headache encountered in the study cohort, as well as BoNT/A injections (15 IU) into the corrugator muscle. Surgical procedures were performed by a single surgeon using an endoscopic surgical approach to release the supraorbital ridge periosteum and to bluntly dissect the glabellar muscle group. Main Outcomes and Measures Headache VAS intensity after oral medication and BoNT/A injections. Additionally, early postoperative follow-up consisted of a daily headache questionnaire that was evaluated after 1 year. Results In total, 22 patients (mean [SD] age, 42.0 [15.3] years; 7 men and 15 women) were included in this cohort study. Oral medication therapy reduced the headache intensity significantly (mean [standard error of the mean {SEM}] VAS score, 6.45 [0.20] [95% CI, 0.34-3.02; P < .001] compared with mean [SEM] pretreatment VAS score, 8.13 [0.22]). Botulinum toxin type A decreased the mean (SEM) headache intensity VAS scores significantly as well (pretreatment, 8.1 [0.22] vs posttreatment, 2.9 [0.42]; 95% CI, 3.89-6.56; P < .001). The mean (SEM) pretreatment headache intensity VAS score (8.10 [0.22]) decreased significantly after surgery at 3 months (1.30 [0.55]; 95% CI, 5.48-8.16; P < .001) and 12 months (1.09 [0.50]; 95% CI, 5.71-8.38; P < .001). There was a significant decrease of headache intensity VAS score in the surgical group over the BoNT/A group (mean [SEM] VAS score, 2.90 [0.42]) after 3 months (mean [SEM] VAS score, 1.30 [0.55]; 95% CI, 0.25-2.93; P < .001) and 12 months (mean [SEM] VAS score, 1.09 [0.50]; 95% CI, 0.48-3.16; P < .001) after surgery. Conclusions and Relevance Endoscopic decompression surgery had a long-lasting successful outcome in this type of frontal secondary headache. Even though BoNT/A had a positive effect, the effect of surgery was significantly higher. Level of Evidence 3.
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Affiliation(s)
- Boris Filipovic
- Department of Otorhinolaryngology-Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands.,Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - J Alexander de Ru
- Department of Otorhinolaryngology-Head and Neck Surgery, Central Military Hospital, Utrecht, the Netherlands
| | - Sara Hakim
- Department of Otorhinolaryngology-Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands
| | - Rick van de Langenberg
- Department of Otorhinolaryngology-Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands
| | - Pepijn A Borggreven
- Department of Otorhinolaryngology-Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands
| | - Peter J F M Lohuis
- Department of Otorhinolaryngology-Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital, Utrecht, the Netherlands
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Drost BH, van de Langenberg R, Manusama OR, Janssens AS, Sikorska K, Zuur CL, Klop WMC, Lohuis PJFM. Dermatography (Medical Tattooing) for Scars and Skin Grafts in Head and Neck Patients to Improve Appearance and Quality of Life. JAMA FACIAL PLAST SU 2017; 19:16-22. [PMID: 27657879 DOI: 10.1001/jamafacial.2016.1084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Dermatography (medical tattooing) is often overlooked as an adjuvant procedure to improve color mismatch in the head and neck area, and its effect on patient satisfaction and quality of life has not been evaluated, to our knowledge. Objective To analyze the effect of dermatography on the subjective perception of the appearance of scars and skin grafts and the quality of life in head and neck patients. Design, Setting, and Participants Case series of patients undergoing dermatography at the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, between July 1, 2007, and April 1, 2015. Participants were invited to respond to 2 questionnaires measuring their scar or graft appearance and their quality of life before and after dermatography as an adjuvant treatment for benign or malignant head and neck tumors. Intervention Use of dermatography. Main Outcomes and Measures Two questionnaires evaluating a visual analog scale score (range, 0-10) and multiple questions on a 5-point scale focusing on satisfaction with the appearance and the quality of life. Results Among 76 patients, 56 (74%) were included in the study. The mean (SD) age of the study cohort was 56.5 (16.0) years, and 42 (75%) were female. The mean improvement in scar or skin graft perception on the visual analog scale of the modified Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty before and after dermatography was 4 points. On the modified Patient Scar Assessment Questionnaire, uniform improvement of approximately 1 point across 9 questions was observed. The answers to all patient satisfaction and quality-of-life questions on both questionnaires improved significantly after dermatography. Conclusions and Relevance Dermatography is an effectual adjuvant procedure to improve the subjective perception of scar and skin graft appearance and the quality of life in head and neck patients. Level of Evidence 4.
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Affiliation(s)
- Brigitte H Drost
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam
| | - Rick van de Langenberg
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam2Center for Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Diakonessen Hospital, Utrecht, the Netherlands
| | - Olivia R Manusama
- Center for Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Diakonessen Hospital, Utrecht, the Netherlands
| | - A Soe Janssens
- Department of Dermatology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam
| | - Karolina Sikorska
- Department of Biometrics, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam
| | - C Lot Zuur
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam
| | - Willem M C Klop
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam
| | - Peter J F M Lohuis
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam2Center for Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Diakonessen Hospital, Utrecht, the Netherlands
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Filipović B, de Ru JA, van de Langenberg R, Borggreven PA, Lacković Z, Lohuis PJFM. Decompression endoscopic surgery for frontal secondary headache attributed to supraorbital and supratrochlear nerve entrapment: a comprehensive review. Eur Arch Otorhinolaryngol 2017; 274:2093-2106. [DOI: 10.1007/s00405-017-4450-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/03/2017] [Indexed: 01/03/2023]
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van de Langenberg R, Dohmen AJ, de Bondt BJ, Nelemans PJ, Baumert BG, Stokroos RJ. Volume Changes After Stereotactic LINAC Radiotherapy in Vestibular Schwannoma: Control Rate and Growth Patterns. Int J Radiat Oncol Biol Phys 2012; 84:343-9. [DOI: 10.1016/j.ijrobp.2011.12.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 08/13/2011] [Accepted: 12/06/2011] [Indexed: 01/09/2023]
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Affiliation(s)
| | | | - Jacobus J. van Overbeeke
- 3Neurosurgery, Maastricht University Medical Centre
- 6Neurosurgery, Gamma Knife Centre Tilburg, St. Elisabeth Hospital, Tilburg; and
| | - Jeroen B. Verheul
- 6Neurosurgery, Gamma Knife Centre Tilburg, St. Elisabeth Hospital, Tilburg; and
| | - Patty J. Nelemans
- 5Department of Epidemiology and Statistics, Maastricht University, Maastricht
| | - Bert J. de Bondt
- 4Department of Radiology, Isala Klinieken, Zwolle, The Netherlands
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van de Langenberg R, Hanssens PEJ, van Overbeeke JJ, Verheul JB, Nelemans PJ, de Bondt BJ, Stokroos RJ. Management of large vestibular schwannoma. Part I. Planned subtotal resection followed by Gamma Knife surgery: radiological and clinical aspects. J Neurosurg 2011; 115:875-84. [PMID: 21838510 DOI: 10.3171/2011.6.jns101958] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In large vestibular schwannoma (VS), microsurgery is the main treatment option, and complete resection is considered the primary goal. However, previous studies have documented suboptimal facial nerve outcomes in patients who undergo complete resection of large VSs. Subtotal resection is likely to reduce the risk of facial nerve injury but increases the risk of lesion regrowth. Gamma Knife surgery (GKS) can be performed to achieve long-term growth control of residual VS after incomplete resection. In this study the authors report on the results in patients treated using planned subtotal resection followed by GKS with special attention to volumetric growth, control rate, and symptoms. METHODS Fifty consecutive patients who underwent the combined treatment strategy of subtotal microsurgical removal and GKS for large VSs between 2002 and 2009 were retrospectively analyzed. Patients with neurofibromatosis Type 2 were excluded. Patient charts were reviewed for clinical symptoms. Audiograms were evaluated to classify hearing pre- and postoperatively. Preoperative and follow-up contrast-enhanced T1-weighted MR images were analyzed using volume-measuring software. RESULTS Surgery was performed via a translabyrinthine (25 patients) or retrosigmoid (25 patients) approach. The median follow-up was 33.8 months. Clinical control was achieved in 92% of the cases and radiological control in 90%. One year after radiosurgery, facial nerve function was good (House-Brackmann Grade I or II) in 94% of the patients. One of the two patients who underwent surgery to preserve hearing maintained serviceable hearing after resection followed by GKS. CONCLUSIONS Considering the good tumor growth control and facial nerve function preservation as well as the possibility of preserving serviceable hearing and the low number of complications, subtotal resection followed by GKS can be the treatment option of choice for large VSs.
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Affiliation(s)
- Rick van de Langenberg
- Departments of Otolaryngology, Head and Neck Surgery, Maastricht University, Maastricht, The Netherlands.
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van de Langenberg R, Hanssens PEJ, Verheul JB, van Overbeeke JJ, Nelemans PJ, Dohmen AJC, de Bondt BJ, Stokroos RJ. Management of large vestibular schwannoma. Part II. Primary Gamma Knife surgery: radiological and clinical aspects. J Neurosurg 2011; 115:885-93. [PMID: 21838503 DOI: 10.3171/2011.6.jns101963] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In large vestibular schwannomas (VSs), microsurgery is the main treatment option. A wait-and-scan policy or radiosurgery are generally not recommended given concerns of further lesion growth or increased mass effect due to transient swelling. Note, however, that some patients do not present with symptomatic mass effect or may still have serviceable hearing. Moreover, others may be old, suffer from severe comorbidity, or refuse any surgery. In this study the authors report the results in patients with large, growing VSs primarily treated with Gamma Knife surgery (GKS), with special attention to volumetric growth, control rate, and symptoms. METHODS The authors retrospectively analyzed 33 consecutive patients who underwent GKS for large, growing VSs, which were defined as > 6 cm(3) and at least indenting the brainstem. Patients with neurofibromatosis Type 2 were excluded from analysis, as were patients who had undergone previous treatment. Volume measurements were performed on contrast-enhanced T1-weighted MR images at the time of GKS and during follow-up. Medical charts were analyzed for clinical symptoms. RESULTS Radiological growth control was achieved in 88% of cases, clinical control (that is, no need for further treatment) in 79% of cases. The median follow-up was 30 months, and the mean VS volume was 8.8 cm(3) (range 6.1-17.7 cm(3)). No major complications occurred, although ventriculoperitoneal shunts were placed in 2 patients. The preservation of serviceable hearing and facial and trigeminal nerve function was achieved in 58%, 91%, and 86% of patients, respectively, with any facial and trigeminal neuropathy being transient. In 92% of the patients presenting with trigeminal hypesthesia before GKS, the condition resolved during follow-up. No patient- or VS-related feature was correlated with growth. CONCLUSIONS Primary GKS for large VSs leads to acceptable radiological growth rates and clinical control rates, with the chance of hearing preservation. Although a higher incidence of clinical control failure and postradiosurgical morbidity is noted, as compared with that for smaller VSs, primary radiosurgery is suitable for a selected group of patients. The absence of symptomatology due to mass effect on the brainstem or cerebellum is essential, as are close clinical and radiological follow-ups, because there is little reserve for growth or swelling.
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Affiliation(s)
- Rick van de Langenberg
- Departments of Otolaryngology, Head and Neck Surgery, Maastricht University MedicalCentre, The Netherlands.
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van de Langenberg R, Stokroos R, de Bondt BJ. Radiology quiz case 2. Metastasis from NSCLC in both IACs. ACTA ACUST UNITED AC 2009; 135:717, 719. [PMID: 19620597 DOI: 10.1001/archoto.2009.59-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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van de Langenberg R, de Bondt BJ, Nelemans PJ, Baumert BG, Stokroos RJ. Follow-up assessment of vestibular schwannomas: volume quantification versus two-dimensional measurements. Neuroradiology 2009; 51:517-24. [PMID: 19418046 PMCID: PMC2710491 DOI: 10.1007/s00234-009-0529-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Accepted: 04/13/2009] [Indexed: 11/24/2022]
Abstract
Introduction A conservative treatment strategy is often proposed as a primary treatment option in the management of vestibular schwannomas (VS). In this “wait and scan” policy, audiovestibular symptoms are monitored regularly, and VS growth is measured on consecutive magnetic resonance images (MRI). The aim of this study is validation of two-dimensional versus volume MRI assessment in the longitudinal follow-up of VS and to define tumor growth beyond measurement error. Methods MRI scans of 68 consecutive patients with VS were analyzed retrospectively. Two-dimensional and volume measurements on contrast enhanced (CE) T1- and T2-weighted images were performed independently by two readers. Smallest detectable differences (SDD) were calculated, and intraclass correlation coefficients (ICCs) were determined for both assessment methods. Results Two-dimensional and volume measurements both showed best reproducibility on CE T1-weighted images. SDD for differences relative to baseline MRI [SDD (%)] for two-dimensional measurements had a higher interobserver error compared to volume measurements (40% versus 19.7%), which decreases when tumor size increases. The ICC for two-dimensional measurements in three directions was 0.947, 0.974, and 0.978 and for volume measurements 0.999. Conclusion Volume measurements are more accurate compared to two-dimensional measurements for the evaluation of VS growth. These measurements are assessed preferably on CE T1-weighted images. SDD (%) strongly depends on VS size. SDD between consecutive scans exceeds the common clinical applied criterion of 1 or 2 mm growth to define growth.
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Affiliation(s)
- Rick van de Langenberg
- Department of Otorhinolaryngology-Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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