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Drakos A, Goncalves Filho A, Woulfe J, Puac Polanco P, de Oliveira EP. Malignant transformation of vestibular schwannoma after radiation therapy. Radiol Case Rep 2024; 19:2654-2662. [PMID: 38645955 PMCID: PMC11033104 DOI: 10.1016/j.radcr.2024.03.033] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 04/23/2024] Open
Abstract
Stereotactic radiosurgery (SRS) is an effective treatment for vestibular schwannomas, offering high rates of tumor control and low neurological risks. Long-term complications of SRS are not fully understood, with several cases of malignant transformation reported in the literature. We report the case of a 50-year-old female with no prior history of neurofibromatosis who presented in 2013 with MRI evidence of a benign vestibular schwannoma. Despite treatment with CyberKnife SRS, she presented 6 years later with new onset neurologic symptoms. Further investigation showed stable lesion size with increasing vasogenic edema and a new area of enhancement in the brainstem, suspicious for malignant transformation. Subsequent treatment with partial craniectomy and histopathologic analysis was consistent with a malignant peripheral nerve sheath tumor diagnosis. Our case adds to a series of 24 similar cases in the literature, details of which have been summarized in our study. Overall, findings support the need for lifelong surveillance following SRS treatment of benign vestibular schwannomas. Patients should be educated on the potential risk of this complication, and clinicians must maintain a high level of suspicion for potential radiation-induced malignancy during the patient's clinical course.
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Affiliation(s)
- Anastasia Drakos
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - John Woulfe
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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2
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Fontana V, Sinosi FA, Marchioni D, Masotto B. Transcanal transpromontorial approach for vestibular schwannoma: experience of a single center. Eur Arch Otorhinolaryngol 2024; 281:2679-2690. [PMID: 38519593 DOI: 10.1007/s00405-024-08565-5] [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: 09/08/2023] [Accepted: 02/16/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The expanded transpromontorial transcanal approach (ExpTTA) represents a recent addition to the surgical approaches available for the treatment of vestibular schwannoma. An initial purely endoscopic version has been complemented by the use of the microscope and it is now one of the possible surgical options for small to medium-sized vestibular schwannomas with a predominantly intracanalar development. METHODS This is a series of 54 patients who underwent microsurgical resection of sporadic, unilateral vestibular schwannoma, mainly Koos I-II with non-serviceable hearing, between January 2016 and January 2023 using the expanded transcanal transpromontorial approach. We describe the surgical technique, focusing on anatomical landmarks, and analyzing its advantages and shortcomings. Retrospective analysis of clinical outcomes is presented, including early and late complications. The mean follow-up was 46.7 months. RESULTS We achieved gross total resection of the lesion in all cases, confirmed on the first follow-up MRI at least 6 months after each procedure. We did not record any intraoperative complication nor disease recurrence. We recorded two postoperative severe facial nerve palsies, one of which was permanent. No cases of disabling vertigo or imbalance were reported, and all patients reported full recovery of autonomy in daily activities. Three cases of otoliquorrhea were managed conservatively successfully. CONCLUSIONS The transcanal transpromontorial approach combines the advantages of endoscopy with the possibilities provided by microsurgery. Our experience confirms its safety in terms of surgical complications and facial nerve outcome. This approach is amongst the treatment options for small-medium schwannomas in patients with impaired hearing, especially in young patients, ensuring radical resection, disease control, and minimal morbidity.
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Affiliation(s)
- Vincenzo Fontana
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy, Ospedale Civile Maggiore Verona, Verona, Italy.
| | - F A Sinosi
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy, Ospedale Civile Maggiore Verona, Verona, Italy
| | - D Marchioni
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - B Masotto
- Posterior Cranial Fossa Unit, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Civile Maggiore Verona, Verona, Italy
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Flores-Milan G, Rainone GJ, Piper K, Peto I, Danner C, Allen KP, Liu SS, van Loveren H, Agazzi S. Temporal lobe injury with middle fossa approach to intracanalicular vestibular schwannomas: a systematic review. Neurosurg Rev 2024; 47:188. [PMID: 38658423 DOI: 10.1007/s10143-024-02425-w] [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: 03/11/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 04/26/2024]
Abstract
There are several surgical approaches for vestibular schwannoma (VS) resection. However, management has gradually shifted from microsurgical resection, toward surveillance and radiosurgery. One of the arguments against microsurgery via the middle fossa approach (MFA) is the risk of temporal lobe retraction injury or sequelae. Here, we sought to evaluate the incidence of temporal lobe retraction injury or sequela from a MFA via a systematic review of the existing literature. This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Relevant studies reporting temporal lobe injury or sequela during MFA for VS were identified. Data was aggregated and subsequently analyzed to evaluate the incidence of temporal lobe injury. 22 studies were included for statistical analysis, encompassing 1522 patients that underwent VS resection via MFA. The overall rate of temporal lobe sequelae from this approach was 0.7%. The rate of CSF leak was 5.9%. The rate of wound infection was 0.6%. Meningitis occurred in 1.6% of patients. With the MFA, 92% of patients had good facial outcomes, and 54.9% had hearing preservation. Our series and literature review support that temporal lobe retraction injury or sequelae is an infrequent complication from an MFA for intracanalicular VS resection.
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Affiliation(s)
- Gabriel Flores-Milan
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA
| | - Gersham J Rainone
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA.
| | - Keaton Piper
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA
| | - Ivo Peto
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA
| | - Christopher Danner
- Tampa Bay Hearing and Balance Center, 5 Tampa General Cir, Ste 610, Tampa, FL, USA
| | - Kyle P Allen
- Tampa Bay Hearing and Balance Center, 5 Tampa General Cir, Ste 610, Tampa, FL, USA
| | - Shih Sing Liu
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA
| | - Harry van Loveren
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA
| | - Siviero Agazzi
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA
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Thomas M, Scheer M, Rampp S, Strauss C, Schönfeld R, Leplow B. Psychological factors and long-term tinnitus handicap in vestibular schwannoma patients after retrosigmoid microsurgery - a cross-sectional study. Int J Audiol 2024:1-8. [PMID: 38613519 DOI: 10.1080/14992027.2024.2339351] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE This study aimed to investigate the connection between psychological factors and postoperative tinnitus in vestibular schwannoma (VS) patients following retrosigmoid microsurgery. DESIGN Cross-sectional study. STUDY SAMPLE Ninety-three VS patients participated, completing questionnaires on demographics, tinnitus severity (THI-12), personality traits (TIPI-G), dizziness impact (DHI), perceived health benefits (GBI), somatisation tendencies (SOMS-2), and psychological distress (HADS-D). Our analysis involved Mann-Whitney U-tests, Spearman's rank-order correlations, and false discovery rate correction. RESULTS Most participants reported postoperative tinnitus (77/93), with 41 experiencing it preoperatively. Emotional stability correlated negatively with tinnitus presence, while tinnitus severity was associated with emotional distress. Preoperative somatisation tendencies were also positively linked to tinnitus severity. Postoperative Tinnitus was further linked to reduced perceived health benefits and increased anxiety and depression levels. Notably, age and gender showed no significant associations. CONCLUSION This study uncovers the interplay between postoperative tinnitus and psychological factors in VS patients, highlighting emotional and cognitive dimensions. Tailored psychological interventions addressing tinnitus's psychosomatic impact may enhance patients quality of life.
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Affiliation(s)
- M Thomas
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Scheer
- Department of Neurosurgery, University Hospital Halle, Halle, Germany
| | - S Rampp
- Department of Neurosurgery, University Hospital Halle, Halle, Germany
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - C Strauss
- Department of Neurosurgery, University Hospital Halle, Halle, Germany
| | - R Schönfeld
- Department of Psychology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - B Leplow
- Department of Psychology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Palavani LB, Batista S, Andreão FF, de Barros Oliveira L, Silva GM, Koester S, Barbieri JF, Bertani R, da Silva VTG, Acioly M, Paiva WS, De Andrade EJ, Rassi MS. Retrosigmoid versus middle fossa approach for hearing and facial nerve preservation in vestibular schwannoma surgery: A systematic review and comparative meta-analysis. J Clin Neurosci 2024; 124:1-14. [PMID: 38615371 DOI: 10.1016/j.jocn.2024.04.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/28/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Vestibular schwannomas (VS) are benign tumors arising from vestibular nerve's Schwann cells. Surgical resection via retrosigmoid (RS) or middle fossa (MF) is standard, but the optimal approach remains debated. This meta-analysis evaluated RS and MF approaches for VS management, emphasizing hearing preservation and Cranial nerve seven (CN VII) outcomes stratified by tumor size. METHODS Systematic searches across PubMed, Cochrane, Web of Science, and Embase identified relevant studies. Hearing and CN VII outcomes were gauged using the American Academy of Otolaryngology-Head and Neck Surgery, Gardner Robertson, and House-Brackmann scores. RESULTS Among 7228 patients, 56 % underwent RS and 44 % MF. For intracanalicular tumors, MF recorded 38 % hearing loss, compared to RS's 54 %. In small tumors (<1.5 cm), MF showed 41 % hearing loss, contrasting RS's lower 15 %. Medium-sized tumors (1.5 cm-2.9 cm) revealed 68 % hearing loss in MF and 55 % in RS. Large tumors (>3cm) were only reported in RS with a hearing loss rate of 62 %. CONCLUSION Conclusively, while MF may be preferable for intracanalicular tumors, RS demonstrated superior hearing preservation for small to medium-sized tumors. This research underlines the significance of stratified outcomes by tumor size, guiding surgical decisions and enhancing patient outcomes.
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Affiliation(s)
| | - Sávio Batista
- Federal University of Rio de Janeiro, Faculty of Medicine, Rio de Janeiro, RJ, Brazil
| | - Filipi Fim Andreão
- Federal University of Rio de Janeiro, Faculty of Medicine, Rio de Janeiro, RJ, Brazil.
| | | | - Guilherme Melo Silva
- Federal University of Rio de Janeiro, Faculty of Medicine, Rio de Janeiro, RJ, Brazil
| | - Stefan Koester
- Vanderbilt University School of Medicine, Nashville, TN, the United States of America
| | | | - Raphael Bertani
- Department of Neurosurgery, University of Sao Paulo Medical School, SP, Brazil
| | | | - Marcus Acioly
- Division of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Wellingson S Paiva
- Department of Neurosurgery, University of Sao Paulo Medical School, SP, Brazil
| | - Erion J De Andrade
- Division of Neurosurgery, Section of Skull Base Surgery, Emory University, Atlanta, GA, the United States of America
| | - Marcio S Rassi
- Division of Neurosurgery, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, SP, Brazil
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Bin-Alamer O, Abou-Al-Shaar H, Peker S, Samanci Y, Pelcher I, Begley S, Goenka A, Schulder M, Tourigny JN, Mathieu D, Hamel A, Briggs RG, Yu C, Zada G, Giannotta SL, Speckter H, Palque S, Tripathi M, Kumar S, Kaur R, Kumar N, Rogowski B, Shepard MJ, Johnson BA, Trifiletti DM, Warnick RE, Dayawansa S, Mashiach E, Vasconcellos FDN, Bernstein K, Schnurman Z, Alzate J, Kondziolka D, Sheehan JP. Vestibular Schwannoma International Study of Active Surveillance Versus Stereotactic Radiosurgery: the VISAS Study. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00482-6. [PMID: 38588868 DOI: 10.1016/j.ijrobp.2024.04.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/23/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The present study assesses the safety and efficacy of stereotactic radiosurgery (SRS) versus observation for Koos grade I and II vestibular schwannoma (VS), benign tumors affecting hearing and neurological function. METHODS This multicenter study analyzed data from Koos grade I and II VS patients managed with SRS (SRS group) or observation (observation group). Propensity score matching balanced patient demographics, tumor volume, and audiometry. Outcomes measured were tumor control, serviceable hearing preservation (SHP), and neurological outcomes. RESULTS In 125 matched patients in each group with a 36-month median follow-up (p=0.49), SRS yielded superior 5- and 10-year tumor control rates (99%, CI: 97.1%-100%, and 91.9%, CI: 79.4%-100%) vs. observation (45.8%, CI: 36.8%-57.2%, and 22%, CI: 13.2%-36.7%; p<0.001). SHP rates at 5 and 9 years were comparable (SRS 60.4%, CI: 49.9%-73%, vs. observation 51.4%, CI: 41.3%-63.9%, and SRS 27%, CI: 14.5%-50.5%, vs. observation 30%, CI: 17.2%-52.2%; p=0.53). SRS were associated with lower odds of tinnitus (OR=0.39, p=0.01), vestibular dysfunction (OR=0.11, p=0.004), and any cranial nerve palsy (OR=0.36, p=0.003), with no change in cranial nerves V or VII (p>0.05). Composite endpoints of tumor progression and/or any of the previous outcomes showed significant lower odds associated with SRS compared to observation alone (p < 0.001). CONCLUSION SRS management in matched cohorts of Koos grade I and II VS patients demonstrated superior tumor control, comparable hearing preservation rates, and significantly lower odds of experiencing neurological deficits. These findings delineate the safety and efficacy of SRS in in the management of this patient population.
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Affiliation(s)
- Othman Bin-Alamer
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Isabelle Pelcher
- Department of Neurosurgery, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Sabrina Begley
- Department of Neurosurgery, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Anuj Goenka
- Department of Neurosurgery, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Michael Schulder
- Department of Neurosurgery, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Jean-Nicolas Tourigny
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Andréanne Hamel
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Robert G Briggs
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Cheng Yu
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Steven L Giannotta
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Herwin Speckter
- Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Sarai Palque
- Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Saurabh Kumar
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rupinder Kaur
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Narendra Kumar
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Brandon Rogowski
- Drexel University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Matthew J Shepard
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Bryan A Johnson
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Ronald E Warnick
- Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio, USA
| | - Samantha Dayawansa
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Elad Mashiach
- Department of Neurosurgery, NYU Langone, Manhattan, New York, USA
| | | | - Kenneth Bernstein
- Department of Radiation Oncology, NYU Langone, Manhattan, New York, USA
| | - Zane Schnurman
- Department of Neurosurgery, NYU Langone, Manhattan, New York, USA
| | - Juan Alzate
- Department of Neurosurgery, NYU Langone, Manhattan, New York, USA
| | | | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
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Freeman LM, Ung TH, Thompson JA, Ovard O, Olson M, Hirt L, Hosokawa P, Thaker A, Youssef AS. Refining the predictive value of preoperative apparent diffusion coefficient (ADC) by whole-tumor analysis for facial nerve outcomes in vestibular schwannomas. Acta Neurochir (Wien) 2024; 166:168. [PMID: 38575773 DOI: 10.1007/s00701-024-06059-1] [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: 01/01/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Apparent diffusion coefficient (ADC) in MRI has been shown to correlate with postoperative House-Brackmann (HB) scores in patients with vestibular schwannoma despite limited methodology. To rectify limitations of single region of interest (ROI) sampling, we hypothesize that whole-tumor ADC histogram analysis will refine the predictive value of this preoperative biomarker related to postoperative facial nerve function. METHODS Of 155 patients who underwent resection of vestibular schwannoma (2014-2020), 125 patients were included with requisite clinical and radiographic data. After volumetric analysis and whole-tumor ADC histogram, regression tree analysis identified ADC cutoff for significant differences in HB grade. Outcomes were extent of resection, facial nerve function, hospital length of stay (LOS), and complications. RESULTS Regression tree analysis defined three quantitative ADC groups (× 10-6 mm2/s) as high (> 2248.77; HB 1.7), mid (1468.44-2248.77; HB 3.1), and low (< 1468.44; HB 2.3) range (p 0.04). The mid-range ADC group had significantly worse postoperative HB scores and longer hospital LOS. Large tumor volume was independently predictive of lower rates of gross total resection (p <0.0001), higher postoperative HB score (p 0.002), higher rate of complications (p 0.04), and longer LOS (p 0.003). CONCLUSIONS Whole-tumor histogram yielded a robust regression tree analysis that defined three ADC groups with significantly different facial nerve outcomes. This likely reflects tumor heterogeneity better than solid-tumor ROI sampling. Whole-tumor ADC warrants further study as a useful radiographic biomarker in patients with vestibular schwannoma who are considering surgical resection.
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Affiliation(s)
- Lindsey M Freeman
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Timothy H Ung
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Olivia Ovard
- Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Madeline Olson
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Lisa Hirt
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Patrick Hosokawa
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ashesh Thaker
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A Samy Youssef
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Department of Otolaryngology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Wakabayashi T, Tamura R, Karatsu K, Hosoya M, Nishiyama T, Inoue Y, Ogawa K, Kanzaki J, Toda M, Ozawa H, Oishi N. Natural history of hearing and tumor growth in vestibular schwannoma in neurofibromatosis type 2-related schwannomatosis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08601-4. [PMID: 38578503 DOI: 10.1007/s00405-024-08601-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/05/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES To determine the natural history of hearing loss and tumor volume in patients with untreated neurofibromatosis type 2 (NF2)-related schwannomatosis. Moreover, we statistically examined the factors affecting hearing prognosis. METHODS This retrospective cohort study was conducted on 37 ears of 24 patients with NF2-related vestibular schwannomatosis followed up without treatment for more than 1 year. We obtained detailed chronological changes in the PTA and tumor volume in each case over time, and the rate of change per year was obtained. Multivariate analysis was also conducted to investigate factors associated with changes in hearing. RESULTS The average follow-up period was approximately 9 years, and hearing deteriorated at an average rate of approximately 4 dB/year. The rate of maintaining effective hearing decreased from 30 ears (81%) at the first visit to 19 ears (51%) at the final follow-up. The average rate of change in tumor growth for volume was approximately 686.0 mm3/year. This study revealed that most patients with NF2 experienced deterioration in hearing acuity and tumor growth during the natural course. A correlation was observed between an increase in tumor volume and hearing loss (r = 0.686; p < 0.001). CONCLUSIONS Although the hearing preservation rate in NF2 cases is poor with the current treatment methods, many cases exist in which hearing acuity deteriorates, even during the natural course. Patients with an increased tumor volume during the follow-up period were more likely to experience hearing deterioration. Trial registration number 20140242 (date of registration: 27 October 2014).
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Affiliation(s)
- Takeshi Wakabayashi
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Ryota Tamura
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kosuke Karatsu
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Makoto Hosoya
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Takanori Nishiyama
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Yasuhiro Inoue
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kaoru Ogawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Jin Kanzaki
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Naoki Oishi
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
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9
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Waqar M, Yaseen O, Chadwick A, Lee JX, Khan G, Evans DG, Horner D, Jaiswal A, Freeman S, Bhalla R, Lloyd S, Hammerbeck-Ward C, Rutherford SA, King AT, Pathmanaban ON. Venous thromboembolism chemical prophylaxis after skull base surgery. Acta Neurochir (Wien) 2024; 166:165. [PMID: 38565732 PMCID: PMC10987339 DOI: 10.1007/s00701-024-06035-9] [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: 11/16/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE There is no guidance surrounding postoperative venous thromboembolism (VTE) prophylaxis using pharmacological agents (chemoprophylaxis) in patients undergoing skull base surgery. The aim of this study was to compare VTE and intracranial haematoma rates after skull base surgery in patients treated with/without chemoprophylaxis. METHODS Review of prospective quaternary centre database including adults undergoing first-time skull base surgery (2009-2020). VTE was defined as deep vein thrombosis (DVT) and pulmonary embolism (PE) within 6 months of surgery. Multivariate logistic regression was used to determine factors predictive of postoperative intracranial haematoma/VTE. Propensity score matching (PSM) was used in group comparisons. RESULTS One thousand five hundred fifty-one patients were included with a median age of 52 years (range 16-89 years) and female predominance (62%). Postoperative chemoprophylaxis was used in 81% of patients at a median of 1 day postoperatively. There were 12 VTE events (1.2%), and the use of chemoprophylaxis did not negate the risk of VTE entirely (p > 0.99) and was highest on/after postoperative day 6 (9/12 VTE events). There were 18 intracranial haematomas (0.8%), and after PSM, chemoprophylaxis did not significantly increase the risk of an intracranial haematoma (p > 0.99). Patients administered chemoprophylaxis from postoperative days 1 and 2 had similar rates of intracranial haematomas (p = 0.60) and VTE (p = 0.60), affirmed in PSM. CONCLUSION Postoperative chemoprophylaxis represents a relatively safe strategy in patients undergoing skull base surgery. We advocate a personalised approach to chemoprophylaxis and recommend it on postoperative days 1 or 2 when indicated.
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Affiliation(s)
- Mueez Waqar
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Geoffrey Jefferson Brain Research Centre, Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Omar Yaseen
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Annabel Chadwick
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Geoffrey Jefferson Brain Research Centre, Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Jing Xian Lee
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Ghazn Khan
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - D Gareth Evans
- Department of Neurogenetics, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Daniel Horner
- Geoffrey Jefferson Brain Research Centre, Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Department of Neurocritical Care, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Archana Jaiswal
- Department of Otorhinolaryngology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Simon Freeman
- Department of Otorhinolaryngology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Rajiv Bhalla
- Department of Otorhinolaryngology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Simon Lloyd
- Department of Otorhinolaryngology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Charlotte Hammerbeck-Ward
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Scott A Rutherford
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Andrew T King
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Geoffrey Jefferson Brain Research Centre, Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Omar N Pathmanaban
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK.
- Geoffrey Jefferson Brain Research Centre, Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
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10
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You N, Zhang J, Zhang D, Zhao Y, Zhang J, Xu B. Predictive factors of tinnitus after vestibular schwannoma surgery: a case-control study. Chin Neurosurg J 2024; 10:10. [PMID: 38566173 PMCID: PMC10988867 DOI: 10.1186/s41016-024-00363-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Tinnitus is very common in patients with vestibular schwannoma (VS). We analyzed the related factors of tinnitus after surgery. METHODS One hundred seventy-three patients diagnosed with unilateral VS operated via the retrosigmoid approach were included in the study. All patients underwent relevant examinations and completed the THI scale before surgery and 6 months after surgery. The prognosis of tinnitus was evaluated according to the changes in THI. RESULTS Of the 129 preoperative tinnitus patients, postoperative tinnitus resolved in 12.4%, improved in 29.5%, remained unchanged in 28.6%, and worsened in 29.5%. 18.2% of 44 patients without preoperative tinnitus appeared new-onset tinnitus postoperatively. Thirty-six patients never had tinnitus. Patients with smaller tumor sizes (≤ 3 cm) were more likely to experience preoperative tinnitus. Younger patients and those with serviceable hearing preoperatively were more likely to report their tinnitus unchanged or worsened. A new onset of postoperative tinnitus in the preoperative non-tinnitus group was found in better preoperative hearing function. CONCLUSIONS In this study, 70% of patients had persistent tinnitus after vestibular schwannoma resection. The prognosis of tinnitus was influenced by age and preoperative hearing function. Tinnitus is a bothersome symptom and is often underestimated by doctors. Assessment of tinnitus is mandatory during the management of vestibular schwannoma.
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Affiliation(s)
- Na You
- Medical School of Chinese PLA, Beijing, China
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jiashu Zhang
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Ding Zhang
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yue Zhao
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jun Zhang
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Bainan Xu
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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11
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Tsuzuki N, Kitama T, Wasano K, Wakabayashi T, Hosoya M, Nishiyama T, Ozawa H, Oishi N. Characteristics of pure tone audiogram in patients with untreated sporadic vestibular schwannoma: Analysis of audiometric shape and interaural differences stratified by age and mode of onset. Auris Nasus Larynx 2024; 51:347-355. [PMID: 37788966 DOI: 10.1016/j.anl.2023.09.004] [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: 04/28/2023] [Revised: 09/09/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Asymmetric sensorineural hearing loss (ASHL) is the most common symptom of sporadic vestibular schwannoma (VS). However, there is still no universally accepted MRI protocol for diagnosing VS. This study identified the characteristics of pure tone audiogram (PTA) in patients with VS. METHODS We conducted a retrospective chart review of patients diagnosed with sporadic unilateral VS. In the analysis, we focused on the shape and interaural differences of PTA, stratified by the mode of onset and patient age. RESULTS In total, 390 patients met the inclusion criteria. The U-shaped audiogram showed the highest proportion in patients with the onset of sudden sensorineural hearing loss (SSNHL). In patients with SSNHL, U-shaped audiograms were younger than other audiograms, and 86.7 % of patients under 40 had U-shaped audiograms. Patients with VS were more likely to have interaural differences at higher frequencies than at lower frequencies. Patients with SSNHL had a significantly higher percentage of interaural differences at 500-4000 Hz than those with onset other than SSNHL (non-SSNHL patients). In addition, non-SSNHL patients had a significant trend toward a higher percentage of interaural differences at all frequencies with increasing age. CONCLUSION MRI screening can be considered in patients with SSNHL with U-shaped audiograms under 40 years of age. In ASHL, not SSNHL, MRI screening can be considered for older patients with interaural differences at wider continuous frequencies. Patients with interaural differences at high frequencies had a higher priority than those with interaural differences at low frequencies as indications for MRI screening for VS.
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Affiliation(s)
- Nobuyoshi Tsuzuki
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro, Tokyo 152-8902, Japan; Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro, Tokyo 152-8902, Japan
| | - Tsubasa Kitama
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Koichiro Wasano
- Department of Otolaryngology, Head and Neck Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara-city, Kanagawa 259-1193, Japan
| | - Takeshi Wakabayashi
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Makoto Hosoya
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Takanori Nishiyama
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Hiroyuki Ozawa
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Naoki Oishi
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
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12
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Nghiemphu PL, Vitte J, Dombi E, Nguyen T, Wagle N, Ishiyama A, Sepahdari AR, Cachia D, Widemann BC, Brackmann DE, Doherty JK, Kalamarides M, Giovannini M. Imaging as an early biomarker to predict sensitivity to everolimus for progressive NF2-related vestibular schwannoma. J Neurooncol 2024; 167:339-348. [PMID: 38372904 PMCID: PMC11023969 DOI: 10.1007/s11060-024-04596-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/01/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE NF2-related schwannomatosis (NF2) is characterized by bilateral vestibular schwannomas (VS) often causing hearing and neurologic deficits, with currently no FDA-approved drug treatment. Pre-clinical studies highlighted the potential of mTORC1 inhibition in delaying schwannoma progression. We conducted a prospective open-label, phase II study of everolimus for progressive VS in NF2 patients and investigated imaging as a potential biomarker predicting effects on growth trajectory. METHODS The trial enrolled 12 NF2 patients with progressive VS. Participants received oral everolimus daily for 52 weeks. Brain imaging was obtained quarterly. As primary endpoint, radiographic response (RR) was defined as ≥ 20% decrease in target VS volume. Secondary endpoints included other tumors RR, hearing outcomes, drug safety and quality of life (QOL). RESULTS Eight participants completed the trial and four discontinued the drug early due to significant volumetric VS progression. After 52 weeks of treatment, the median annual VS growth rate decreased from 77.2% at baseline to 29.4%. There was no VS RR and 3 of 8 (37.5%) participants had stable disease. Decreased or unchanged VS volume after 3 months of treatment was predictive of stabilization at 12 months. Seven of eight participants had stable hearing during treatment except one with a decline in word recognition score. Ten of twelve participants reported only minimal changes to their QOL scores. CONCLUSIONS Volumetric imaging at 3 months can serve as an early biomarker to predict long-term sensitivity to everolimus treatment. Everolimus may represent a safe treatment option to decrease the growth of NF2-related VS in patients who have stable hearing and neurological condition. TRN: NCT01345136 (April 29, 2011).
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Affiliation(s)
- Phioanh Leia Nghiemphu
- Department of Neurology, UCLA Neuro‑Oncology Program, David Geffen School of Medicine and Jonsson Comprehensive Cancer Center (JCCC), University of California, Los Angeles, Los Angeles, CA, USA
| | - Jeremie Vitte
- Department of Head and Neck Surgery, David Geffen School of Medicine and Jonsson Comprehensive Cancer Center (JCCC), University of California, Los Angeles, 675 Charles E Young Dr. S, MRL 2240, Los Angeles, CA, 90095-7286, USA
| | - Eva Dombi
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Thien Nguyen
- Department of Neurology, UCLA Neuro‑Oncology Program, David Geffen School of Medicine and Jonsson Comprehensive Cancer Center (JCCC), University of California, Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, Stem Cell Transplant and Regenerative Medicine, Stanford University, Palo Alto, CA, USA
| | - Naveed Wagle
- Department of Medicine, Division of Medical Oncology, Norris Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Translational Neurosciences, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Akira Ishiyama
- Department of Head and Neck Surgery, David Geffen School of Medicine and Jonsson Comprehensive Cancer Center (JCCC), University of California, Los Angeles, 675 Charles E Young Dr. S, MRL 2240, Los Angeles, CA, 90095-7286, USA
| | - Ali R Sepahdari
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Diagnostic Neuroradiology, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - David Cachia
- Department of Neurosurgery, Division of Neuro-oncology, Medical University of South Carolina, Charleston, SC, USA
- Department of Medicine, Division of Hematology/Oncology, University of Massachusetts, Worcester, MA, USA
| | | | - Derald E Brackmann
- Department of Otolaryngology and Neurotology, House Clinic and Research Institute, Los Angeles, CA, USA
| | - Joni K Doherty
- Center for Neural Tumor Research, House Research Institute, Los Angeles, CA, USA
- Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | - Michel Kalamarides
- Department of Neurosurgery, Hôpital Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Marco Giovannini
- Department of Head and Neck Surgery, David Geffen School of Medicine and Jonsson Comprehensive Cancer Center (JCCC), University of California, Los Angeles, 675 Charles E Young Dr. S, MRL 2240, Los Angeles, CA, 90095-7286, USA.
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13
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Riedy LN, Shanker RM, Sloane DC, Heiferman DM, Rezaii EG, Finucane SE, Veras P, Leonetti JP, Anderson DE. Long-term quality of life outcomes in patients undergoing microsurgical resection of vestibular schwannoma. World Neurosurg X 2024; 22:100294. [PMID: 38450247 PMCID: PMC10914591 DOI: 10.1016/j.wnsx.2024.100294] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
Background While previous studies have assessed patient reported quality of life (QOL) of various vestibular schwannoma (VS) treatment modalities, few studies have assessed QOL as related to the amount of residual tumor and need for retreatment in a large series of patients. Objective: To assess patient reported QOL outcomes following VS resection with a focus on extent of resection and retreatment. Methods A retrospective chart review was performed using single-center institutional data of adult patients who underwent VS resection by the senior authors between 1989-2018 at Loyola University Medical Center. The Penn Acoustic Neuroma Quality of Life (PANQOL) survey was sent to all patients via postal mail. Results Fifty-five percent of 367 total patients were female with a mean age of 61.6 years (SD 12.63). The mean period between surgery and PANQOL response was 11.4 years (IQR: 4.74-7.37). The median tumor size was 2 cm (IQR: 1.5-2.8). The mean total PANQOL score was 70 (SD 19). Patients who required retreatment reported lower overall scores (μdiff = -10.11, 95% CI: -19.48 to -0.74; p = 0.03) and face domain scores (μdiff = -20.34, 95% CI: -29.78 to -10.91; p < .001). There was no association between extent of resection and PANQOL scores in any domain. Conclusion In an analysis of 367 patients who underwent microsurgical resection of VS, extent of resection did not affect PANQOL scores in contrast to previous reports in the literature, while the need for retreatment and facial function had a significant impact on patient-reported outcomes.
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Affiliation(s)
- Loren N. Riedy
- Committee Neurobiology, University of Chicago, Hyde Park, IL, USA
| | - Rachyl M. Shanker
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Dayna C. Sloane
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Daniel M. Heiferman
- Department of Neurological Surgery, Edward-Elmhurst Health, Naperville, IL, USA
| | - Elhaum G. Rezaii
- Department of Neurological Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sarah E. Finucane
- Department of Otolaryngology, Loyola University Medical Center, Maywood, IL, USA
| | - Perry Veras
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - John P. Leonetti
- Department of Otolaryngology, Loyola University Medical Center, Maywood, IL, USA
| | - Douglas E. Anderson
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, USA
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14
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Lassaletta L, Calvino M, Díaz M, Morales-Puebla JM, Sánchez-Cuadrado I, Varela-Nieto I, Gavilán J. Intraoperative assessment of cochlear nerve functionality in various vestibular schwannoma scenarios: Lessons learned. Hear Res 2024; 446:108997. [PMID: 38564963 DOI: 10.1016/j.heares.2024.108997] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
The use of cochlear implants (CIs) is on the rise for patients with vestibular schwannoma (VS). Besides CI following tumor resection, new scenarios such as implantation in observed and/or irradiated tumors are becoming increasingly common. A significant emerging trend is the need of intraoperative evaluation of the functionality of the cochlear nerve in order to decide if a CI would be placed. The purpose of this paper is to explore the experience of a tertiary center with the application of the Auditory Nerve Test System (ANTS) in various scenarios regarding VS patients. The results are compared to that of the studies that have previously used the ANTS in this condition. Patients with unilateral or bilateral VS (NF2) who were evaluated with the ANTS prior to considering CI in a tertiary center between 2021 and 2023 were analyzed. The presence of a robust wave V was chosen to define a positive electrical auditory brainstem response (EABR). Two patients underwent promontory stimulation (PromStim) EABR previous to ANTS evaluation. Seven patients, 2 NF-2 and 5 with sporadic VS were included. The initial scenario was simultaneous translabyrinthine (TL) tumor resection and CI in 3 cases while a CI placement without tumor resection was planned in 4 cases. The ANTS was positive in 4 cases, negative in 2 cases, and uncertain in one case. Two patients underwent simultaneous TL and CI, 1 patient simultaneous TL and auditory brainstem implant, 3 patients posterior tympanotomy with CI, and 1 patient had no implant placement. In the 5 patients undergoing CI, sound detection was present. There was a good correlation between the PromStim and ANTS EABR. The literature research yielded 35 patients with complete information about EABR response. There was one false negative and one false positive case; that is, the 28 implanted cases with a present wave V following tumor resection had some degree of auditory perception in all but one case. The ANTS is a useful intraoperative tool to asses CI candidacy in VS patients undergoing observation, irradiation or surgery. A positive strongly predicts at least sound detection with the CI.
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Affiliation(s)
- Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
| | - Miryam Calvino
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
| | - Miguel Díaz
- MED-EL Elektromedizinische Geräte GmbH. Madrid, Spain
| | - José Manuel Morales-Puebla
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
| | - Isabel Sánchez-Cuadrado
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - Isabel Varela-Nieto
- La Paz Research Institute (IdiPAZ), Madrid, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain; Neuropathology of Hearing and Myelinopathies, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM, Madrid, Spain
| | - Javier Gavilán
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain
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15
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Lee SA, Lee JH, Hong HS, Lee JD. Tumor shape as a prognostic factor for the growth of intracanalicular vestibular schwannoma: a long-term observational study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08540-0. [PMID: 38498190 DOI: 10.1007/s00405-024-08540-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/08/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE To evaluate the predictive factors of tumor growth in patients with vestibular schwannoma (VS) managed with the wait-and-scan approach. METHODS The data of 31 patients diagnosed with intracanalicular VS and followed for > 5 years were retrospectively analyzed. VS was diagnosed according to MRI findings and tumor growth was monitored. Tumor growth was defined as an increase of 2 mm or more in the maximal tumor diameter. The association between the initial tumor size and shape and tumor growth was assessed. RESULTS Tumor growth was observed in 16 of 31 patients (51.6%) over a mean follow-up duration of 7.3 years. The initial tumor size was not statistically correlated with tumor growth. However, fusiform or cylindrical tumors exhibited higher growth rates than oval or round tumors. Additionally, a significant correlation was observed between cerebellopontine angle extension and tumor shape. CONCLUSION In this study, 51.6% of the patients with intracanalicular VS who were managed with the wait-and-scan strategy over a follow-up period of > 5 years showed tumor growth. Tumor shape, especially fusiform or cylindrical shape, was found to be a significant predictor of tumor growth.
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Affiliation(s)
- Se A Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 14584, Republic of Korea
| | - Jae Ha Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 14584, Republic of Korea
| | - Hyun Sook Hong
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Jong Dae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 14584, Republic of Korea.
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16
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Wang Y, Piras G, Lauda L, Caruso A, Russo A, Taibah A, Sanna M. Superior petrosal vein sacrifice in translabyrinthine approach for resection of vestibule schwannoma. Eur Arch Otorhinolaryngol 2024; 281:1195-1203. [PMID: 37665344 DOI: 10.1007/s00405-023-08208-1] [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: 04/05/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The aim of this study was to evaluate the safety and surgical outcome of superior petrosal vein (SPV, Dandy's vein) sacrifice in translabyrinthine approach (TLA) for resection of vestibule schwannoma (VS) as compared with SPV preservation, with further investigation of preoperational factors associated with the implement of SPV sacrifice. METHODS The authors prospectively collected data from patients surgically treated for VS through TLA between June 2021 and April 2022 at the Gruppo Otologico. RESULTS There were 30 and 49 patients in SPV sacrifice and preservation groups, respectively. SPV sacrifice group had significantly larger tumor size (2.46 vs. 1.40 cm), less percentage of solid tumor (26.7% vs. 83.7%), higher incidence of brainstem compression (80% vs. 26.5%), and higher percentage of facial numbness (20.0% vs. 4.1%) than SPV preservation group. Gross total resection (GTR) rates were 73.3% after SPV sacrifice and 87.8% after SPV preservation. Facial nerve preservation rates were similar. No complication related with SPV sacrifice was observed. Logistic regression analysis showed tumor size and complete solid consistency as significant risk factors associated with SPV sacrifice. ROC curve further demonstrated tumor size as a fair predictor (AUC = 0.833), with optimum cutoff value of 1.68 cm. CONCLUSION SPV sacrifice via TLA as needed is a safe and effective maneuver for removal of relatively large VS. Tumor size and consistency can be used as a guidance in preoperational decision-making, with cutoff value of 1.68 cm and cystic formation as predictive indicators.
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Affiliation(s)
- Yongjie Wang
- Department of Neurosurgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, #88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Gianluca Piras
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy.
| | - Lorenzo Lauda
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Antonio Caruso
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Alessandra Russo
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Abdelkader Taibah
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Mario Sanna
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
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Lassaletta L, Acle Cervera L, Altuna X, Amilibia Cabeza E, Arístegui Ruiz M, Batuecas Caletrio Á, Benítez Del Rosario J, Cabanillas Farpón R, Costales Marcos M, Escada P, Espinosa-Sánchez JM, García Leal R, Gavilán J, Gómez Martínez J, González-Aguado R, Martinez-Glez V, Guerra Jiménez G, Harguindey Antolí-Candela A, Hernández García BJ, Orús Dotú C, Polo López R, Manrique M, Martín Sanz E, Martínez Álvarez R, Martínez H, Martínez-Martínez M, Rey-Martinez J, Ropero Romero F, Santa Cruz Ruiz S, Vallejo LÁ, Soto Varela A, Varela-Nieto I, Morales Puebla JM. Clinical practice guideline on the management of vestibular schwannoma. Acta Otorrinolaringol Esp (Engl Ed) 2024; 75:108-128. [PMID: 38346489 DOI: 10.1016/j.otoeng.2023.10.005] [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: 08/23/2023] [Accepted: 10/19/2023] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Vestibular schwannoma (VS) is the most common tumour of the cerebellopontine angle. The greater accessibility to radiological tests has increased its diagnosis. Taking into account the characteristics of the tumour, the symptoms and the age of the patient, three therapeutic strategies have been proposed: observation, surgery or radiotherapy. Choosing the most appropriate for each patient is a frequent source of controversy. MATERIAL AND METHODS This paper includes an exhaustive literature review of issues related to VS that can serve as a clinical guide in the management of patients with these lesions. The presentation has been oriented in the form of questions that the clinician usually asks himself and the answers have been written and/or reviewed by a panel of national and international experts consulted by the Otology Commission of the SEORL-CCC. RESULTS A list has been compiled containing the 13 most controversial thematic blocks on the management of VS in the form of 50 questions, and answers to all of them have been sought through a systematic literature review (articles published on PubMed and Cochrane Library between 1992 and 2023 related to each thematic area). Thirty-three experts, led by the Otology Committee of SEORL-CCC, have analyzed and discussed all the answers. In Annex 1, 14 additional questions divided into 4 thematic areas can be found. CONCLUSIONS This clinical practice guideline on the management of VS offers agreed answers to the most common questions that are asked about this tumour. The absence of sufficient prospective studies means that the levels of evidence on the subject are generally medium or low. This fact increases the interest of this type of clinical practice guidelines prepared by experts.
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Affiliation(s)
- Luis Lassaletta
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, Spain.
| | | | - Xabier Altuna
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
| | - Emilio Amilibia Cabeza
- Servicio de Otorrinolaringología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Miguel Arístegui Ruiz
- Servicio de Otorrinolaringología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Batuecas Caletrio
- Servicio de Otorrinolaringología, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Jesús Benítez Del Rosario
- Servicio de Otorrinolaringología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | - María Costales Marcos
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Pedro Escada
- Servicio de Otorrinolaringología, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Juan Manuel Espinosa-Sánchez
- Servicio de Otorrinolaringología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
| | - Roberto García Leal
- Servicio de Neurocirugía, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Gavilán
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Justo Gómez Martínez
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Rocío González-Aguado
- Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Victor Martinez-Glez
- Center for Genomic Medicine, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autónoma de Barcelona, Sabadell, Barcelona, Spain
| | - Gloria Guerra Jiménez
- Servicio de Otorrinolaringología, Complejo Hospitalario Universitario Insular Materno Infantil de las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | | | - Cesar Orús Dotú
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rubén Polo López
- Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Manuel Manrique
- Servicio de Otorrinolaringología, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain
| | - Eduardo Martín Sanz
- Servicio de Otorrinolaringología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - Henry Martínez
- Servicio de Otorrinolaringología, Hospital Universitario Clínica San Rafael, Sur Bogotá D. C., Colombia; Servicio de Otorrinolaringología, Hospital San José, Bogotá, Colombia
| | | | - Jorge Rey-Martinez
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
| | | | - Santiago Santa Cruz Ruiz
- Servicio de Otorrinolaringología, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Luis Ángel Vallejo
- Servicio de Otorrinolaringología, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Andrés Soto Varela
- Servicio de Otorrinolaringología, Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Complexo Hospitalario Universitario de Santiago, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Isabel Varela-Nieto
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain; Grupo de Audición y Mielinopatías, Instituto de Investigaciones Biomédicas Alberto Sols, CSIC-UAM, CIBERER-ISCIII, Madrid, Spain
| | - José Manuel Morales Puebla
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
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Khanna O, Hogan E, Alvarez R, Youssef AS. How I do it: hearing preservation in large vestibular schwannomas using vestibular nerve fiber preservation technique. Acta Neurochir (Wien) 2024; 166:105. [PMID: 38403779 DOI: 10.1007/s00701-024-05998-z] [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: 11/01/2023] [Accepted: 01/03/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND To improve hearing function after resection of large vestibular schwannomas, we describe a strategy of vestibular-nerve-fiber preservation. Anatomical considerations and stepwise dissection are described. METHOD Steps include locating the vestibular nerve at the brainstem and identifying a dissection plane between nerve fibers and tumor capsule. Using this plane to mobilize and resect tumor reduced manipulation and maintained vascularity of underlying cochlear and facial nerves. CONCLUSION Preservation of hearing function is feasible in large vestibular schwannomas with vestibular-nerve-fiber preservation. Reducing manipulation and ischemic injury of underlying cochlear and facial nerves thereby helped facilitate hearing preservation, even in large tumors.
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Affiliation(s)
- Omaditya Khanna
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Elizabeth Hogan
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Reinier Alvarez
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - A Samy Youssef
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
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Szymoniuk M, Kochański M, Wilk K, Miazga D, Kanonik O, Dryla A, Kamieniak P. Stereotactic radiosurgery for Koos grade IV vestibular schwannoma: a systematic review and meta-analysis. Acta Neurochir (Wien) 2024; 166:101. [PMID: 38393397 DOI: 10.1007/s00701-024-05995-2] [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: 11/05/2023] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is a well-established treatment option for Koos stage I-III vestibular schwannomas (VS), often used as the first line of treatment or after subtotal resection. However, the optimal treatment for Koos-IV VS remains unclear. Therefore, our study aimed to evaluate the effectiveness of SRS as a primary treatment for large VS classified as Koos-IV. METHODS A systematic search was performed on December 28th, 2022, based on PubMed, Web of Science, and Scopus according to the PRISMA statement. The review was updated on September 7th, 2023. The risk of bias was assessed using the NIH Quality Assessment Tool. The R software (ver. 4.3.2) was used for all quantitative analyses and preparation of the forest plots. Publication bias and sensitivity analysis were performed to evaluate the reliability of the obtained results. RESULTS Among 2941 screened records, ten studies (1398 patients) have been included in quantitative synthesis. The overall tumor control rate was 90.7% (95%CI 86.3-94.4). Kaplan-Meier estimates of tumor control at 2, 6, and 10 years were 96.0% (95% CI 92.9-97.6%), 88.8% (95% CI 86.9-89.8%), and 84.5% (95% CI, 81.2-85.8%), respectively. The overall hearing preservation rate was 56.5% (95%CI 37-75.1). Kaplan-Meier estimates of hearing preservation rate at 2, 6, and 10 years were 77.1% (95% CI 67.9-82.5%), 53.5% (95% CI 44.2-58.5%), and 38.1% (95% CI 23.4-40.7%), respectively. The overall facial nerve preservation rate was 100% (95%CI 99.9-100.0). The overall trigeminal neuropathy rate reached 5.7% (95%CI 2.9-9.2). The overall rate of new-onset hydrocephalus was 5.6% (95%CI 3-9). The overall rates of worsening or new-onset tinnitus and vertigo were 6.8% (95%CI 4.2-10.0) and 9.1% (95%CI 2.1-19.6) respectively. No publication bias was detected according to the used methods. CONCLUSIONS Our systematic review and meta-analysis demonstrated a high overall tumor control rate, excellent facial nerve preservation, and low incidence of new-onset or worsened tinnitus and vertigo. However, several drawbacks associated with SRS should be noted, such as the presence of post-SRS hydrocephalus risk, mediocre long-term hearing preservation, and the lack of immediate tumor decompression. Nevertheless, the use of SRS may be beneficial in appropriately selected cases of Koos-IV VS. Moreover, further prospective studies directly comparing SRS with surgery are necessary to determine the optimal treatment for large VS and verify our results on a higher level of evidence. Registration and protocol: CRD42023389856.
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Affiliation(s)
- Michał Szymoniuk
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland.
| | - Marek Kochański
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Karolina Wilk
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Dominika Miazga
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Oliwia Kanonik
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Aleksandra Dryla
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Piotr Kamieniak
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
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Litwiniuk-Kosmala M, Makuszewska M, Niemczyk K, Bartoszewicz R, Wojtas B, Gielniewski B. High-throughput RNA sequencing identifies the miRNA expression profile, target genes, and molecular pathways contributing to growth of sporadic vestibular schwannomas. Acta Neurochir (Wien) 2024; 166:71. [PMID: 38329606 DOI: 10.1007/s00701-024-05984-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE To assess the differences in the miRNA expression profile between small (stage I Koos classification) and large solid vestibular schwannoma (VS) tumors, using the RNA-seq technique. METHODS Twenty tumor samples (10 small and 10 large tumors) were collected from patients operated for VS in a Tertiary Academic Center. Tumor miRNA expression was analyzed using high-throughput RNA sequencing (RNA-seq) technique, with NovaSeq 6000 Illumina system. Bioinformatics analysis was done using statistical software R. Gene enrichment and functional analysis was performed using miRTargetLink 2.0 and DIANA miRpath 3.0 online tools. RESULTS We identified 9 differentially expressed miRNAs in large VS samples: miR-7, miR-142 (-3p and -5p), miR-155, miR-342, miR-1269, miR-4664, and miR-6503 were upregulated, whereas miR-204 was significantly down-regulated in comparison to small VS samples. Gene enrichment analysis showed that the most enriched target genes were SCD, TMEM43, LMNB2, JARID2, and CCND1. The most enriched functional pathways were associated with lipid metabolism, along with signaling pathways such as Hippo and FOXO signaling pathway. CONCLUSION We identified a set of 9 miRNAs that are significantly deregulated in large VS in comparison to small, intracanalicular tumors. The functional enrichment analysis of these miRNAs suggests novel mechanisms, such as that lipid metabolism, as well as Hippo and FOxO signaling pathways that may play an important role in VS growth regulation.
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Affiliation(s)
| | - Maria Makuszewska
- Department of Otorhinolaryngology, Head and Neck Surgery, Warsaw Medical University, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology, Head and Neck Surgery, Warsaw Medical University, Warsaw, Poland
| | - Robert Bartoszewicz
- Department of Otorhinolaryngology, Head and Neck Surgery, Warsaw Medical University, Warsaw, Poland
| | - Bartosz Wojtas
- Laboratory of Sequencing, Nencki Institute of Experimental Biology, Warsaw, Poland
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21
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Sharma M, Papisetty S, Dhawan S, Ahluwalia MS, Venteicher AS, Chen CC. Comparison of Stereotactic Radiosurgery and Hypofractionated Radiosurgery for Vestibular Schwannomas: A Meta-Analysis of Available Literature. World Neurosurg 2024; 182:e742-e754. [PMID: 38092351 DOI: 10.1016/j.wneu.2023.12.029] [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: 10/31/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) and recently, hypofractionated radiosurgery (hSRS) are increasingly utilized as treatment for vestibular schwannomas (VS). We performed a meta-analysis of literature comparing these modalities. METHODS The PubMed database of articles was searched for studies that compared SRS and hSRS in patients with VS. Variables analyzed include tumor control, hearing preservation, facial nerve preservation, trigeminal nerve preservation, and total complications. Heterogeneity across the studies was gauged using Higgins's inconsistency index. Funnel plots and Egger's regression intercept test were used to address the publication bias. RESULTS Thirteen studies that satisfied the search criteria were selected for meta-analysis. The studies identified in our study included 353 SRS and 511 hSRS-treated patients. Analysis of heterogeneity showed that hSRS is employed for relatively larger tumor sizes in comparison to SRS. Pooled meta-analysis estimates showed no significant differences between SRS and hSRS in terms of tumor control (odds ratio [OR], 0.620; 95% confidence interval [CI], 0.21-1.86, P = 0.39), hearing preservation (OR, 1.07; 95% CI, 0.59-1.93, P = 0.83), facial nerve preservation (OR, 0.53; 5% CI, 0.23-1.21, P = 0.13), or trigeminal nerve preservation (OR, 0.67; 95% CI, 0.24-1.89, P = 0.49) at a mean follow-up of 39 months. Statistically significant heterogeneity was found across the studies only for tumor diameter (Higgins's inconsistency index = 65.69%, P = 0.003) but not for other variables. CONCLUSIONS Meta-analysis of thirteen studies comparing SRS and hSRS as treatment for VS showed comparable tumor control, hearing preservation, facial nerve preservation, and trigeminal nerve preservation.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Minnesota, MMC 96, Minneapolis, Minnesota, USA.
| | - Saikarthik Papisetty
- Department of Neurosurgery, University of Minnesota, MMC 96, Minneapolis, Minnesota, USA
| | - Sanjay Dhawan
- Department of Neurosurgery, University of Minnesota, MMC 96, Minneapolis, Minnesota, USA
| | - Manmeet S Ahluwalia
- Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Andrew S Venteicher
- Department of Neurosurgery, University of Minnesota, MMC 96, Minneapolis, Minnesota, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, MMC 96, Minneapolis, Minnesota, USA
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Carretta A, Voglis S, Röösli C, Mazzatenta D, Krayenbühl N, Huber A, Regli L, Serra C. Intraoperative ultrasonography in microsurgical resection of vestibular schwannomas via retrosigmoid approach: surgical technique and proof-of-concept illustrative case series. Acta Neurochir (Wien) 2024; 166:55. [PMID: 38289396 DOI: 10.1007/s00701-024-05962-x] [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: 09/02/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE Intraoperative ultrasonography (ioUS) is an established tool for the real-time intraoperative orientation and resection control in intra-axial oncological neurosurgery. Conversely, reports about its implementation in the resection of vestibular schwannomas (VS) are scarce. The aim of this study is to describe the role of ioUS in microsurgical resection of VS. METHODS ioUS (Craniotomy Transducer N13C5, BK5000, B Freq 8 MHz, BK Medical, Burlington, MA, USA) is integrated into the surgical workflow according to a 4-step protocol (transdural preresection, intradural debulking control, intradural resection control, transdural postclosure). Illustrative cases of patients undergoing VS resection through a retrosigmoid approach with the use of ioUS are showed to illustrate advantages and pitfalls of the technique. RESULTS ioUS allows clear transdural identification of the VS and its relationships with surgically relevant structures of the posterior fossa and of the cerebellopontine cistern prior to dural opening. Intradural ioUS reliably estimates the extent of tumor debulking, thereby helping in the choice of the right moment to start peripheral preparation and in the optimization of the extent of resection in those cases where subtotal resection is the ultimate goal of surgery. Transdural postclosure ioUS accurately depicts surgical situs. CONCLUSION ioUS is a cost-effective, safe, and easy-to-use intraoperative adjunctive tool that can provide a significant assistance during VS surgery. It can potentially improve patient safety and reduce complication rates. Its efficacy on clinical outcomes, operative time, and complication rate should be validated in further studies.
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Affiliation(s)
- Alessandro Carretta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
| | - Stefanos Voglis
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christof Röösli
- Department of Otorhinolaryngology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Diego Mazzatenta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Via Altura 3, 40139, Bologna, Italy
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Niklaus Krayenbühl
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Division of Pediatric Neurosurgery, University Children's Hospital, Zurich, Switzerland
| | - Alexander Huber
- Department of Otorhinolaryngology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Hosmann A, Kamdar V, Misra BK. Malignant transformation of vestibular schwannoma following radiosurgery-a case report and review of the literature. Acta Neurochir (Wien) 2024; 166:52. [PMID: 38289497 DOI: 10.1007/s00701-024-05921-6] [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: 08/12/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024]
Abstract
Malignant transformation of vestibular schwannoma (VS) post-radiosurgery is an extremely rare but life-threatening complication. We present a patient who underwent two surgeries for a benign VS and received Gamma Knife radiosurgery for residual tumour. Five and a half years post-radiosurgery, the patient was reoperated for symptomatic recurrence of the tumour. Histopathology confirmed the diagnosis of a high-grade spindle cell sarcoma. Although near-total resection was uneventful, the patient deteriorated rapidly, and comfort care was chosen. This report is the 13th documented case of histopathologically confirmed malignant transformation of a benign VS that strictly meets the modified Cahan's criteria, suggesting the direct link to radiosurgery-induced malignancy.
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Affiliation(s)
- Arthur Hosmann
- Department of Neurosurgery & Gamma Knife Surgery, P D Hinduja National Hospital & Medical Research Centre, Veer Savarkar Marg, Mumbai, India
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Vatsal Kamdar
- Department of Neurosurgery & Gamma Knife Surgery, P D Hinduja National Hospital & Medical Research Centre, Veer Savarkar Marg, Mumbai, India
| | - Basant K Misra
- Department of Neurosurgery & Gamma Knife Surgery, P D Hinduja National Hospital & Medical Research Centre, Veer Savarkar Marg, Mumbai, India.
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Lazak J, Betka J, Zverina E, Vlasak A, Bonaventurova M, Balatkova Z, Kana M, Fik Z. Quality of life in patients after vestibular schwannoma surgery. Acta Neurochir (Wien) 2024; 166:33. [PMID: 38270649 PMCID: PMC10810939 DOI: 10.1007/s00701-024-05936-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/26/2023] [Indexed: 01/26/2024]
Abstract
AIM To evaluate the most important factors of quality of life in patients after vestibular schwannoma surgery. MATERIALS AND METHODS Patients with unilateral sporadic occurrence of vestibular schwannoma who underwent surgery via suboccipital-retrosigmoid approach were included in the prospective study (2018-2021). Patients after previous Leksell gamma knife irradiation (or other methods of stereotactic radiosurgery) were excluded. Quality of life was assessed using 10 validated questionnaires that were distributed preoperatively, 3 months and 1 year after the surgery. RESULTS A total of 76 patients were included in the study, complete data were analysed in 43 of them (response rate 57%). Grade III and IV represented up to 70% of all tumors. Patients with larger tumors had a significantly higher risk of postoperative facial nerve paresis, liquorrhea and lower probability of hearing preservation. Patients with smaller tumors and those, who suffered from headaches before surgery had more frequent and severe headaches after surgery. Postoperative headaches were associated with higher incidence of anxiety and tinnitus. More frequent anxiety was also identified in patients with preoperative serviceable hearing who became deaf after surgery. Nevertheless, tinnitus and hearing impairment appeared to have less impact on overall quality of life compared to headaches and facial nerve function. CONCLUSION According to our results, tumor size, postoperative function of the facial nerve and occurrence of postoperative headaches had the greatest influence on the overall postoperative quality of life in patients after vestibular schwannoma surgery.
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Affiliation(s)
- Jan Lazak
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Jan Betka
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Eduard Zverina
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Ales Vlasak
- Department of Neurosurgery for Children and Adults, Second Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Marketa Bonaventurova
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Zuzana Balatkova
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Martin Kana
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Zdenek Fik
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
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Koester SW, Bishay AE, Rogers JL, Dambrino RJ, Liles C, Feldman M, Chambless LB. Cost considerations for vestibular schwannoma screening and imaging: a systematic review. Neurosurg Rev 2024; 47:59. [PMID: 38252395 DOI: 10.1007/s10143-024-02305-3] [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: 10/01/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
Vestibular schwannomas (VS) account for approximately 8% of all intracranial neoplasms. Importantly, the cost of the diagnostic workup for VS, including the screening modalities most commonly used, has not been thoroughly investigated. Our aim is to conduct a systematic review of the published literature on costs associated with VS screening. A systematic review of the literature for cost of VS treatment was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The terms "vestibular schwannoma," "acoustic neuroma," and "cost" were queried using the PubMed and Embase databases. Studies from all countries were considered. Cost was then corrected for inflation using the US Bureau of Labor Statistics Inflation Calculator, correcting to April 2022. The search resulted in an initial review of 483 articles, of which 12 articles were included in the final analysis. Screening criteria were used for non-neurofibromatosis type I and II patients who complained of asymmetric hearing loss, tinnitus, or vertigo. Patients included in the studies ranged from 72 to 1249. The currency and inflation-adjusted mean cost was $418.40 (range, $21.81 to $487.03, n = 5) for auditory brainstem reflex and $1433.87 (range, $511.64 to $1762.15, n = 3) for non-contrasted computed tomography. A contrasted magnetic resonance imaging (MRI) scan was found to have a median cost of $913.27 (range, $172.25-$2733.99; n = 8) whereas a non-contrasted MRI was found to have a median cost of $478.62 (range, $116.61-$3256.38, n = 4). In terms of cost reporting, of the 12 articles, 1 (8.3%) of them separated out the cost elements, and 10 (83%) of them used local prices, which include institutional costs and/or average costs of multiple institutions. Our findings describe the limited data on published costs for screening and imaging of VS. The paucity of data and significant variability of costs between studies indicates that this endpoint is relatively unexplored, and the cost of screening is poorly understood.
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Affiliation(s)
| | | | - James L Rogers
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Robert J Dambrino
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Campbell Liles
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Feldman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Machetanz K, Roegele M, Liebsch M, Oberle L, Weinbrenner E, Gorbachuk M, Wang SS, Tatagiba M, Naros G. Predictive value of facial motor-evoked potential and electromyography for facial motor function in vestibular schwannoma surgery. Acta Neurochir (Wien) 2024; 166:23. [PMID: 38240816 PMCID: PMC10799139 DOI: 10.1007/s00701-024-05927-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE Intraoperative neuromonitoring (IONM) aims to preserve facial nerve (FN) function during vestibular schwannoma (VS) surgery. However, current techniques such as facial nerve motor evoked potentials (FNMEP) or electromyography (fEMG) alone are limited in predicting postoperative facial palsy (FP). The objective of this study was to analyze a compound fEMG/FNMEP approach. METHODS Intraoperative FNMEP amplitude and the occurrence of fEMG-based A-trains were prospectively determined for the orbicularis oris (ORI) and oculi (OCU) muscle in 322 VS patients. Sensitivity and specificity of techniques to predict postoperative FN function were calculated. Confounding factors as tumor size, volume of intracranial air, or IONM duration were analyzed. RESULTS A relevant immediate postoperative FP was captured in 105/322 patients with a significant higher risk in large VS. While fEMG demonstrated a high sensitivity (77% and 86% immediately and 15 month postoperative, respectively) for identifying relevant FP, specificity was low. In contrast, FNMEP have a significantly higher specificity of 80.8% for predicting postoperative FP, whereas the sensitivity is low. A retrospective combination of techniques demonstrated still an incorrect prediction of FP in ~ 1/3 of patients. CONCLUSIONS FNMEP and fEMG differ in sensitivity and specificity to predict postoperative FP. Although a combination of IONM techniques during VS surgery may improve prediction of FN function, current techniques are still inaccurate. Further development is necessary to improve IONM approaches for FP prediction.
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Affiliation(s)
- Kathrin Machetanz
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.
| | - Martin Roegele
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Marina Liebsch
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Linda Oberle
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Eliane Weinbrenner
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Mykola Gorbachuk
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Sophie S Wang
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Georgios Naros
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
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Lim KH, Lee SH, Song I, Yoon HS, Kim HJ, Lee YH, Kim E, Rah YC, Choi J. Analysis of the association between vestibular schwannoma and hearing status using a newly developed radiomics technique. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-023-08410-1. [PMID: 38183454 DOI: 10.1007/s00405-023-08410-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/09/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE Vestibular schwannoma is a benign tumor originating from Schwann cells surrounding the eighth cranial nerve and can cause hearing loss, tinnitus, balance problems, and facial nerve disorders. Because of the slow growth of the tumor, predicting the hearing function of patients with vestibular schwannoma's is important to obtain information that would be useful for deciding the treatment modality. This study aimed to analyze the association between magnetic resonance imaging features and hearing status using a new radiomics technique. METHODS We retrospectively analyzed 115 magnetic resonance images and hearing results from 73 patients with vestibular schwannoma. A total of 70 radiomics features from each tumor volume were calculated using T1-weighted magnetic resonance imaging. Radiomics features were classified as histogram-based, shape-based, texture-based, and filter-based. The least absolute shrinkage and selection operator method was used to select the radiomics features among the 70 features that best predicted the hearing test. To ensure the stability of the selected features, the least absolute shrinkage and selection operator method was repeated 10 times. Finally, features set five or more times were selected as radiomics signatures. RESULTS The radiomics signatures selected using the least absolute shrinkage and selection operator method were: minimum, variance, maximum 3D diameter, size zone variance, log skewness, skewness slope, and kurtosis slope. In random forest, the mean performance was 0.66 (0.63-0.77), and the most important feature was Log skewness. CONCLUSIONS Newly developed radiomics features are associated with hearing status in patients with vestibular schwannoma and could provide information when deciding the treatment modality.
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Affiliation(s)
- Kang Hyeon Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University Ansan Hospital, Korea University, 123, Jeokgeum-ro, Danwon-gu, Ansan-Si, Gyeonggi-do, 15355, Republic of Korea
| | - Seung-Hak Lee
- Core Research & Development Center, Korea University, Ansan Hospital, Ansan, Republic of Korea
| | - Insik Song
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University Ansan Hospital, Korea University, 123, Jeokgeum-ro, Danwon-gu, Ansan-Si, Gyeonggi-do, 15355, Republic of Korea
| | - Hee Soo Yoon
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University Ansan Hospital, Korea University, 123, Jeokgeum-ro, Danwon-gu, Ansan-Si, Gyeonggi-do, 15355, Republic of Korea
| | - Hong Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University Ansan Hospital, Korea University, 123, Jeokgeum-ro, Danwon-gu, Ansan-Si, Gyeonggi-do, 15355, Republic of Korea
| | - Ye Hwan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University Ansan Hospital, Korea University, 123, Jeokgeum-ro, Danwon-gu, Ansan-Si, Gyeonggi-do, 15355, Republic of Korea
| | - Eunjin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University Ansan Hospital, Korea University, 123, Jeokgeum-ro, Danwon-gu, Ansan-Si, Gyeonggi-do, 15355, Republic of Korea
| | - Yoon Chan Rah
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University Ansan Hospital, Korea University, 123, Jeokgeum-ro, Danwon-gu, Ansan-Si, Gyeonggi-do, 15355, Republic of Korea
| | - June Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University Ansan Hospital, Korea University, 123, Jeokgeum-ro, Danwon-gu, Ansan-Si, Gyeonggi-do, 15355, Republic of Korea.
- Department of Medical Informatics, Korea University College of Medicine, Seoul, Republic of Korea.
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Quimby AE, Salmon MK, Zhao CH, Y K Lee J, Bigelow DC, Ruckenstein MJ, Brant JA. Socioeconomic determinants impact quality of life at vestibular schwannoma diagnosis. J Clin Neurosci 2024; 119:122-128. [PMID: 38007900 DOI: 10.1016/j.jocn.2023.11.028] [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: 08/28/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Socioeconomic variables including race, education, and income have been shown to affect vestibular schwannoma incidence, treatment, and outcomes. We sought to determine the impact of socioeconomic factors on quality of life at the time of vestibular schwannoma diagnosis. METHODS Retrospective cohort study conducted at a tertiary academic center. All patients evaluated for vestibular schwannoma from March 1, 2010 to December 31, 2021 who completed at least one Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire at presentation or prior to any intervention were included. PANQOL scores were compared across income quintiles, racial groups, and health insurance categories. RESULTS Two-hundred and ninety-six patients who had non-missing information on variables of interest were included. Compared to White/Caucasian patients (84.5 %), Black/African American patients (4.7 %) had significantly lower PANQOL total scores (b = -12.8[-21.7, -4.0], p = 0.005). Compared to patients with Commercial insurance (53 %), patients who were Uninsured/ Self-pay (1.7 %) had significantly lower PANQOL total scores (b = -16.7[-31.4, -1.9], p = 0.027). Patients in higher income quintiles had significantly higher PANQOL total scores (b = 11.7[3.9, 19.5], p = 0.004 comparing highest income quintile to lowest). After controlling for potential confounders, income quintile (b = 9.6[1.3, 17.9], p = 0.023 comparing highest quintile to lowest) and insurance (b = -17.0[-31.9, -21], p = 0.025 comparing Uninsured/Self-pay to Commercial insurance) remained predictors of total PANQOL score. CONCLUSIONS Socioeconomic factors including race, health insurance, and income appear to contribute to quality of life at the time of vestibular schwannoma diagnosis. These variables are interrelated and the effects of race may be mediated in part by differences in income and health insurance coverage.
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Affiliation(s)
- Alexandra E Quimby
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA; Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Mandy K Salmon
- Department of Otolaryngology, Oregon Health & Science University, Portland, OR, USA
| | | | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas C Bigelow
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael J Ruckenstein
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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Fuentealba Bassaletti C, van Esch BF, Jansen JC, van Benthem PPG, Hensen EF. The effect of intratympanic gentamicin as a prehabilitation strategy for objective and subjective vestibular function in patients undergoing microsurgery for a unilateral vestibular schwannoma. Eur Arch Otorhinolaryngol 2024; 281:31-41. [PMID: 37750993 PMCID: PMC10764376 DOI: 10.1007/s00405-023-08240-1] [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: 07/13/2023] [Accepted: 09/10/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE To review the literature on intratympanic gentamicin treatment as prehabilitation for patients undergoing surgery for a unilateral vestibular schwannoma. DATA SOURCES A systematic literature search was conducted up to March 2023 in Pubmed, Embase, Cochrane, Web of Science, Academic Search Premier, Google Scholar and Emcare databases. REVIEW METHODS Articles on the effect of intratympanic gentamicin followed by vestibular schwannoma surgery were reviewed. Data on objective vestibular function and subjective outcomes were compiled in tables for analysis. Relevance and methodological quality were assessed with the methodological index for non-randomized tool. RESULTS A total of 281 articles were identified. After screening and exclusion of duplicates, 13 studies were reviewed for eligibility, of which 4 studies could be included in the review. The posturography test, the subjective visual horizontal test, and the optokinetic nystagmus test showed decreased vestibular function in the group of patients who received intratympanic gentamicin before microsurgery compared to the group of patients without gentamicin. Other objective tests did not show significant differences between patient groups. Subjective vestibular outcomes, as evaluated by questionnaires on quality of life and/or dizziness, did not seem to improve from intratympanic gentamicin pretreatment. CONCLUSION Vestibular schwannoma patients who received intratympanic gentamicin before surgical resection of the tumor performed better in the posturography test, subjective visual horizontal test, and the optokinetic nystagmus test afterwards. However, studies that also evaluated subjective outcomes such as dizziness, anxiety, depression, and balance self-confidence did not show a positive effect of intratympanic gentamicin on the vestibular complaints and symptoms.
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Affiliation(s)
- Constanza Fuentealba Bassaletti
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
- Escuela de Fonoaudiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile.
| | - Babette F van Esch
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Jeroen C Jansen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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30
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Tai A, Kim J, Croci D, Mhaskar R, Allen K, Danner C, Boyev K, van Loveren H, Agazzi S. Significant tumor compression of the middle cerebellar peduncle is associated with worse facial nerve outcomes and lower extent of resection in surgery for medium-sized vestibular schwannomas - A radiographic analysis of a case series. Clin Neurol Neurosurg 2024; 236:108114. [PMID: 38232608 DOI: 10.1016/j.clineuro.2024.108114] [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: 11/20/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND AND OBJECTIVE Optimizing the extent of resection (EOR) and facial nerve outcomes (FNO) remain a challenge in medium to large vestibular schwannomas (VS). Currently, tumor size has been the only consistently reported factor predicting FNO and EOR. Here, we sought to evaluate whether the degree of the tumor's compression on the middle cerebellar peduncle (PC) influences FNO and EOR in medium to large VS. METHODS This retrospective case series included 99 patients who underwent surgical resection of their VSs from 2014 to 2022. Preoperative MR imaging was used to measure the degree of PC. Patient medical records were queried to determine the EOR and FNO. RESULTS Patients with unfavorable FNO (HB 3 +) immediately post-op had significantly greater PC than those with favorable FNO (19.9 vs. 15.4 mm, P = .047). This significance was not observed at the last follow-up but there was a trend. When medium-sized tumors (15-30 mm) were analyzed separately, patients with unfavorable FNO immediate post-op and at last follow-up had significantly greater PC than their favorable counterparts (14.1 vs 8.7 mm). Significantly greater PC was also observed in patients who underwent subtotal resection (20.7 mm) compared to near (14.3 mm) and gross total resection (10.8 mm). Multivariate analyses confirmed these findings in medium-sized tumors, but not large-sized tumors. CONCLUSION The degree of PC as measured on preoperative imaging can predict FNO and EOR in medium-sized vestibular schwannomas. Medium-sized tumors with > 15 mm of PC likely will have worse FNO and lower EOR.
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Affiliation(s)
- Alexander Tai
- Department of Neurosurgery and Brain Repair, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - John Kim
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL 33602, USA
| | - Davide Croci
- Department of Neurosurgery and Brain Repair, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Rahul Mhaskar
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL 33602, USA
| | - Kyle Allen
- Tampa Bay Hearing and Balance Center, 5 Tampa General Circle Suite 610 Harborside Medical Tower, Tampa, FL 33606, USA
| | - Christopher Danner
- Tampa Bay Hearing and Balance Center, 5 Tampa General Circle Suite 610 Harborside Medical Tower, Tampa, FL 33606, USA
| | - Kestutis Boyev
- Department of Otolaryngology, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Harry van Loveren
- Department of Neurosurgery and Brain Repair, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Siviero Agazzi
- Department of Neurosurgery and Brain Repair, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA
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De Marco R, Lo Bue E, Di Perna G, Penner F, Vercelli A, Baldassarre BM, Albera R, Garbossa D, Zenga F. Introducing endoscopic assistance on routinary basis for vestibular schwannomas resection: A single centre acceptance analysis. Neurochirurgie 2024; 70:101524. [PMID: 38118265 DOI: 10.1016/j.neuchi.2023.101524] [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: 06/13/2023] [Revised: 10/15/2023] [Accepted: 12/12/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVE The use of endoscopic assistance in retrosigmoid approach for tumors of the cerebellopontine angle brought undoubted technological advantages in skull base surgery. Nonetheless, the use of the endoscope is not as widespread as it could be. The aim of the study is to analyze the impressions of neurosurgeons and otologists with different experience in vestibular schwannoma surgery, experiencing the introduction of the endoscope in surgical daily practice. METHODS All patients undergoing vestibular schwannoma surgery were recruited in the period from January 2019 to December 2020. The endoscope-assistance and a minimum follow-up of 12 months were considered inclusion criteria. An eight items questionnaire was administered to the surgeons who used endoscope-assistance during surgery. RESULTS A total number of 20 patients were recruited. Five surgeons experienced the use of 0° and 45° optics in the "pre-resection" and "intra-meatal" phases of the procedures. The survey gave positive feedbacks on the introduction of the endoscope in vestibular schwannoma resection. The main drawback was the difficulty to manage the use of angled optics. CONCLUSIONS Despite the known limitations of the study, the idea of investigating surgeons' impressions on the use of the endoscope could be another motif to explain why this instrument and its diffusion is limited despite its advantages in vestibular schwannoma surgery.
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Affiliation(s)
- Raffaele De Marco
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin 10126, Italy; Skull Base and Pitutary Surgery Unit, "Città della Salute e della Scienza" University Hospital, Turin 10126, Italy
| | - Enrico Lo Bue
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin 10126, Italy; Skull Base and Pitutary Surgery Unit, "Città della Salute e della Scienza" University Hospital, Turin 10126, Italy
| | - Giuseppe Di Perna
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin 10126, Italy; Skull Base and Pitutary Surgery Unit, "Città della Salute e della Scienza" University Hospital, Turin 10126, Italy.
| | - Federica Penner
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin 10126, Italy; Skull Base and Pitutary Surgery Unit, "Città della Salute e della Scienza" University Hospital, Turin 10126, Italy
| | - Alberto Vercelli
- Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Largo Piero Palagi 1, 50137 Florence, Italy
| | - Bianca Maria Baldassarre
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin 10126, Italy; Skull Base and Pitutary Surgery Unit, "Città della Salute e della Scienza" University Hospital, Turin 10126, Italy
| | - Roberto Albera
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, 10126, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin 10126, Italy; Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin 10126, Italy
| | - Francesco Zenga
- Skull Base and Pitutary Surgery Unit, "Città della Salute e della Scienza" University Hospital, Turin 10126, Italy; Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin 10126, Italy
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32
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Hevia-Rodríguez P, Armendariz-Guezala M, Undabeitia J. Distant cerebellar recurrence of vestibular schwannoma twelve years after surgery. J Clin Neurosci 2024; 119:141-142. [PMID: 38029696 DOI: 10.1016/j.jocn.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Affiliation(s)
| | | | - José Undabeitia
- Department of Neurosurgery, Donostia University Hospital, San Sebastian, Spain
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33
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Putz F, Bock M, Schmitt D, Bert C, Blanck O, Ruge MI, Hattingen E, Karger CP, Fietkau R, Grigo J, Schmidt MA, Bäuerle T, Wittig A. Quality requirements for MRI simulation in cranial stereotactic radiotherapy: a guideline from the German Taskforce "Imaging in Stereotactic Radiotherapy". Strahlenther Onkol 2024; 200:1-18. [PMID: 38163834 PMCID: PMC10784363 DOI: 10.1007/s00066-023-02183-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024]
Abstract
Accurate Magnetic Resonance Imaging (MRI) simulation is fundamental for high-precision stereotactic radiosurgery and fractionated stereotactic radiotherapy, collectively referred to as stereotactic radiotherapy (SRT), to deliver doses of high biological effectiveness to well-defined cranial targets. Multiple MRI hardware related factors as well as scanner configuration and sequence protocol parameters can affect the imaging accuracy and need to be optimized for the special purpose of radiotherapy treatment planning. MRI simulation for SRT is possible for different organizational environments including patient referral for imaging as well as dedicated MRI simulation in the radiotherapy department but require radiotherapy-optimized MRI protocols and defined quality standards to ensure geometrically accurate images that form an impeccable foundation for treatment planning. For this guideline, an interdisciplinary panel including experts from the working group for radiosurgery and stereotactic radiotherapy of the German Society for Radiation Oncology (DEGRO), the working group for physics and technology in stereotactic radiotherapy of the German Society for Medical Physics (DGMP), the German Society of Neurosurgery (DGNC), the German Society of Neuroradiology (DGNR) and the German Chapter of the International Society for Magnetic Resonance in Medicine (DS-ISMRM) have defined minimum MRI quality requirements as well as advanced MRI simulation options for cranial SRT.
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Affiliation(s)
- Florian Putz
- Strahlenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Michael Bock
- Klinik für Radiologie-Medizinphysik, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Daniela Schmitt
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Christoph Bert
- Strahlenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Maximilian I Ruge
- Klinik für Stereotaxie und funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Cologne, Germany
| | - Elke Hattingen
- Institut für Neuroradiologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christian P Karger
- Abteilung Medizinische Physik in der Strahlentherapie, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
- Nationales Zentrum für Strahlenforschung in der Onkologie (NCRO), Heidelberger Institut für Radioonkologie (HIRO), Heidelberg, Germany
| | - Rainer Fietkau
- Strahlenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Johanna Grigo
- Strahlenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Manuel A Schmidt
- Neuroradiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tobias Bäuerle
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Wittig
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Würzburg, Würzburg, Germany
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Neve O, van Buchem M, Kunneman M, van Benthem P, Boosman H, Hensen E. The added value of the artificial intelligence patient-reported experience measure (AI-PREM tool) in clinical practise: Deployment in a vestibular schwannoma care pathway. PEC Innov 2023; 3:100204. [PMID: 37693727 PMCID: PMC10483065 DOI: 10.1016/j.pecinn.2023.100204] [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] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 06/06/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
Objectives Patient-reported experience measures (PREMs) can be used for the improvement of quality of care. In this study, the outcome of an open-ended question PREM combined with computer-assisted analysis is compared to the outcome of a closed-ended PREM questionnaire. Methods This survey study assessed the outcome of the open-ended questionnaire PREM and a close-ended question PREM of patients with unilateral vestibular schwannoma in a tertiary vestibular schwannoma expert centre. Results The open-ended questions PREM, consisting of five questions, was completed by 507 participants and resulted in 1508 positive and 171 negative comments, categorised into 27 clusters. The close-ended questions PREM results were mainly positive (overall experience graded as 8/10), but did not identify specific action points. Patients who gave high overall scores (>8) on the close-ended question provided points for improvement in the open-ended question PREM, which would have been missed using the close-ended questions only. Conclusions Compared to the close-ended question PREM, the open-ended question PREM provides more detailed and specific information about the patient experience in the vestibular schwannoma care pathway. Innovation Automated analysis of feedback with the open-ended question PREM revealed relevant insights and identified topics for targeted quality improvement, whereas the close-ended PREM did not.
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Affiliation(s)
- O.M. Neve
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, the Netherlands
| | - M.M. van Buchem
- Information Technology & Digital Innovation Department, Leiden University Medical Centre, the Netherlands
| | - M. Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States of America
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - P.P.G. van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, the Netherlands
| | - H. Boosman
- Morgens consultancy, Leiden, the Netherlands
| | - E.F. Hensen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, the Netherlands
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de Melo Junior JO, Benalia VHC, Landeiro JA. Surgical salvage for recurrent vestibular schwannoma after primary stereotactic radiosurgery. Surg Neurol Int 2023; 14:419. [PMID: 38213456 PMCID: PMC10783665 DOI: 10.25259/sni_875_2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 11/09/2023] [Indexed: 01/13/2024] Open
Abstract
Background The management of vestibular schwannoma has evolved over the past hundred years. In the last decades, surgery has been gradually replaced by radiation therapy as a primary treatment modality, particularly for small tumors, due to the less invasive nature and the compared reported outcomes in tumor control and hearing preservation. However, irradiation sometimes fails to stop tumor growth. In a long-term follow-up after primary fractionated stereotactic radiotherapy, the rate of treatment failure was reported as 3% and needed surgical salvage. For single-fraction modality, Hasegawa et al. reported salvage treatment after primary Gamma Knife radiosurgery in 8%, where 90% of these underwent surgery and 50% of those who were treated with a second gamma knife surgery required surgical intervention later. An increase in tumor volume by more than 10-20%, tumor growth after three years, and no return to pretreatment volume after transient swelling have been considered as tumor recurrence rather than pseudoprogression, a transient increase in tumor volume after radiotherapy that occurs up to 30% of cases. It has been reported that microsurgery after radiotherapy is more difficult, with most authors reporting a loss of defined arachnoid planes and worse cranial nerve outcomes, especially for hearing and facial nerve function. Case Description A 43-year-old female patient was incidentally (asymptomatic) diagnosed on a magnetic resonance imaging (MRI) scan harboring a left vestibular schwannoma, grade T2 (Hannover classification), in 2015. Neurologic examination was unremarkable, and audiometry testing was normal. She was initially treated with observation. Three years later, in 2018, the lesion had enlarged, becoming a grade T3a and reaching the cistern of the cerebellopontine angle. The tumor was then treated with fractionated stereotactic radiosurgery (5 sessions of 5 Gy). MRI scans in 2019 and 2020 showed slight tumor growth. This enlargement was attributed to a pseudoprogression after radiosurgery, and only observation was advocated. In 2022, 4 years later, after radiosurgery, the tumor was still growing, and the patient began to suffer from hearing loss. A failure treatment was considered, and microsurgery was indicated. The patient was counseled about the risk of functional nerve impairment, and surgical consent was obtained. A retro sigmoid approach was planned. A gross total resection was attempted due to the clear subperineural plane during tumor dissection and because it was the only option that would provide a cure for the patient. The adjacent neurovascular structures were firmly adhered to the tumor capsule, which represented a major challenge for microdissection. The tumor was soft, without significant bleeding. A total resection was achieved, and the facial nerve was anatomically preserved. The patient developed facial paresis (House-Brackmann III) in the immediate postoperative period, which improved at the 6-month follow-up. Hearing loss did not improve. Postoperative MRI showed total resection. Conclusion Microsurgery after radiotherapy for vestibular schwannoma is challenging in terms of indication, when to indicate, resection target, difficulty in dissection due to local changes, and outcome. Gross total resection may be considered, as it is the only treatment that may provide a cure for the patient. However, the patient should be counseled about the risks.
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Affiliation(s)
| | - Victor H. C. Benalia
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, United States of America
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Hosmann A, Hari S, Misra BK. Cystic recurrence of vestibular schwannoma post-radiosurgery: an institutional experience. Acta Neurochir (Wien) 2023; 165:4149-4156. [PMID: 38008799 DOI: 10.1007/s00701-023-05841-x] [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: 08/02/2023] [Accepted: 10/05/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Stereotactic radiosurgery effectively controls vestibular schwannoma (VS). However, in certain cases, microsurgical resection may be necessary for post-radiosurgery tumour progression. The characteristics and microsurgical challenges of uncommon cystic recurrences post-radiosurgery are rarely addressed. METHOD We retrospectively analysed 24 consecutive patients who underwent microsurgical intervention for recurrent VS post-radiosurgery by the senior author. RESULTS Tumour recurrence post-radiosurgery occurred as solid growth in 19 patients (79%), while 5 patients (21%) developed large brainstem-compressing cysts. The median time interval for tumour recurrence post-radiosurgery was similar between cystic and non-cystic recurrent VS (30 vs. 25 months; p=0.08). Cystic recurrences occurred in primarily cystic VS in 3 patients, and new cysts developed in 2 patients with primarily solid VS. Intra-operatively, tumours were firm in 18 cases (75%) and strongly adhered to surrounding structures in 14 cases (58%). All cystic cases underwent cyst decompression, while complete resection of solid tumour components was avoided due to neurovascular adherence. At a mean follow-up of 42±39 months, 12 patients (50%) showed contrast-enhancing tumour residuals in follow-up imaging, including all cystic recurrent cases. Tumour residuals remained stable without requiring further intervention, except for one patient revealing malignant tumour transformation. House-Brackmann grade I/II was preserved in 15 patients (62%). Three patients (13%) developed new facial palsy, and two patients (8%) improved to House-Brackmann grade II. Cystic recurrences had a significantly higher frequency of tumour residuals compared to solid recurrences (100% vs. 37%; p=0.01) but similar rates of facial palsy (60% vs. 32%; p=0.24) CONCLUSIONS: Cyst development in VS post-radiosurgery is more common in primary cystic lesions but can also occur in rare cases of primary solid VS. Symptomatic cysts require microsurgical decompression. However, complete resection of the solid tumour component is not crucial for long-term tumour control and should be avoided if it risks neurological function in this delicate area.
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Affiliation(s)
- Arthur Hosmann
- Department of Neurosurgery & Gamma Knife Surgery, P D Hinduja National Hospital & Medical Research Centre, Veer Savarkar Marg, Mumbai, India
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Subhashree Hari
- Department of Neurosurgery & Gamma Knife Surgery, P D Hinduja National Hospital & Medical Research Centre, Veer Savarkar Marg, Mumbai, India
| | - Basant K Misra
- Department of Neurosurgery & Gamma Knife Surgery, P D Hinduja National Hospital & Medical Research Centre, Veer Savarkar Marg, Mumbai, India.
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Yamashiro K, Sadato A, Hasegawa M, Wakako A, Omi T, Nakagawa M, Kuroda M, Hirose Y. Radiation-induced anterior inferior cerebellar artery pseudoaneurysm after stereotactic radiosurgery for vestibular schwannoma: features observed by direct surgery. Br J Neurosurg 2023; 37:1675-1679. [PMID: 34148476 DOI: 10.1080/02688697.2021.1940856] [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: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In vestibular schwannoma (VS) patients treated with stereotactic radiosurgery (SRS), radiation-induced pseudoaneurysm is a rare long-term complication. To the best of our knowledge, there has been only one report of direct surgery in ruptured cases, and the optimal strategy for direct surgery is yet to be clarified. This case report describes a case of ruptured VS-related SRS-induced pseudoaneurysm that was successfully treated by direct surgery. CASE PRESENTATION A 57-year -old man underwent SRS for VS, and the tumour was well controlled after the SRS. Nine years after the SRS, however, he developed subarachnoid haemorrhage, and a SRS-induced distal anterior inferior cerebellar artery aneurysm was detected on the surface of the tumour. During the trapping surgery, the aneurysm was embedded in the tumour, and it was difficult to separate the aneurysm and tumour. Besides, the facial nerve and tumour restricted exposure of the parent artery. The parent artery proximal to the aneurysm could only be exposed by resecting caudal part of the tumour. The aneurysm was trapped with permanent clips and it was pathologically diagnosed as pseudoaneurysm. CONCLUSION It was suggested that the VS-related SRS-induced pseudoaneurysm is tightly adhered with surrounding structures and exposure of the parent artery could be limited due to the tumour and facial nerve. In this case report, we describe detailed intraoperative findings that will be useful for developing strategies for trapping surgery in future.
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Affiliation(s)
- Kei Yamashiro
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
- Department of Neurosurgery, Fujita Health University, Toyoake, Japan
| | - Akiyo Sadato
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
- Department of Neurosurgery, Fujita Health University, Toyoake, Japan
| | | | - Akira Wakako
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
- Department of Neurosurgery, Fujita Health University, Toyoake, Japan
| | - Tatsuo Omi
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
- Department of Neurosurgery, Fujita Health University, Toyoake, Japan
| | - Mitsuru Nakagawa
- Department of Diagnostic Pathology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Makoto Kuroda
- Department of Diagnostic Pathology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, Toyoake, Japan
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Ahmed ANA. Preoperative Magnetic Resonance Elastography (MRE) of Skull Base Tumours: A Review. Indian J Otolaryngol Head Neck Surg 2023; 75:4173-4178. [PMID: 37974805 PMCID: PMC10645913 DOI: 10.1007/s12070-023-03955-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/08/2023] [Indexed: 11/19/2023] Open
Abstract
Conventional magnetic resonance imaging (MRI) can detect tumors consistency, but it can't predict tumor stiffness or adherence of the tumor to nearby structures. Magnetic resonance elastography (MRE) is a known non-invasive MRI based imaging technique used to assess the viscoelasticity of the tissues particularly liver fibrosis. This study discussed the importance of preoperative MRE in skull base tumors and the future implications of this new imaging modality. We did review of the English literature (by searching PubMed) regarding the use of MRE in preoperative assessment of skull base tumours stiffness and adherence to surrounding tissues. Recent research demonstrated that MRE can detect the stiffness and adherence of skull base tumors to surrounding structures by recording the spread of mechanical waves in the different tissues. In addition to non-radiation exposure, this technique is fast and can be incorporated into the conventional (MRI) study. MRE can palpate skull base tumours by imaging, allowing the stiffness of the tumour to be assessed. Preoperative assessment of brain tumours consistency, stiffness, and adherence to surrounding tissues is critical to avoid injury of important nearby structures and better preoperative patient counselling regarding surgical approach (endoscopic or open), operative time, and suspected surgical complications. However, the accuracy of MRE is less in small and highly vascular tumors. Also, MRE can't accurately detect tumour-brain adherence, but the new modality (slip-interface imaging) can. Hence, adding MRE to the conventional MRI study may help in preoperative diagnosis and treatment of skull base tumours.
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Affiliation(s)
- Ahmed Nabil Abdelhamid Ahmed
- Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, 6th Nile Valley Street, Hadayek Alkoba, Cairo, 11331 Egypt
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Fairhead R, Harris L, Shoakazemi A, Pollock J. Hydrocephalus in patients with vestibular schwannoma. Acta Neurochir (Wien) 2023; 165:4169-4174. [PMID: 37935949 DOI: 10.1007/s00701-023-05866-2] [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: 08/14/2023] [Accepted: 10/20/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Hydrocephalus (HC) is common in patients with vestibular schwannoma (VS). This can be managed with a cerebrospinal fluid (CSF) diversion procedure prior to VS resection or with VS resection, keeping CSF diversion in reserve unless required postoperatively. No clear consensus exists as to which approach is superior. This study identifies factors predictive of the development of HC, and analyses outcomes for those managed with primary CSF resection versus tumour resection. METHODS Single-centre retrospective cohort study of 204 consecutive adult patients with a unilateral VS from May 2009 to June 2021. Data was collected on patient and tumour demographics, management, and outcome. RESULTS 204 patients, with a mean age at presentation of 59.5 (21-83), with 50% female, and a mean follow-up of 7.5 years (1.8-13.9) were included. 119 were managed conservatively, 36 with stereotactic radiosurgery only, and 49 with surgery. 30 (15%) patients had radiological HC, of which 23 (77%) were obstructive, and 7 (23%) were communicating. Maximum intracranial tumour diameter and Koos grade were higher in patients with HC. Of the patients with HC the majority (20, 67%) were managed initially with CSF diversion, with 12 patients undergoing subsequent tumour resection, and three patients avoiding primary resection. Nine (30%) were managed with primary surgical resection, of whom three required subsequent CSF diversion. Complication rates and Modified Rankin Scale (MRS) were comparable or lower in the CSF diversion group (8%, MRS ≤2 = 83%), versus the primary resection group (67%, MRS ≤2 = 67%), and the primary surgical resection without HC group (25%, MRS ≤2 = 86%). CONCLUSIONS CSF diversion prior to tumour resection is a safe and acceptable strategy compared to primary VS resection, with improved outcomes and reduced surgical complications. Randomized studies and national databases are needed to determine the long-term outcomes of patients treated with CSF diversion versus primary resection.
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Dahm V, Schwarz-Nemec U, Arnoldner MA, Liepins R, Auinger AB, Matula C, Arnoldner C. MRI surveillance after translabyrinthine vestibular schwannoma resection and cochlear implantation: is it feasible? Eur Arch Otorhinolaryngol 2023; 280:5259-5265. [PMID: 37266754 PMCID: PMC10620274 DOI: 10.1007/s00405-023-08036-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/14/2022] [Indexed: 06/03/2023]
Abstract
PURPOSE Cochlear implantation in patients with vestibular schwannomas is of increasing importance and interest. Two remaining challenges are the assessment of conduction of the cochlear nerve and the possibility of postoperative surveillance with magnetic resonance imaging. The aim of the current study was to assess follow-up imaging and determine the visibility of the internal auditory canal after vestibular schwannoma resection and cochlear implantation as well as in patients with persistent vestibular schwannomas and cochlear implants in place. Visibility of the internal auditory canal, cerebellopontine angle, and labyrinth were evaluated and graded. METHODS For this retrospective study, 15 MR examinations of 13 patients after translabyrinthine vestibular schwannoma resection and ipsilateral cochlear implantation were included. All patients had been implanted with an MED-EL cochlear implant. Magnetic resonance imaging was carried out on a 1.5T device. All patients were prepped according to the manufacturer's recommendations. RESULTS All 15 examinations were carried out without any adverse event during imaging, such as pain, magnet dislocation, or malfunction. The internal auditory canal and the cerebellopontine angle were sufficiently visible in all cases to allow for vestibular schwannoma follow-up. CONCLUSION Magnetic resonance imaging surveillance of the internal auditory canal following vestibular schwannoma resection and cochlear implantation is feasible and safe with modern implants with a 1.5T magnetic resonance imaging device using metal artifact reduction sequences. Necessary follow-up imaging should not be a contraindication for cochlear implantation in patients with vestibular schwannomas.
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Affiliation(s)
- Valerie Dahm
- Department of Otorhinolaryngology, Head & Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Ursula Schwarz-Nemec
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
| | - Michael A Arnoldner
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rudolfs Liepins
- Department of Otorhinolaryngology, Head & Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Alice B Auinger
- Department of Otorhinolaryngology, Head & Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Matula
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Head & Neck Surgery, Medical University of Vienna, Vienna, Austria
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Bubeníková A, Vlasák A, Fík Z, Sedlák V, Tesařová M, Bradáč O. Application of diffusion tensor imaging of the facial nerve in preoperative planning for large vestibular schwannoma: a systematic review. Neurosurg Rev 2023; 46:298. [PMID: 37950058 DOI: 10.1007/s10143-023-02214-x] [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: 09/16/2023] [Revised: 10/28/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
The accurate identification and preservation of the facial nerve (FN) during vestibular schwannoma (VS) surgery is crucial for maintaining facial function. Investigating the application of diffusion tensor imaging (DTI) in preoperative planning for large VS surgery is provided. PubMed, Cochrane Library, Science Direct, ISI Web of Science, Embase, and additional sources were searched to identify cohort studies about the preoperative DTI usage for the FN tracking before large VS (≥ 2.5 cm) surgery published between 1990 and 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed; the Newcastle-Ottawa Scale was used to assess the risk of bias and to evaluate limitations based on selection/outcome biases. A total of 8 publications yielding 149 VS (mean size 3.66 ± 0.81 cm) were included. Surgical concordance with preoperative DTI FN tracking was 91.67% (range 85-100%). Overall DTI reliability was 88.89% (range 81.81-95.83%). Larger tumor size predicted either DTI inaccurate finding or complete DTI failure (p = 0.001). VS size above > 3.5 cm was associated with a higher risk of DTI failure (p = 0.022), with a higher risk of inaccurate DTI finding preoperatively (p = 0.033), and with a higher House-Brackman score postoperatively (p = 0.007). Application of DTI in larger VS surgery is a valuable FN identification along with electrophysiological monitoring and neuronavigation, therefore also in its preservation and in lowering risk of complications. DTI represents a valuable adjunct to electrophysiological monitoring and neuronavigation in FN identification, applicable not only for smaller, but also larger VS.
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Affiliation(s)
- Adéla Bubeníková
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Prague, Czech Republic
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Aleš Vlasák
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Prague, Czech Republic.
| | - Zdeněk Fík
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Vojtěch Sedlák
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - Michaela Tesařová
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Prague, Czech Republic
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
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Shapey J, Vos SB, Mancini L, Sanders B, Thornton JS, Tournier JD, Saeed SR, Kitchen N, Khalil S, Grover P, Bradford R, Dorent R, Sparks R, Vercauteren T, Yousry T, Bisdas S, Ourselin S. Diffusion MRI of the facial-vestibulocochlear nerve complex: a prospective clinical validation study. Eur Radiol 2023; 33:8067-8076. [PMID: 37328641 PMCID: PMC10598116 DOI: 10.1007/s00330-023-09736-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/08/2023] [Accepted: 03/12/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Surgical planning of vestibular schwannoma surgery would benefit greatly from a robust method of delineating the facial-vestibulocochlear nerve complex with respect to the tumour. This study aimed to optimise a multi-shell readout-segmented diffusion-weighted imaging (rs-DWI) protocol and develop a novel post-processing pipeline to delineate the facial-vestibulocochlear complex within the skull base region, evaluating its accuracy intraoperatively using neuronavigation and tracked electrophysiological recordings. METHODS In a prospective study of five healthy volunteers and five patients who underwent vestibular schwannoma surgery, rs-DWI was performed and colour tissue maps (CTM) and probabilistic tractography of the cranial nerves were generated. In patients, the average symmetric surface distance (ASSD) and 95% Hausdorff distance (HD-95) were calculated with reference to the neuroradiologist-approved facial nerve segmentation. The accuracy of patient results was assessed intraoperatively using neuronavigation and tracked electrophysiological recordings. RESULTS Using CTM alone, the facial-vestibulocochlear complex of healthy volunteer subjects was visualised on 9/10 sides. CTM were generated in all 5 patients with vestibular schwannoma enabling the facial nerve to be accurately identified preoperatively. The mean ASSD between the annotators' two segmentations was 1.11 mm (SD 0.40) and the mean HD-95 was 4.62 mm (SD 1.78). The median distance from the nerve segmentation to a positive stimulation point was 1.21 mm (IQR 0.81-3.27 mm) and 2.03 mm (IQR 0.99-3.84 mm) for the two annotators, respectively. CONCLUSIONS rs-DWI may be used to acquire dMRI data of the cranial nerves within the posterior fossa. CLINICAL RELEVANCE STATEMENT Readout-segmented diffusion-weighted imaging and colour tissue mapping provide 1-2 mm spatially accurate imaging of the facial-vestibulocochlear nerve complex, enabling accurate preoperative localisation of the facial nerve. This study evaluated the technique in 5 healthy volunteers and 5 patients with vestibular schwannoma. KEY POINTS • Readout-segmented diffusion-weighted imaging (rs-DWI) with colour tissue mapping (CTM) visualised the facial-vestibulocochlear nerve complex on 9/10 sides in 5 healthy volunteer subjects. • Using rs-DWI and CTM, the facial nerve was visualised in all 5 patients with vestibular schwannoma and within 1.21-2.03 mm of the nerve's true intraoperative location. • Reproducible results were obtained on different scanners.
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Affiliation(s)
- Jonathan Shapey
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
- Department of Neurosurgery, King's College Hospital, London, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
| | - Sjoerd B Vos
- Centre for Medical Image Computing, University College London, London, UK
- Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK
| | - Laura Mancini
- Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Brett Sanders
- Department of Neurophysiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - John S Thornton
- Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | | | - Shakeel R Saeed
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- The Ear Institute, University College London, London, UK
- The Royal National Throat, Nose and Ear Hospital, London, UK
| | - Neil Kitchen
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Sherif Khalil
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- The Royal National Throat, Nose and Ear Hospital, London, UK
| | - Patrick Grover
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Robert Bradford
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Reuben Dorent
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Rachel Sparks
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Tom Vercauteren
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Tarek Yousry
- Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Sotirios Bisdas
- Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
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Koetsier KS, Oud M, de Klerck E, Hensen EF, van Vulpen M, van Linge A, Paul van Benthem P, Slagter C, Habraken SJ, Hoogeman MS, Méndez Romero A. Cochlear-optimized treatment planning in photon and proton radiosurgery for vestibular schwannoma patients. Clin Transl Radiat Oncol 2023; 43:100689. [PMID: 37867612 PMCID: PMC10585330 DOI: 10.1016/j.ctro.2023.100689] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Objective To investigate the potential to reduce the cochlear dose with robotic photon radiosurgery or intensity-modulated proton therapy planning for vestibular schwannomas. Materials and Methods Clinically delivered photon radiosurgery treatment plans were compared to five cochlear-optimized plans: one photon and four proton plans (total of 120). A 1x12 Gy dose was prescribed. Photon plans were generated with Precision (Cyberknife, Accuray) with no PTV margin for set-up errors. Proton plans were generated using an in-house automated multi-criterial planning system with three or nine-beam arrangements, and applying 0 or 3 mm robustness for set-up errors during plan optimization and evaluation (and 3 % range robustness). The sample size was calculated based on a reduction of cochlear Dmean > 1.5 Gy(RBE) from the clinical plans, and resulted in 24 patients. Results Compared to the clinical photon plans, a reduction of cochlear Dmean > 1.5 Gy(RBE) could be achieved in 11/24 cochlear-optimized photon plans, 4/24 and 6/24 cochlear-optimized proton plans without set-up robustness for three and nine-beam arrangement, respectively, and in 0/24 proton plans with set-up robustness. The cochlea could best be spared in cases with a distance between tumor and cochlea. Using nine proton beams resulted in a reduced dose to most organs at risk. Conclusion Cochlear dose reduction is possible in vestibular schwannoma radiosurgery while maintaining tumor coverage, especially when the tumor is not adjacent to the cochlea. With current set-up robustness, proton therapy is capable of providing lower dose to organs at risk located distant to the tumor, but not for organs adjacent to it. Consequently, photon plans provided better cochlear sparing than proton plans.
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Affiliation(s)
- Kimberley S. Koetsier
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | - Michelle Oud
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Erik de Klerck
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | | | - Anne van Linge
- Department of Otorhinolaryngology and Head & Neck Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter Paul van Benthem
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | - Cleo Slagter
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Steven J.M. Habraken
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Mischa S. Hoogeman
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - A. Méndez Romero
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
- HollandPTC, Delft, the Netherlands
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Shah F, Hamilton LOW, Yiannakis CP, Slim MAM, Kontorinis G. A systematic review and meta-analysis of stereotactic radiosurgery as a primary treatment in fast-growing vestibular schwannomas. J Laryngol Otol 2023; 137:1193-1199. [PMID: 37194631 DOI: 10.1017/s0022215123000786] [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] [Indexed: 05/18/2023]
Abstract
BACKGROUND Stereotactic radiosurgery has been shown to be an effective method of managing vestibular schwannomas. The primary aim here is to establish the impact of pre-treatment fast-growing vestibular schwannomas on the efficacy of stereotactic radiosurgery. METHODS PubMed, Medline and Embase databases were used. The ROBINS-I ('Risk Of Bias In Non-randomised Studies - of Interventions') tool was utilised to assess for risk of bias. Proportionate meta-analysis and sub-analysis for fast-growing tumours were performed to explore the success rate of stereotactic radiosurgery in stabilising or decreasing the tumour burden in vestibular schwannomas. RESULTS Four moderate risk studies were included in the analysis. Overall, 91 per cent (95 per cent confidence interval = 0.83-0.97, p < 0.01, I2 = 80 per cent) of the tumours demonstrated successful size reduction or stabilisation following stereotactic radiosurgery. Nevertheless, the efficacy of stereotactic radiosurgery in reducing or stabilising fast-growing vestibular schwannomas decreased by 79 per cent (95 per cent confidence interval = 0.64-0.91, p = 0.11, I2 = 62 per cent). CONCLUSION Stereotactic radiosurgery has a statistically significant success rate in stabilising or decreasing the vestibular schwannoma size. This success rate is diminished in fast-growing vestibular schwannomas.
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Affiliation(s)
- Faizan Shah
- ENT Department, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
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El Sayed Ahmad Y, Gallois Y, Sol JC, Boetto S, Attal J, Sabatier J, Debs R, Deguine O, Marx M. Evolution in the management of vestibular schwannoma: a single-center 15-year experience. Eur Arch Otorhinolaryngol 2023; 280:4885-4894. [PMID: 37195345 DOI: 10.1007/s00405-023-08009-6] [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: 02/10/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To highlight the changes in the management of vestibular schwannoma (VS) since 2004 with a focus on small- to middle-size VS. METHODS Retrospective analysis of the decisions made in skull base tumor board between 2004 and 2021. RESULTS 1819 decisions were analyzed (average age 59.25, 54% females). Overall, 850 (47%) cases were allocated to a Wait and Scan (WS) approach, 416 (23%) received radiotherapy and 553 (30%) were treated surgically (MS). All stages considered WS increased from 39% before 2010 to 50% after 2010. Similarly, Stereotactic Radio Therapy (SRT) increased from 5 to 18%. MS decreased from 46 to 25%. It was more commonly proposed to younger patients and larger tumors, p < 0.001. For Koos stages 1, 2, and 3 there was a statistically significant increase in SRT, and a decrease in MS, p < 0.001. WS also increased for stages 1 and 2. However, such a trend was not observed for stage 3. MS remained the primary treatment modality for stage 4 tumors throughout the study period, p = 0.057. The significance of advanced age as a factor favoring SRT decreased over time. The opposite is true for serviceable hearing. There was also a decrease in the percentage of the justification "young age" in the MS category. CONCLUSION The is a continuing trend towards non-surgical treatment. Small- to medium-sized VS witnessed an increase in both WS and SRT. There is only an increase in SRT for moderately large VS. Physicians are less and less considering young age as a factor favoring MS over SRT. There is a tendency towards favoring SRT when hearing is serviceable.
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Affiliation(s)
- Youssef El Sayed Ahmad
- Department of Otology, Otoneurology and Pediatric Otolaryngology, Pierre-Paul Riquet Hospital, Toulouse University hospital, Toulouse, France.
| | - Yohan Gallois
- Department of Otology, Otoneurology and Pediatric Otolaryngology, Pierre-Paul Riquet Hospital, Toulouse University hospital, Toulouse, France
| | | | - Sergio Boetto
- Neuro-Surgery Department, CHU de Toulouse, Purpan, 31000, Toulouse, France
| | - Justine Attal
- Radiotherapy Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Jean Sabatier
- Department of Neuroradiology, Purpan Hospital, Toulouse, France
| | - Rachel Debs
- Department of Neurology, Pierre-Paul Riquet/Purpan University Hospital, Toulouse, France
| | - Olivier Deguine
- Department of Otology, Otoneurology and Pediatric Otolaryngology, Pierre-Paul Riquet Hospital, Toulouse University hospital, Toulouse, France
| | - Mathieu Marx
- Department of Otology, Otoneurology and Pediatric Otolaryngology, Pierre-Paul Riquet Hospital, Toulouse University hospital, Toulouse, France
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Hosoya M, Nagaoka Y, Wakabayashi T, Shimanuki MN, Nishiyama T, Ueno M, Ozawa H, Oishi N. A novel intraoperative continuous monitoring method combining dorsal cochlear nucleus action potentials monitoring with auditory nerve test system. J Otolaryngol Head Neck Surg 2023; 52:67. [PMID: 37803428 PMCID: PMC10557301 DOI: 10.1186/s40463-023-00671-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
Highly accurate real-time cochlear nerve monitoring to preserve cochlear nerve function is essential for simultaneous cochlear implantation and ipsilateral vestibular schwannoma resection. In the present study, we developed a novel real-time monitoring system that combines dorsal cochlear nucleus action potential monitoring with intracochlear stimulating electrodes (Auditory Nerve Test System, ANTS). We used this system for a case with vestibular schwannoma resection via the translabyrinthine approach. The monitoring system developed in this study detected highly reliable evoked potentials from the cochlear nerve every two seconds continuously during tumor resection. Near-total tumor resection was achieved, and cochlear implantation was performed successfully after confirming the preservation of cochlear nerve function in a case. The patient's hearing was well compensated by cochlear implantation after surgery. Our novel method continuously achieved real-time monitoring of the cochlear nerve every two seconds during vestibular schwannoma resection. The usefulness of this monitoring system for simultaneous tumor resection and cochlear implantation was demonstrated in the present case. The system developed in this study is compatible with continuous facial nerve monitoring. This highly accurate and novel monitoring method will broaden the number of candidates for this type of surgery in the future.
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Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuriko Nagaoka
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takeshi Wakabayashi
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Marie N Shimanuki
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takanori Nishiyama
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masafumi Ueno
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroyuki Ozawa
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naoki Oishi
- Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Sung JY, Lee JW. Telomere maintenance mechanism subtype reveals different immune activity in vestibular schwannoma. J Neurooncol 2023; 165:113-126. [PMID: 37864645 PMCID: PMC10638157 DOI: 10.1007/s11060-023-04458-5] [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: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND The immortality of cancer cells relies on maintaining the length of telomeres, which prevents cellular senescence and enables unlimited replication. However, little is currently known about telomerase activity and the alternative lengthening of telomeres (ALT) in vestibular schwannomas. In this study we aimed to elucidate the role that telomerase and ALTs play in vestibular schwannomas. METHODS To address this gap, we conducted a study where we used the gene set variation analysis algorithm with bulk RNA-seq and single-cell RNA-seq to identify the characteristics of each group of patients with vestibular schwannomas, based on their telomere maintenance mechanism subtype. RESULTS Our findings suggest that patients with relatively high ALT-like groups have a better prognosis than those with relatively high telomerase groups. Specifically, we found that the high telomerase group had relatively higher antigen-presenting cell (APC) activity than the high ALT like group. At the single-cell level, microglia, neutrophils, and fibroblasts showed high telomerase activity and relatively high APC activity compared to other cell types. In addition, Schwann cells in the group with low ALT levels exhibited elevated immune activity at the single-cell level. CONCLUSION These results suggest that personalized drug therapy could be developed from the perspective of precision medicine for patients with relatively high telomerase activity and a high ALT-like group.
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Affiliation(s)
- Ji-Yong Sung
- Center for Genome Engineering, Institute for Basic Science, 55, Expo-ro, Yuseong-gu, Daejeon, 34126, Republic of Korea.
| | - Jung Woo Lee
- Department of Orthopaedic Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Republic of Korea.
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Gore YA, Doshi J, Muzumdar DP. Crocodile tears syndrome after vestibular schwannoma surgery: A case report. Int J Surg Case Rep 2023; 111:108850. [PMID: 37742358 PMCID: PMC10520793 DOI: 10.1016/j.ijscr.2023.108850] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION Crocodile tears syndrome is paroxysmal lacrimal hypersecretion while eating or drinking. It is relatively rare and mainly observed after peripheral facial nerve injury due to any cause. PRESENTATION OF CASE We describe a case of crocodile tears syndrome after vestibular schwannoma surgery in a patient with pre-operative trigeminal nerve involvement. We also discuss the various treatment options offered to the patient and the natural course of the illness. DISCUSSION It is hypothesized that facial nerve fibers undergo misdirected re-innervation of the lacrimal gland instead of the salivary gland. After vestibular schwannoma surgery, facial nerve palsy is well described. The sensory symptoms are relatively neglected by the surgeon, even though they cause discomfort to the patient. This may be the cause for the underestimation of its incidence. CONCLUSION The knowledge of the incidence, mechanism and natural course of crocodile tears syndrome along with patient education is important to reduce post-operative distress to the patient. We also hypothesize the correlation of crocodile tears syndrome with motor component of facial function and the role of preservation of nervus intermedius in reducing post-operative facial palsy.
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Affiliation(s)
- Yash Asit Gore
- Department of Neurosurgery, Seth G.S. Medical College and King Edward Memorial Hospital, Acharya Dhonde Marg, Parel, Mumbai 400012, Maharashtra, India.
| | - Jash Doshi
- Department of Neurosurgery, Seth G.S. Medical College and King Edward Memorial Hospital, Acharya Dhonde Marg, Parel, Mumbai 400012, Maharashtra, India
| | - Dattatray P Muzumdar
- Department of Neurosurgery, Seth G.S. Medical College and King Edward Memorial Hospital, Acharya Dhonde Marg, Parel, Mumbai 400012, Maharashtra, India
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Kanaya K, Horiuchi T. Postoperative hematoma can be a risk factor in delayed facial palsy after vestibular schwannoma resection via a retrosigmoid approach: a retrospective single-center cohort study. Acta Neurol Belg 2023; 123:1703-1707. [PMID: 35674908 DOI: 10.1007/s13760-022-01959-4] [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: 02/25/2022] [Accepted: 04/13/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Delayed facial palsy (DFP) is a rare postoperative complication after vestibular schwannoma (VS) surgery. The exact mechanism of DFP remains uncertain and the risk factors for DFP are still controversial. The authors aimed to investigate the characteristics, risk factors, and etiology of DFP after VS resection retrospectively. METHODS Ninety-one consecutive surgeries with VS were analyzed. Patients with neurofibromatosis 2 in eight surgeries and postoperative facial palsy House-Brackmann (HB) grade more than 3 in two surgeries were excluded. Eighty-one surgeries were included in this research. Facial nerve function was evaluated using the HB grade. Delayed facial palsy was defined as deterioration in the facial function of at least 1 HB grade more than 1 day after undergoing VS resection. The characteristics of patients with VS and risk factors for DFP were analyzed. RESULTS All surgeries were performed via a retrosigmoid approach. DFP was observed in nine patients. There were no statistically significant differences between the DFP group and non-DFP group in terms of the following characteristics: sex, age, side, size, Koos grading system, postoperative facial palsy, or extent of resection. Postoperative hematoma in the cerebellopontine angle (CPA) cistern was significantly higher in the DFP group than in the non-DFP group (p = 0.0023), and was significantly associated with DFP after VS surgery (odds ratio 18.40, p < 0.001). DFP improved in seven patients, but two patients did not improve. CONCLUSION DFP occurred in 11.1% of patients after VS surgery. This study revealed that postoperative hematoma in the CPA cistern was significantly associated with DFP after VS surgery.
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Affiliation(s)
- Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Kuroiwa M, Murata T, Hirayama S, Hokama M, Miyashita T. Very small vestibular schwannoma as the source of fatal subarachnoid hemorrhage: a case report. Br J Neurosurg 2023; 37:1254-1257. [PMID: 33155858 DOI: 10.1080/02688697.2020.1844147] [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: 07/29/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) is commonly caused by an aneurysm, trauma, other vascular diseases, and infrequently by a metastatic tumor or glioma. SAH due to a benign intracranial tumor, such as a vestibular schwannoma (VS), is rare. We report a case in which a very small (1 mm) VS caused fatal SAH. CASE PRESENTATION A 75-year-old woman presented with a sudden severe headache. Computed tomography showed SAH at the right of the cerebellopontine angle. On post-onset day (POD) 27, MRI revealed a 1-mm mass on the cerebellopontine angle's right side. She was discharged with House-Brackmann grade 4 right-side facial weakness and hearing disturbance. She re-presented on POD 45 with headache and loss of consciousness. Computed tomography revealed massive SAH and intracerebellar hemorrhage. She died 4 days later. Histopathological evidence indicated a highly vascular vestibular schwannoma. CONCLUSIONS Vestibular schwannoma should therefore be considered a source of SAH, particularly in patients with facial weakness and/or hearing disturbance.
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Affiliation(s)
- Masafumi Kuroiwa
- Department of Neurosurgery, Shinonoi General Hospital, Nagano, Japan
- Department of Neurosurgery, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Murata
- Department of Neurosurgery, Shinonoi General Hospital, Nagano, Japan
| | - Shuichi Hirayama
- Department of Neurosurgery, Shinonoi General Hospital, Nagano, Japan
| | - Masanobu Hokama
- Department of Neurosurgery, Shinonoi General Hospital, Nagano, Japan
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