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King AM, Cooper JN, Oganezova K, Mittal J, McKenna K, Godur DA, Zalta M, Danesh AA, Mittal R, Eshraghi AA. Vestibular Schwannoma and Tinnitus: A Systematic Review of Microsurgery Compared to Gamma Knife Radiosurgery. J Clin Med 2024; 13:3065. [PMID: 38892775 PMCID: PMC11173275 DOI: 10.3390/jcm13113065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Vestibular schwannoma (VS) is a benign tumor of the eighth cranial nerve formed from neoplastic Schwann cells. Although VS can cause a variety of symptoms, tinnitus is one of the most distressing symptoms for patients and can greatly impact quality of life. The objective of this systematic review is to comprehensively examine and compare the outcomes related to tinnitus in patients undergoing treatment for VS. Specifically, it evaluates patient experiences with tinnitus following the removal of VS using the various surgical approaches of traditional surgical resection and gamma knife radiosurgery (GKS). By delving into various aspects such as the severity of tinnitus post-treatment, the duration of symptom relief, patient quality of life, new onset of tinnitus after VS treatment, and any potential complications or side effects, this review aims to provide a detailed analysis of VS treatment on tinnitus outcomes. Methods: Following PRISMA guidelines, articles were included from PubMed, Science Direct, Scopus, and EMBASE. Quality assessment and risk of bias analysis were performed using a ROBINS-I tool. Results: Although VS-associated tinnitus is variable in its intensity and persistence post-resection, there was a trend towards a decreased tinnitus burden in patients. Irrespective of the surgical approach or the treatment with GKS, there were cases of persistent or worsened tinnitus within the studied cohorts. Conclusion: The findings of this systematic review highlight the complex relationship between VS resection and tinnitus outcomes. These findings underscore the need for individualized patient counseling and tailored treatment approaches in managing VS-associated tinnitus. The findings of this systematic review may help in guiding clinicians towards making more informed and personalized healthcare decisions. Further studies must be completed to fill gaps in the current literature.
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Affiliation(s)
- Ava M. King
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Jaimee N. Cooper
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Karina Oganezova
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Jeenu Mittal
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Keelin McKenna
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Dimitri A. Godur
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Max Zalta
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Ali A. Danesh
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
- Department of Communication Sciences and Disorders, Florida Atlantic University, Boca Raton, FL 33431, USA
- Department of Integrated Medical Sciences, Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Rahul Mittal
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Adrien A. Eshraghi
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33143, USA
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Mohanty AJ, DeVahl J, Kutz WJ, Rozen SM. Neurofibromatosis Type II and Facial Paralysis: Clinical Evaluation and Management. Plast Reconstr Surg 2024; 153:415e-423e. [PMID: 37075282 DOI: 10.1097/prs.0000000000010561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Facial paralysis secondary to neurofibromatosis type 2 (NF2) presents the reconstructive surgeon with unique challenges because of its pathognomonic feature of bilateral acoustic neuromas, involvement of multiple cranial nerves, use of antineoplastic agents, and management. Facial reanimation literature on managing this patient population is scant. METHODS A comprehensive literature review was performed. All patients with NF2-related facial paralysis who presented in the past 13 years were reviewed retrospectively for type and degree of paralysis, NF2 sequelae, number of cranial nerves involved, interventional modalities, and surgical notes. RESULTS Twelve patients with NF2-related facial paralysis were identified. All patients presented after resection of vestibular schwannoma. Mean duration of weakness before surgical intervention was 8 months. On presentation, one patient had bilateral facial weakness, 11 had multiple cranial nerve involvement, and seven were treated with antineoplastic agents. Two patients underwent gracilis free functional muscle transfer, five underwent masseteric-to-facial nerve transfer (of whom two were dually innervated with a crossfacial nerve graft), and one patient underwent depressor anguli oris myectomy. Trigeminal schwannomas did not affect reconstructive outcomes if trigeminal nerve motor function on clinical examination was normal. In addition, antineoplastic agents such as bevacizumab and temsirolimus did not affect outcomes if stopped in the perioperative period. CONCLUSIONS Effectively managing patients with NF2-related facial paralysis necessitates understanding the progressive and systemic nature of the disease, bilateral facial nerve and multiple cranial nerve involvement, and common antineoplastic treatments. Neither antineoplastic agents nor trigeminal nerve schwannomas associated with normal examination affected outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Affiliation(s)
| | | | - Walter J Kutz
- Otolaryngology and Head and Neck Surgery, University of Texas Southwestern Medical Center
| | - Shai M Rozen
- From the Departments of Plastic and Reconstructive Surgery
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Neurosurgical Treatment and Outcome of Pediatric Skull Base Lesions: A Case Series and Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020216. [PMID: 36832345 PMCID: PMC9954611 DOI: 10.3390/children10020216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Pediatric skull base lesions occur rarely and are of various etiologies. Traditionally, open craniotomy has been the treatment of choice; however, nowadays, endoscopic approaches are increasingly applied. In this retrospective case series, we describe our experience in treating pediatric skull base lesions and provide a systematic overview of the literature on the treatment and outcome of pediatric skull base lesions. METHODS We conducted a retrospective data collection of all pediatric patients (<18 years) treated for a skull base lesion at the Division of Pediatric Neurosurgery, University Children's Hospital Basel, Switzerland, between 2015 and 2021. Descriptive statistics and a systematic review of the available literature were additionally conducted. RESULTS We included 17 patients with a mean age of 8.92 (±5.76) years and nine males (52.9%). The most common entity was sellar pathologies (n = 8 47.1%), with craniopharyngioma being the most common pathology (n = 4, 23.5%). Endoscopic approaches, either endonasal transsphenoidal or transventricular, were used in nine (52.9%) cases. Six patients (35.3%) suffered from transient postoperative complications, while in none of the patients these were permanent. Of the nine (52.9%) patients with preoperative deficits, two (11.8%) showed complete recovery and one (5.9%) partial recovery after surgery. After screening 363 articles, we included 16 studies with a total of 807 patients for the systematic review. The most common pathology reported in the literature confirmed our finding of craniopharyngioma (n = 142, 18.0%). The mean PFS amongst all the studies included was 37.73 (95% CI [36.2, 39.2]) months, and the overall weighted complication rate was 40% (95% CI [0.28 to 0.53] with a permanent complication rate of 15% (95% CI [0.08 to 0.27]. Only one study reported an overall survival of their cohort of 68% at five years. CONCLUSION This study highlights the rarity and heterogeneity of skull base lesions in the pediatric population. While these pathologies are often benign, achieving GTR is challenging due to the deep localization of the lesions and eloquent adjacent structures, leading to high complication rates. Therefore, skull base lesions in children require an experienced multidisciplinary team to provide optimal care.
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Webb MJ, Neth BJ, Webb LM, Van Gompel JJ, Link MJ, Neff BA, Carlson ML, Driscoll CL, Dornhoffer J, Ruff MW, Anderson KA, Kizilbash SH, Campian JL, Uhm JH, Lane JI, Benson JC, Blezek DJ, Mehta PM, Bathla G, Sener UT. Withdrawal of bevacizumab is associated with rebound growth of vestibular schwannomas in neurofibromatosis type 2-related schwannomatosis patients. Neurooncol Adv 2023; 5:vdad123. [PMID: 37841698 PMCID: PMC10576512 DOI: 10.1093/noajnl/vdad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Background Neurofibromatosis type 2 (NF2)-related schwannomatosis is an autosomal dominant tumor-predisposition syndrome characterized by bilateral vestibular schwannomas (VS). In patients with VS associated with NF2, vascular endothelial growth factor A inhibitor, bevacizumab, is a systemic treatment option. The aim of this study is to retrospectively evaluate NF2 patient responses to bevacizumab on VS growth and symptom progression. Methods This is a retrospective analysis of patients seen at the Mayo Clinic Rochester Multidisciplinary NF2 Clinic. Results Out of 76 patients with NF2 evaluated between 2020 and 2022, we identified 19 that received treatment with bevacizumab. Thirteen of these patients discontinued bevacizumab after median treatment duration of 12.2 months. The remaining 6 patients are currently receiving bevacizumab treatment for a median duration of 9.4 months as of March, 2023. Fifteen patients had evaluable brain MRI data, which demonstrated partial responses in 5 patients, stable disease in 8, and progression in 2. Within 6 months of bevacizumab discontinuation, 5 patients had rebound growth of their VS greater than 20% from their previous tumor volume, while 3 did not. Three patients with rebound growth went on to have surgery or irradiation for VS management. Conclusions Our single-institution experience confirms prior studies that bevacizumab can control progression of VS and symptoms associated with VS growth. However, we note that there is the potential for rapid VS growth following bevacizumab discontinuation, for which we propose heightened surveillance imaging and symptom monitoring for at least 6 months upon stopping anti-VEGF therapy.
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Affiliation(s)
- M J Webb
- Department of Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryan J Neth
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neuro-Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lauren M Webb
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian A Neff
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew L Carlson
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Colin L Driscoll
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jim Dornhoffer
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael W Ruff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neuro-Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelsey A Anderson
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jian L Campian
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joon H Uhm
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neuro-Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jack I Lane
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - John C Benson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Blezek
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Parv M Mehta
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Girish Bathla
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ugur T Sener
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Management of neurofibromatosis type 2 and schwannomatosis associated peripheral and intraspinal schwannomas: influence of surgery, genetics, and localization. J Neurooncol 2022; 159:271-279. [PMID: 35771312 PMCID: PMC9424169 DOI: 10.1007/s11060-022-04061-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Abstract
Introduction Peripheral and intraspinal schwannomas are common and clinically complex pathologies in patients with Neurofibromatosis Type 2 (NF2) and Schwannomatosis (SWNT). Functional preservation and pain relief are the major goals in treating these tumors. Methods This retrospective observational study investigates the clinical and functional outcome of 205 operated peripheral (n = 148, 72%) and intraspinal (n = 57, 28%) schwannomas in 85 patients (53 NF2, 32 SWNT) treated at our department between 2006 and 2017. Associated factors such as genetics, age, and location were evaluated. Results Persisting drug-resistant pain was the most common symptom (84%, n = 173) and indication for surgery (54%, n = 110). Improvement in pain intensity was postoperatively seen in 81%. Peripheral nerve schwannomas exhibited worse pain intensity preoperatively compared to intraspinal lesions (p = 0.017 NF2, p = 0.029 SWNT). More total resections could be achieved in 93% of SWNT vs. 82% of NF2-associated tumors, p = 0.030). NF2 patients with intraspinal lesions were more neurologically affected (p < 0.05). Perioperative comparison of both tumor syndromes showed more neurological deficits (p = 0.027), and less pain (p = 0.024) in NF2-associated tumors. Mosaic NF2 patients had worse pain levels before surgery, and SWNT patients had a worse neurological function and more pain compared to non-mosaic or non-mutated cases. Conclusions Resection of peripheral and intraspinal schwannomas is an effective and low-risk treatment in both NF2 and SWNT. Patients with severe pain have a particular benefit from surgical treatment. Intraspinal lesions are associated with worse neurological function whereas peripheral lesions showed a higher pain intensity. The influence of mutations needs to be further investigated in larger cohorts. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-022-04061-0.
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Ota Y, Liao E, Capizzano AA, Baba A, Kurokawa R, Kurokawa M, Srinivasan A. Intracranial paragangliomas versus schwannomas: Role of dynamic susceptibility contrast perfusion and diffusion MRI. J Neuroimaging 2022; 32:875-883. [PMID: 35562184 PMCID: PMC9546409 DOI: 10.1111/jon.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/09/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Differentiating paragangliomas from schwannomas and distinguishing sporadic from neurofibromatosis type 2 (NF 2)-related schwannomas is challenging but clinically important. This study aimed to assess the utility of dynamic susceptibility contrast perfusion MRI (DSC-MRI) and diffusion-weighted imaging (DWI) in discriminating infratentorial extra-axial schwannomas from paragangliomas and NF2-related schwannomas. METHODS This retrospective study included 41 patients diagnosed with paragangliomas, sporadic schwannomas, and NF2-related schwannomas in the infratentorial extra-axial space between April 2013 and August 2021. All cases had pretreatment DSC-MRI and DWI. Normalized mean apparent diffusion coefficient (nADCmean), normalized relative cerebral blood volume (nrCBV), and normalized relative cerebral blood flow (nrCBF) were compared between paragangliomas and schwannomas and between sporadic and NF2-related schwannomas as appropriate. RESULTS nrCBV and nrCBF were significantly higher in paragangliomas than in sporadic/NF2-related schwannomas (nrCBV: median 11.5 vs. 1.14/3.74; p < .001 and .004, nrCBF: median 7.43 vs. 1.13/2.85; p < .001 and .007, respectively), while nADCmean were not. The corresponding diagnostic performances were area under the curves (AUCs) of .99/.92 and 1.0/.90 with cutoffs of 2.56/4.22 and 1.94/3.36, respectively. nADCmean were lower, and nrCBV and nrCBF were higher in NF2-related than in sporadic schwannomas (nADCmean: median 1.23 vs. 1.58, nrCBV: median 3.74 vs. 1.14, nrCBF: median 2.85 vs. 1.13; all p < .001), and the corresponding diagnostic performances were AUCs of .93, .91, and .95 with cutoffs of 1.37, 2.63, and 2.48, respectively. CONCLUSIONS DSC-MRI and DWI both can aid in differentiating paragangliomas from schwannomas and sporadic from NF2-related schwannomas.
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Affiliation(s)
- Yoshiaki Ota
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Liao
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Aristides A Capizzano
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Akira Baba
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryo Kurokawa
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariko Kurokawa
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashok Srinivasan
- Department of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, Michigan, USA
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Roman Souza G, Abdalla A, Mahadevan D. Clinical Trials Targeting Neurofibromatoses-associated Tumors: A Systematic Review. Neurooncol Adv 2022; 4:vdac005. [PMID: 35291225 PMCID: PMC8919406 DOI: 10.1093/noajnl/vdac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background There is a paucity of literature that comprehensively analyzes previous and current clinical trials targeting neurofibromatoses-related tumors. This article aims to provide readers with drug development efforts targeting these tumors by analyzing translational and clinical findings. Methods This systematic review was written according to the PRISMA guidelines. Inclusion criteria were clinical trials involving patients with neurofibromatosis type 1, type 2, or schwannomatosis that were treated with therapies targeting neurofibromatoses-associated tumors and that were registered on clinicaltrials.gov. In addition, a search was performed in PubMed, Web of Science, Google Scholar, and Embase European for articles fully describing these clinical trials. Results A total of 265 clinical trials were registered and screened for eligibility. Ninety-two were included in this systematic review involving approximately 4636 participants. The number of therapies analyzed was more than 50. Drugs under investigation mainly act on the MAPK/ERK and PI3K/AKT/mTOR pathways, tumor microenvironment, or aberrantly over-expressed cell surface receptors. Selumetinib was the most effective medication for treating a neurofibromatosis type 1-associated tumor with approximately 68%–71% partial response for inoperable or progressive plexiform neurofibromas in children 2 years of age and older and bevacizumab for a neurofibromatosis type 2-related tumor with approximately 36%–41% partial response for vestibular schwannomas in patients 12 years of age and older. Conclusions This systematic review presents the results of previous clinical investigations and those under development for neurofibromatoses-associated tumors. Clinicians may use this information to strategize patients to appropriate clinical trials.
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Affiliation(s)
- Gabriel Roman Souza
- Institute for Drug Development, Division of Hematology and Medical Oncology, Mays Cancer Center, University of Texas Health San Antonio MD Anderson Cancer Center, Texas, United States of America
| | - Ahmed Abdalla
- Institute for Drug Development, Division of Hematology and Medical Oncology, Mays Cancer Center, University of Texas Health San Antonio MD Anderson Cancer Center, Texas, United States of America
| | - Daruka Mahadevan
- Institute for Drug Development, Division of Hematology and Medical Oncology, Mays Cancer Center, University of Texas Health San Antonio MD Anderson Cancer Center, Texas, United States of America
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Risk Stratification for Immediate Postoperative Hearing Loss by Preoperative BAER (Brainstem Auditory Evoked Response) and Audiometry in NF2-Associated Vestibular Schwannomas. Cancers (Basel) 2021; 13:cancers13061384. [PMID: 33803788 PMCID: PMC8003145 DOI: 10.3390/cancers13061384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Hearing preservation is one of the major goals in the surgical treatment of Neurofibromatosis Type 2 (NF2) associated vestibular schwannomas (VS) and hearing diagnostics are important monitoring parameters and intraoperative tools to pursue this goal. Our monocentric retrospective analysis aimed to predict postoperative hearing deterioration or loss based on preoperative audiometry and neurophysiological (brainstem auditory evoked potentials, BAEP) findings. In this respect and according to our data evaluation in 100 NF2-associated VS of 72 patients both parameters seem to be prognostic markers, particularly BAEP findings. Large discrepancies between both audiometry and BAEPs which were identified in twenty-one cases of our cohort appear to be at high risk of significant postoperative hearing worsening. Abstract Both brainstem auditory evoked potentials (BAEP) and audiometry play a crucial role in neuro-oncological treatment decisions in Neurofibromatosis Type 2 associated (NF2) vestibular schwannoma (VS) as hearing preservation is the major goal. In this study, we investigated the risk of immediate postoperative hearing deterioration (>15 dB and/or 15% loss in pure-tone average [PTA]/ speech discrimination score [SDS] in a cohort of 100 operated VS (ears) in 72 NF2 patients by retrospective analysis of pre- and postoperative hearing data (PTA, SDS, American Association of Otolaryngology–Head and Neck Surgery [AAO-HNS], and brainstem auditory evoked potential [BAEP] class) taking into account relevant influencing factors, particularly preoperative audiometry and BAEP status and the extent of resection. Immediately after surgery, the hearing was preserved in 73% of ears and approximately ~60% of ears kept their hearing classes. Preoperative BAEP (p = 0.015) and resection amount (p = 0.048) significantly influenced postoperative hearing outcome. The prediction model for postoperative hearing deterioration/loss between preoperative BAEP and AAO-HNS class showed increased risk by increasing BAEP class. Twenty-one tumors/ears were identified with large BAEP and AAO-HNS class discrepancies (≥2 points) and were associated with a high (48–100%) risk of deafness after surgery in ears with preoperative available hearing. Overall, the results were heterogeneous but the better both BAEP and audiometry class before surgery, the higher the chance of hearing maintenance afterwards. Large resection amounts (e.g., 100% risk in near-total resections) exhibit a significant (p < 0.05) higher risk compared to smaller amounts (e.g., 10/20% in laser-coagulated/partially resected tumors). Our results emphasized the indispensable role of both hearing monitoring in form of audiometry and neurophysiology (BAEP) in the pre-and perioperative monitoring of NF2-associated VS. Both BAEP and audiometry are good prognostic markers for the postoperative hearing outcome. The extent of resection should be strictly guided by and adjusted to the intraoperative neurophysiological monitoring.
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