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Yap J, Palmer G, Graving K, Stone S, Gane EM. Vestibular Rehabilitation: Improving Symptomatic and Functional Outcomes of Persons With Vestibular Schwannoma: A Systematic Review. Phys Ther 2024; 104:pzae085. [PMID: 38982735 PMCID: PMC11450271 DOI: 10.1093/ptj/pzae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 01/30/2024] [Accepted: 07/07/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE Persons with vestibular schwannoma suffer from dizziness, imbalance, and decreased function leading to reduced quality of life. Other forms of peripheral vestibular hypofunction show improvements in these signs and symptoms with vestibular rehabilitation; however, the efficacy of this intervention for those with vestibular schwannoma is unknown. Therefore, the aim of this systematic review was to determine the effect of vestibular physical therapy on subjective and objective measures of vestibular symptoms and function in people with vestibular schwannoma. METHODS Four electronic databases were searched: PubMed, CINAHL, EMBASE, and Cochrane. Included studies were experimental or observational in design and featured patients with vestibular schwannoma who had undergone vestibular physical therapy. Screening and quality assessment was completed independently by 2 researchers. Risk of bias was assessed with a tool appropriate for study design (eg, Cochrane Risk of Bias 2.0 tool for randomized trials). The Grading of Recommendations Assessment, Development and Evaluation approach was used to synthesize findings. RESULTS Twenty-three studies were included. Overall, the effect of vestibular physical therapy for patients with vestibular schwannoma was uncertain. Outcomes of dizziness, static and dynamic balance, and vestibular function all showed very low certainty on the Grading of Recommendations Assessment, Development and Evaluation assessment. Multimodal physical therapist interventions consistent with clinical practice guidelines (eg, gaze stability, habituation, balance training, gait training) demonstrated potential for improvement in dizziness, balance, and vestibular function, respectively. Results were mostly insignificant when a single modality was used. CONCLUSION There may be benefit in multimodal vestibular physical therapy for people with vestibular schwannoma to improve symptoms and function. More high-quality studies specific to vestibular schwannoma prehabilitation and rehabilitation are needed to increase the certainty in the evidence. IMPACT Physical therapists are encouraged to use multimodal vestibular rehabilitation for vestibular schwannoma in clinical practice in line with clinical guidelines for peripheral vestibular hypofunction.
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Affiliation(s)
- Jayden Yap
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Gretta Palmer
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kate Graving
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Shona Stone
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Elise M Gane
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
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Niemczyk K, Pobożny I, Bartoszewicz R, Morawski K. Intraoperative Hearing Monitoring Using ABR and TT-ECochG and Hearing Preservation during Vestibular Schwannoma Resection. J Clin Med 2024; 13:4230. [PMID: 39064270 PMCID: PMC11278406 DOI: 10.3390/jcm13144230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Quick and appropriate diagnostics and the use of intraoperative monitoring (IM) of hearing during vestibular schwannoma (VS) resection increase the likelihood of hearing preservation. During surgery, various methods of IM can be used, i.e., auditory brainstem responses (ABRs), transtympanic electrocochleography (TT-ECochG), and direct cochlear nerve action potentials. The aim of the study was to evaluate the prognostic values of IM of hearing using ABR and TT-ECochG in predicting postoperative hearing preservation and to evaluate relationships between them during various stages of surgery. Methods: This retrospective study presents the pre- and postoperative audiological test results and IM of hearing records (TT-ECochG and ABR) in 75 (43 women, 32 men, aged 18-69) patients with diagnosed VS. Results: The preoperative pure tone average hearing threshold was 25.02 dB HL, while after VS resection, it worsened on average by 30.03 dB HL. According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Hearing Classification, before and after (pre/post) surgery, there were 47/24 patients in hearing class A, 9/8 in B, 2/1 in C, and 17/42 in D. In speech audiometry, the average preoperative speech discrimination score at an intensity of 60 dB SPL was 70.93%, and after VS resection, it worsened to 38.93%. The analysis of electrophysiological tests showed that before the tumor removal the I-V ABR interlatencies was 5.06 ms, and after VS resection, it was 6.43 ms. Conclusions: The study revealed correlations between worse postoperative hearing and changes in intraoperatively measured ABR and TT-ECochG. IM of hearing is very useful in predicting postoperative hearing in VS patients and increases the chance of postoperative hearing preservation in these patients.
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Affiliation(s)
- Kazimierz Niemczyk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Izabela Pobożny
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Robert Bartoszewicz
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Krzysztof Morawski
- Department of Otorhinolaryngology, Institute of Medical Sciences, University of Opole, 45-040 Opole, Poland
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Homer AS, Kasthuri VS, Homer BJ, Jain R, Gall EK, Noonan KY. The Association Between Medicaid Expansion and Disparities in Vestibular Schwannoma Incidence. Laryngoscope 2024. [PMID: 38837793 DOI: 10.1002/lary.31517] [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: 01/15/2024] [Revised: 03/26/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES The effect of Medicaid expansion as a part of the Affordable Care Act on vestibular schwannoma (VS) incidence overall and in marginalized populations has not yet been elucidated. The goal of this study was to determine if Medicaid expansion was associated with increases in VS incidence overall, as well as in patients of non-white race or in counties of low socioeconomic status (SES). METHODS We performed a difference-in-difference (DiD) analysis from January 1st 2010-December 31st 2017 utilizing the Surveillance, Epidemiology, and End Results (SEER) database. Our DiD method compared the change in VS rate between counties that did and did not expand Medicaid among patients of white and non-white race, in low and high SES counties, before and after expansion. RESULTS The study included 17,312 cases across 1020 counties. Medicaid expansion was associated with a 15% increase (incidence rate ratio 95% CI: [11%, 19]) in VS incidence. White populations saw a 10% increase (CI: [1.06, 1.19]), Black populations saw a 20% increase (CI: [1.10, 1.29]), and patients of other races saw a 44% increase in incidence associated with expansion (CI: [1.21, 1.70]). Low SES counties saw an increase in incidence 1.12 times higher than that of high SES counties (CI:[1.04, 1.20]). CONCLUSION Medicaid expansion was associated with increases in VS incidence across populations. Furthermore, this increase was more evident in disadvantaged populations, such as patients of non-white race and those from low SES counties. These findings emphasize the impact of Medicaid expansion on healthcare utilization for VS diagnosis. LEVEL OF EVIDENCE Step/Level 3-Retrospective Cohort Study Laryngoscope, 2024.
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Affiliation(s)
- Alexander S Homer
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Viknesh S Kasthuri
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Benjamin J Homer
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Rishubh Jain
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Emily K Gall
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Kathryn Y Noonan
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
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Dayawansa S, Dumot C, Mantziaris G, Mehta GU, Lekovic GP, Kondziolka D, Mathieu D, Reda WA, Liscak R, Cheng-chia L, Kaufmann AM, Barnet G, Trifiletti DM, Lunsford LD, Sheehan J. Facial Nerve Schwannoma Treatment with Stereotactic Radiosurgery (SRS) versus Resection followed by SRS: Outcomes and a Management Protocol. J Neurol Surg B Skull Base 2024; 85:75-80. [PMID: 38274481 PMCID: PMC10807954 DOI: 10.1055/a-1990-2861] [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: 08/27/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022] Open
Abstract
Background Stereotactic radiosurgery (SRS) and resection are treatment options for patients with facial nerve schwannomas without mass effect. Objective This article evaluates outcomes of patients treated with SRS versus resection + SRS. Method We retrospectively compared 43 patients treated with SRS to 12 patients treated with resection + SRS. The primary study outcome was unfavorable combined endpoint, defined as worsening or new clinical symptoms, and/or tumor radiological progression. SRS (38.81 ± 5.3) and resection + SRS (67.14 ± 11.8) groups had similar clinical follow-ups. Results At the time of SRS, the tumor volumes of SRS (mean ± standard error; 1.83 ± 0.35 mL) and resection + SRS (2.51 ± 0.75 mL) groups were similar. SRS (12.15 ± 0.08 Gy) and resection + SRS (12.16 ± 0.14 Gy) groups received similar radiation doses. SRS group (42/43, 98%) had better local tumor control than the resection + SRS group (10/12, 83%, p = 0.04). Most of SRS (32/43, 74%) and resection + SRS (10/12, 83%) group patients reached a favorable combined endpoint following SRS ( p = 0.52). Considering surgical associated side effects, only 2/10 patients of the resection + SRS group reached a favorable endpoint ( p < 0.001). Patients of SRS group, who are > 34 years old ( p = 0.02), have larger tumors (> 4 mL, 0.04), internal auditory canal (IAC) segment tumor involvement ( p = 0.01) were more likely to reach an unfavorable endpoint. Resection + SRS group patients did not show such a difference. Conclusion While resection is still needed for larger tumors, SRS offers better clinical and radiological outcomes compared to resection followed by SRS for facial schwannomas. Younger age, smaller tumors, and non-IAC situated tumors are factors that portend a favorable outcome.
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Affiliation(s)
- Sam Dayawansa
- Department of Neurosurgery, University of Virginia Gamma Knife Surgery Center, Charlottesville, Virginia, United States
| | - Chloe Dumot
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, United States
| | - Georgios Mantziaris
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, United States
| | - Gautam U. Mehta
- Department of Neurological Surgery, House Ear Institute, Los Angeles, California, United States
- Department of Neurological Surgery, Charlottesville, Virginia, United States
| | - Gregory P. Lekovic
- Department of Neurological Surgery, House Ear Institute, Los Angeles, California, United States
- Department of Neurosurgery, House Clinic, Los Angeles, California, United States
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Medical Center, New York, New York, United States
| | - David Mathieu
- Department of Neurosurgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Wael A. Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Lee Cheng-chia
- Department of Neurosurgery, Taipei Veteran General Hospital, Taipei, Taiwan
- Department of Neurosurgery, National Yang-Ming University, Hsinchu, Taiwan
| | | | - Gene Barnet
- Department of Neuro Oncology, Cleveland Clinic, Cleveland, Ohio, United States
| | - Daniel M. Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, United States
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Alekseev IM, Ovchinnikov VA, Chupalenkov SM, Zuev AA. [Our approach to the treatment of vestibular schwannomas with arachnoid dissection of the facial nerve]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:38-49. [PMID: 39169580 DOI: 10.17116/neiro20248804138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Preserving the function of the facial nerve is extremely important in surgery for vestibular schwannomas. Two methods of arachnoid dissection are described for resection of vestibular schwannoma via retrosigmoid approach (from the brain stem and internal auditory canal). OBJECTIVE To evaluate the results of arachnoid dissection of the facial nerve from internal auditory canal when resecting the vestibular schwannoma. MATERIAL AND METHODS We analyzed 61 patients with vestibular schwannomas. Patients were divided into 2 groups depending on surgical technique. We estimated facial nerve function before and after surgery, preoperative dimension of vestibular schwannoma and extent of resection. The influence of various factors on extent of resection and postoperative facial nerve function was studied. RESULTS Vestibular schwannoma resection from the brain stem was performed in 30 patients, arachnoid dissection - in 31 patients. There was no significant between-group difference. Gross total resection was performed in 78.7% of cases. Both techniques demonstrated similar results regarding extent of resection. Arachnoid dissection showed the advantage regarding facial nerve function immediately after surgery (p=0.012) and 6 months later (p<0.001). Normal facial nerve function in 6 months after arachnoid dissection was observed in 80.7% of patients. Preoperative dimension of tumor influenced facial nerve function in addition to technique of resection (p=0.001). CONCLUSION We identified the factors influencing facial nerve function after resection of vestibular schwannoma. Surgical technique was the most significant factor. These data expand and popularize arachnoid dissection in surgery of vestibular schwannomas.
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Affiliation(s)
- I M Alekseev
- Pirogov National Medical Surgical Center, Moscow, Russia
| | | | | | - A A Zuev
- Pirogov National Medical Surgical Center, Moscow, Russia
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Piperno G, Ferrari A, Volpe S, Cattani F, Zaffaroni M, Comi S, Pansini F, Bergamaschi L, Mazzola GC, Ceci F, Colandrea M, Petralia G, Orecchia R, Jereczek-Fossa BA, Alterio D. Hypofractionated proton therapy for benign tumors of the central nervous system: A systematic review of the literature. Crit Rev Oncol Hematol 2023; 191:104114. [PMID: 37683814 DOI: 10.1016/j.critrevonc.2023.104114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/26/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
AIMS Aim of the present analysis was to report results of a systematic review of the literature in the setting of patients treated with hypoF PT for benign lesions of the central nervous system (CNS). METHODS The methodology complied with the PRISMA recommendations. PubMed, EMBASE and Scopus databases were interrogated in September 2022. RESULTS Twelve papers have been selected including patients treated for base of the skull meningiomas (6 papers), vestibular schwannoma (3 papers) and pituitary adenomas (3 papers). Clinical outcomes were evaluated with both radiologic images and clinical parameters. Long-term toxicity was reported in all but one series with an incidence ranging from 2 % to 7 % in patients treated for base of skull meningioma and 1-9 % for schwannoma. CONCLUSIONS HypoF PT is a safe and effective treatment in selected benign tumors of the CNS. Further dosimetric and clinical comparisons are required to better refine the patients' selection criteria.
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Affiliation(s)
- Gaia Piperno
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - Federica Cattani
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Floriana Pansini
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Bergamaschi
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | | | - Francesco Ceci
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Marzia Colandrea
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
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Maldonado J, Porto E, Revuelta Barbero JM, Tello I, Rodas A, Vivas EX, Mattox DE, Solares CA, Garzon Muvdi T, Pradilla G. Thermal Analysis of an Ultrasonic Aspirator Micro Claw Tool Compared With Standard High-Speed Drilling During Internal Auditory Canal Opening in a Cadaveric Model. Oper Neurosurg (Hagerstown) 2023; 25:183-189. [PMID: 37083749 DOI: 10.1227/ons.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/16/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The ultrasonic aspirator micro claw tool (UAmCT) can be used to remove the bone of the internal auditory canal (IAC) during vestibular schwannoma resection via the retrosigmoid approach (RSA) without the risk of a spinning drill shaft. However, the thermal profile of the UAmCT during IAC removal has not been reported. OBJECTIVE To compare the thermal profile of the UAmCT during access of the IAC to that of a conventional high-speed drill (HSD) and to present an illustrative case of this application. METHODS IAC opening via RSA was performed in 5 embalmed cadaveric specimens using the UAmCT with 3, 8, and 15 mL/min irrigation on the left and the HSD at 75 000 revolutions per minute and 0%, 14%, and 22% irrigation on the right. Peak bone surface temperatures were measured 4 times in 20-second intervals, and statistical analyses were performed using SPSS software. An illustrative case of a vestibular schwannoma resected via an RSA using the UAmCT to access the IAC is presented. RESULTS The IAC was opened in all 5 specimens using both the UAmCT and HSD without complication. The mean peak bone surface temperatures were significantly lower with the UAmCT compared with the HSD ( P < .001). The UAmCT did not meaningfully prolong the operating time in the illustrative case, and the IAC was accessed without complication. CONCLUSION The UAmCT may be a safe and effective alternative to HSD for IAC opening during vestibular schwannoma resection via the RSA. Larger studies under clinical conditions are required to further validate these findings.
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Affiliation(s)
- Justin Maldonado
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Edoardo Porto
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - J Manuel Revuelta Barbero
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Isaac Tello
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel V. Suárez, Mexico City, Mexico
| | - Alejandra Rodas
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Esther X Vivas
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Douglas E Mattox
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - C Arturo Solares
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | | | - Gustavo Pradilla
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
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Kurucz P, Ganslandt O, Buchfelder M, Barany L. Microsurgical anatomy and pathoanatomy of the outer arachnoid membranes in the cerebellopontine angle: cadaveric and intraoperative observations. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05601-x. [PMID: 37133788 DOI: 10.1007/s00701-023-05601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE The cerebellopontine angle (CPA) is a frequent region of skull base pathologies and therefore a target for neurosurgical operations. The outer arachnoid is the key structure to approach the here located lesions. The goal of our study was to describe the microsurgical anatomy of the outer arachnoid of the CPA and its pathoanatomy in case of space-occupying lesions. METHODS Our examinations were performed on 35 fresh human cadaveric specimens. Macroscopic dissections and microsurgical and endoscopic examinations were performed. Retrospective analysis of the video documentations of 35 CPA operations was performed to describe the pathoanatomical behavior of the outer arachnoid. RESULTS The outer arachnoid cover is loosely attached to the inner surface of the dura of the CPA. At the petrosal surface of the cerebellum the pia mater is strongly adhered to the outer arachnoid. At the level of the dural penetration of the cranial nerves, the outer arachnoid forms sheath-like structures around the nerves. In the midline, the outer arachnoid became detached from the pial surface and forms the base of the posterior fossa cisterns. In pathological cases, the outer arachnoid became displaced. The way of displacement depends on the origin of the lesion. The most characteristic patterns of changes of the outer arachnoid were described in case of meningiomas, vestibular schwannomas, and epidermoid cysts of the CPA. CONCLUSION The knowledge of the anatomy of the outer arachnoid of the cerebellopontine region is essential to safely perform microsurgical approaches as well as of dissections during resection of pathological lesions.
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Affiliation(s)
- Peter Kurucz
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanalage 60, 91054, Erlangen, Germany.
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.
| | - Oliver Ganslandt
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanalage 60, 91054, Erlangen, Germany
| | - Laszlo Barany
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanalage 60, 91054, Erlangen, Germany
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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9
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Novikova S, Soloveva N, Farafonova T, Tikhonova O, Shimansky V, Kugushev I, Zgoda V. Proteomic Shotgun and Targeted Mass Spectrometric Datasets of Cerebrospinal Fluid (Liquor) Derived from Patients with Vestibular Schwannoma. DATA 2023. [DOI: 10.3390/data8040071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Vestibular schwannomas are relatively rare intracranial tumors compared to other brain tumors. Data on the molecular features, especially on schwannoma proteome, are scarce. The 41 cerebrospinal fluid (liquor) samples were obtained during the surgical removal of vestibular schwannoma. Obtained peptide samples were analyzed by shotgun LC-MS/MS high-resolution mass spectrometry. The same peptide samples were spiked with 148 stable isotopically labeled peptide standards (SIS) followed by alkaline fractionation and scheduled multiple reaction monitoring (MRM) for quantitative analysis. The natural counterparts of SIS peptides were mapped onto 111 proteins that were Food and Drug Administration (FDA)-approved for diagnostic use. As a result, 525 proteins were identified by shotgun LC-MS/MS with high confidence (at least two peptides per protein, FDR < 1%) in liquor samples. Absolute quantitative concentrations were obtained for 54 FDA-approved proteins detected in at least five experimental samples. Since there is lack of data on the molecular landscape of vestibular schwannoma, the obtained datasets are unique and one of the first in its field.
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Affiliation(s)
| | | | | | - Olga Tikhonova
- Institute of Biomedical Chemistry, 119121 Moscow, Russia
| | - Vadim Shimansky
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, 125047 Moscow, Russia
| | - Ivan Kugushev
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, 125047 Moscow, Russia
| | - Victor Zgoda
- Institute of Biomedical Chemistry, 119121 Moscow, Russia
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10
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Yagi K, Ikeda R, Suzuki J, Sunose H, Kawase T, Katori Y. Long-term tumor growth and hearing after conservative management of vestibular schwannomas. Acta Otolaryngol 2023; 143:37-42. [PMID: 36694965 DOI: 10.1080/00016489.2023.2168747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND There has been no report of a detailed long-term study of hearing at defined frequencies. AIMS/OBJECTIVES This study aimed to evaluate long-term vestibular shwannoma (VS) growth and long-term changes in hearing thresholds at defined frequencies. METHODS We retrospectively retrieved the medical records of 67 VS patients. Cases that were followed up for more than 5 years were analyzed. RESULTS Tumor growth was observed in 15 cases (22.4%) and 6 cases underwent gamma knife treatment (9.0%). The longest case of tumor growth and gamma knife treatment was observed 11 years after the initial diagnosis. Hearing thresholds at 500-2000 Hz was significantly different between the no growth and growth group (p < .05). Particularly at 1000 Hz, there was a significant difference between the two groups from an early time-point. CONCLUSIONS AND SIGNIFICANCE Even a 10-year or longer follow-up of VS may show an increase in tumor growth. Moreover, hearing thresholds, particularly at 1000 kHz, may predict tumor growth when following-up VS patients.
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Affiliation(s)
- Kazutake Yagi
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology and Head and Neck Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Jun Suzuki
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroki Sunose
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuaki Kawase
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Yakkala VK, Mammi M, Lamba N, Kandikatla R, Paliwal B, Elshibiny H, Corrales CE, Smith TR, Mekary RA. Audiovestibular symptoms and facial nerve function comparing microsurgery versus SRS for vestibular schwannomas: a systematic review and meta-analysis. Acta Neurochir (Wien) 2022; 164:3221-3233. [PMID: 35962847 DOI: 10.1007/s00701-022-05338-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/02/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Surgery and radiosurgery represent the most common treatment options for vestibular schwannoma. A systematic review and meta-analysis were conducted to compare the outcomes of surgery versus stereotactic radiosurgery (SRS). METHODS The Cochrane library, PubMed, Embase, and clinicaltrials.gov were searched through 01/2021 to find all studies on surgical and stereotactic procedures performed to treat vestibular schwannoma. Using a random-effects model, pooled odds ratios (OR) and their 95% confidence intervals (CI) comparing post- to pre-intervention were derived for pre-post studies, and pooled incidence of adverse events post-intervention were calculated for case series and stratified by intervention type. RESULTS Twenty-one studies (18 pre-post design; three case series) with 987 patients were included in the final analysis. Comparing post- to pre-intervention, both surgery (OR: 3.52, 95%CI 2.13, 5.81) and SRS (OR: 3.30, 95%CI 1.39, 7.80) resulted in greater odds of hearing loss, lower odds of dizziness (surgery OR: 0.10; 95%CI 0.02, 0.47 vs. SRS OR: 0.22; 95%CI 0.05, 0.99), and tinnitus (surgery OR: 0.23; 95%CI 0.00, 37.9; two studies vs. SRS OR: 0.11; 95%CI 0.01, 1.07; one study). Pooled incidence of facial symmetry loss was larger post-surgery (14.3%, 95%CI 6.8%, 22.7%) than post-SRS (7%, 95%CI 1%, 36%). Tumor control was larger in the surgery (94%, 95%CI 83%, 98%) than the SRS group (80%, 95%CI 31%, 97%) for small-to-medium size tumors. CONCLUSION Both surgery and SRS resulted in similar odds of hearing loss and similar improvements in dizziness and tinnitus among patients with vestibular schwannoma; however, facial symmetry loss appeared higher post-surgery.
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Affiliation(s)
- Vinod Kumar Yakkala
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Marco Mammi
- Department of Neurosurgery, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Nayan Lamba
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiation Oncology, Harvard Medical School, Boston, MA, USA
| | - Renuka Kandikatla
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Bhaskar Paliwal
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Hoda Elshibiny
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - C Eduardo Corrales
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rania A Mekary
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA.
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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