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Kim WH, Park HH, Ahn SJ, Park M, Hong CK. The use of cochlear-enhancement imaging to predict hearing preservation following vestibular schwannoma removal. J Neurosurg Sci 2024; 68:174-180. [PMID: 33940784 DOI: 10.23736/s0390-5616.21.05395-9] [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: 11/08/2022]
Abstract
BACKGROUND Hearing preservation is challenging for patients after the removal of large vestibular schwannomas (VSs). Here, using preoperative magnetic resonance (MR) imaging, we investigated the significance of cochlear enhancement (CE) for predicting postoperative hearing preservation. METHODS Between January 2014 and December 2019, 34 VS-patients with serviceable hearing underwent tumor-removal surgery using a retrosigmoid approach. The presence or absence of CE using both T2-weighted and gadolinium-enhanced T1-weighted MR images was assessed in VS patients using the pixel-analysis method. Segmented volumetric analyses were also performed using GrowCut 3D slicer software. RESULTS There were 17 patients (50%) without CE and 17 (50%) with CE. Ten of the 17 non-CE patients (58.8%) had postoperative hearing preservation. In contrast, only 3 of the 17 patients with CE (17.6%) had postoperative hearing preservation. There were no significant tumor-characteristic differences between the two groups. The presence of CE on both the T2-weighted and the gadolinium-enhanced T1-weighted MR images correlated significantly with postoperative hearing outcomes (P=0.032). Only pure-tone averages were significantly different between the two groups (P=0.049). CONCLUSIONS Preoperative serviceable hearing is likely to be preserved after surgery in non-CE VS patients. Preoperative CE assessment using MR imaging may be a useful predictor for postoperative hearing outcomes in VS patients.
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Affiliation(s)
- Woo-Hyun Kim
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Hun H Park
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Sung J Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang K Hong
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea -
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2
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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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3
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Wu X, Wang X, Song G, Li M, Hou C, Chen G, Guo H, Xiao X, Tang J, Lin Q, Bao Y, Liang J. The effects of different surgical positions (semi-sitting and lateral position) on the surgical outcomes of large vestibular schwannoma: study protocol for a randomized controlled trial. Trials 2022; 23:492. [PMID: 35701794 PMCID: PMC9194341 DOI: 10.1186/s13063-022-06437-z] [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: 01/13/2021] [Accepted: 05/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background There is an ongoing discussion about the advantages and disadvantages of different surgical positions (semi-sitting and lateral position) for vestibular schwannoma surgery. Each position has its advantages, disadvantages, challenges, and risk profiles. The objectives of this study are to compare the effects of different surgical positions (semi-sitting and lateral position) on the outcomes of large vestibular schwannoma, primarily including effectiveness and safety. Methods In this single-centre, open, randomized controlled trial, we will recruit a total of 116 participants according to the inclusion and exclusion criteria who will be randomized to an experimental group or control group. Patients will undergo operations in semi-sitting and lateral positions. The primary endpoint will be the percentage of gross total resection. The secondary endpoints will include the facial nerve function, hearing preservation, surgical position placement time, time of operation (skin-to-skin surgical time), hospital stay, total hospitalization fee, and complications. The follow-up period will be at least 12 months, during which time patients will be evaluated both clinically and radiologically. Discussion This issue is still debated after 30 years since the first large comparative study was published in 1989, so the study will be useful. Therefore, more high-quality studies are required to compare clinical outcomes, complications, and other factors associated with these two positions. Trial registration Chinese Clinical Trial Registry ChiCTR1900027550. Registered on 17 November 2019
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Affiliation(s)
- Xiaolong Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Xu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Gang Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Chengbei Hou
- Centre for Evidence-Based Medicine, Xuanwu Hospital, Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Hongchuan Guo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Xinru Xiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Jie Tang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Qingtang Lin
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Yuhai Bao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China. .,International Neuroscience Institute (China-INI), Beijing, China.
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Fujita Y, Uozumi Y, Yamaguchi Y, Nakai T, Sasayama T, Kohmura E. Symptom-based opioid-free treatment for persistent postoperative headache after vestibular schwannoma resection via the retrosigmoid approach. World Neurosurg 2022; 162:e347-e357. [DOI: 10.1016/j.wneu.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
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Li SW, Zhang J, Tang HL, Li P, Wang B, Zhao F, Liu PN. Establishment of nomograms for the prediction of useful hearing loss in patients with neurofibromatosis type 2. J Neurooncol 2021; 155:373-381. [PMID: 34751884 DOI: 10.1007/s11060-021-03889-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/28/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Treatment for vestibular schwannoma (VS) in patients with neurofibromatosis type 2 (NF2) is extremely challenging due to the high risk of hearing loss. The aim of this study was to develop nomograms for the prediction of useful hearing loss in patients with NF2. METHODS The nomogram was based on a retrospective study of 111 NF2 patients who underwent resection of large VS (> 2 cm) at Beijing Tiantan Hospital between 2011 and 2018. The utility of the proposed nomogram models was evaluated by receiver operating characteristic (ROC) curve, area under ROC curve (AUC), and calibration curve. The results were validated using a prospective cohort study on 33 patients consecutively enrolled at the same institution from 2019 to 2021. RESULTS On multivariate analysis of the primary cohort, large tumour size (> 3 cm) and long duration of symptoms (> 24 months) were independent risk factors for preoperative useful hearing loss (AAO-HNS Class D) (P = 0.001 and P = 0.011, respectively), while large tumour size (> 3 cm), poor hearing (Class C), and lobular growth were significantly related to postoperative useful hearing loss (P < 0.001, P = 0.031 and P = 0.033, respectively). Factors derived from multivariable analysis were all assembled into the nomogram. The calibration curve for probability of hearing loss showed good agreement between predictions by nomogram models and actual observation. The ROC curves showed good predictive accuracy of the nomogram models in both cohorts (AUC: 0.708 to 0.951). CONCLUSION The proposed nomograms resulted in accurate predictions of hearing outcomes for patients with NF2.
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Affiliation(s)
- Shi-Wei Li
- Department of Neural Reconstruction, Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Neurosurgical Department, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Neural Reconstruction, Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Han-Lu Tang
- Neurosurgical Department, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Peng Li
- Neurosurgical Department, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Bo Wang
- Neurosurgical Department, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Fu Zhao
- Department of Neural Reconstruction, Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
- Neurosurgical Department, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
| | - Pi-Nan Liu
- Department of Neural Reconstruction, Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
- Neurosurgical Department, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
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6
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Schackert G, Ralle S, Martin KD, Reiss G, Kowalski M, Sobottka SB, Hennig S, Podlesek D, Sandi-Gahun S, Juratli TA. Vestibular Schwannoma Surgery: Outcome and Complications in Lateral Decubitus Position versus Semi-sitting Position-A Personal Learning Curve in a Series of 544 Cases over 3 Decades. World Neurosurg 2020; 148:e182-e191. [PMID: 33383200 DOI: 10.1016/j.wneu.2020.12.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To retrospectively evaluate influence of intraoperative positioning (semisitting vs. lateral decubitus) and surgeon's learning curve with regard to functional outcome of patients with vestibular schwannoma. METHODS This study included 544 patients (median age 57 years) and spanned 3 decades: 1991-1999 (n = 103), 2000-2009 (n = 210), and 2010-2019 (n = 231). Surgery was performed in the lateral decubitus position in 318 patients and the semisitting position in 163 patients. Large T3 and T4 tumors were present in 77% of patients. RESULTS Complete tumor removal was achieved in 94.3% of patients. A significant reduction in surgery duration and blood loss was observed over 3 decades for T3 (from 325 to 261 minutes, P < 0.001) and T4 (from 440 to 330 minutes, P < 0.001), but not for T1 and T2, tumors. The semisitting position diminished surgical time in T3 and T4 tumors by 1 more hour (P < 0.001). Over 3 decades, facial nerve outcome improved significantly from 59.8% House-Brackmann grade 1-2 in the first decade to 81.7% in the last decade (P < 0.001). Furthermore, hearing was preserved in 45.3%: 23.3% of patients in the first decade and 50.5% in the last decade (P = 0.03). However, neither facial nerve outcome nor hearing preservation significantly differed in patients operated on in the lateral decubitus versus the semisitting position. The most common complication was cerebrospinal fluid leak (6.1%) followed by hemorrhage (3.5%) and pulmonary embolism (2.2%). CONCLUSIONS Follow-up over 3 decades illustrates a learning curve with significantly improved results. While the semisitting position accelerates the procedure and is associated with reduced blood loss, it does not significantly influence functional outcome.
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Affiliation(s)
- Gabriele Schackert
- Department of Neurosurgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Susann Ralle
- Department of Neurosurgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - K Daniel Martin
- Department of Neurosurgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gilfe Reiss
- Department of Neurosurgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Matthias Kowalski
- Department of Neurosurgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephan B Sobottka
- Department of Neurosurgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Silke Hennig
- Department of Neurosurgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Dino Podlesek
- Department of Neurosurgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sahr Sandi-Gahun
- Department of Neurosurgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Tareq A Juratli
- Department of Neurosurgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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7
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Wang X, Li M, Liang J, Liu Q, Ma T, Chen G, Guo H, Song G, Ling F, Bao Y. Monitoring of intracranial venous sinus pressure and prevention for venous air embolism during operation with semi-sitting position. J Clin Neurosci 2020; 81:220-226. [DOI: 10.1016/j.jocn.2020.09.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/22/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
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8
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Wu X, Li M, Zhang Z, Li X, Di M, Song G, Wang X, Li M, Kong F, Liang J. Reliability of Preoperative Prediction of the Location of the Facial Nerve Using Diffusion Tensor Imaging-Fiber Tracking in Vestibular Schwannoma: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 146:351-361.e3. [PMID: 33130136 DOI: 10.1016/j.wneu.2020.10.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022]
Abstract
The popularization and application of microscopy, the in-depth study of the microanatomy of the cerebellopontine angle, and the application of intraoperative electrophysiological monitoring technology to preserve facial nerve function have laid a solid foundation for the modern era of neurosurgery. The preoperative prediction of the location of the facial nerve is a long-desired goal of neurosurgeons. The advances in neuroimaging seem to be making this goal a reality. Many studies investigating the reliability of the preoperative prediction of the location of the facial nerve using diffusion tensor imaging-fiber tracking in vestibular schwannoma have been reported in the last 20 years. The PubMed, Embase, and Cochrane databases were searched for articles published before March 30, 2020. A comprehensive review of published studies was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Authors performed a systematic review and meta-analysis of the reported data to assess the reliability of the preoperative prediction of the location of the facial nerve using diffusion tensor imaging-fiber tracking in vestibular schwannoma. The data were analyzed using a fixed-effects model. The estimated overall intraoperative verification concordance rate was 89.05% (95% confidence interval 85.06%-92.58%). Preoperatively predicting the location of the facial nerve using diffusion tensor imaging-fiber tracking in vestibular schwannoma is reliable, but the extent to which it contributes to long-term facial nerve function is still unclear. To further verify these results, studies with larger sample sizes are needed in the future, especially prospective randomized controlled trials focusing on the long-term functional preservation of the facial nerve.
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Affiliation(s)
- Xiaolong Wu
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Mengjun Li
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China; Department of Neurosurgery, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, China
| | - Zhiping Zhang
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Xiaotong Li
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Manlin Di
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Gang Song
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Xu Wang
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Feng Kong
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China.
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Preet K, Ong V, Sheppard JP, Udawatta M, Duong C, Romiyo P, Nguyen T, Kwan I, Yang I. Postoperative Hearing Preservation in Patients Undergoing Retrosigmoid Craniotomy for Resection of Vestibular Schwannomas: A Systematic Review of 2034 Patients. Neurosurgery 2020; 86:332-342. [PMID: 31149722 DOI: 10.1093/neuros/nyz147] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Vestibular schwannomas (VS) are benign tumors derived from Schwann cells ensheathing the vestibulocochlear nerve. The retrosigmoid (RS) surgical approach is useful to resect tumors of multiple sizes while affording the possibility of preserving postoperative hearing. OBJECTIVE To conduct a systematic review of published literature investigating hearing preservation rates in patients who underwent the RS approach for VS treatment. METHODS The PubMed, Scopus, and Embase databases were surveyed for studies that reported preoperative and postoperative hearing grades on VS patients who underwent RS treatment. Hearing preservation rates were calculated, and additional patient demographic data were extracted. Tumor size data were stratified to compare hearing preservation rates after surgery for intracanalicular, small (0-20 mm), and large (>20 mm) tumors. RESULTS Of 383 deduplicated articles, 26 studies (6.8%) met eligibility criteria for a total of 2034 patients with serviceable preoperative hearing, for whom postoperative hearing status was evaluated. Aggregate hearing preservation was 31% and 35% under a fixed and random effects model, respectively. A mixed effects model was used to determine hearing preservation rates depending on tumor size, which were determined to be 57%, 37%, and 12% for intracanalicular, small, and large tumors, respectively. Significant cross-study heterogeneity was found (I2 = 93%, τ2 = .964, P < .01; Q = 287.80, P = < .001), with rates of hearing preservation ranging from 0% to 100%. CONCLUSION Tumor size may have an effect on hearing preservation rates, but multiple factors should be considered. Discussion of a patient's expectations for hearing preservation is critical when deciding on VS treatment plans.
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Affiliation(s)
- Komal Preet
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Vera Ong
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - John P Sheppard
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Methma Udawatta
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Courtney Duong
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Prasanth Romiyo
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Thien Nguyen
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Isabelle Kwan
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.,Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California.,Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, Los Angeles, California.,Los Angeles Biomedical Research Institute, Harbor UCLA Medical Center, University of California, Los Angeles, Los Angeles, California
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10
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The association of age, body mass index, and frailty with vestibular schwannoma surgical morbidity. Clin Neurol Neurosurg 2020; 197:106192. [PMID: 32916396 DOI: 10.1016/j.clineuro.2020.106192] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate whether increased body mass index (BMI), age, or frailty influence vestibular schwannoma (VS) short-term surgical morbidity. METHODS The 2005-2017 National Surgical Quality Improvement Program database was queried for patients with VS undergoing surgical resection. Age was stratified according to age <50, 50-64, and ≥65, while BMI was stratified based on a threshold of 30. Frailty score (0-5) was indicated based on functional status, diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. RESULTS A total of 1405 patients were included consisting of 56.7 % females with a mean age of 50.7 ± 13.8 years and mean BMI of 29.4 ± 6.6. Patients <50 (n = 604), 50-64 (n = 578), and ≥65 (n = 223), had different duration of surgery (428 ± 173 vs. 392 ± 149 vs. 387 ± 154 min; p < 0.001) and 30-day mortality rates (0.7 % vs. 0% vs. 1.8 %; p = 0.01). However, post-operative length of stay (LOS) (p = 0.16), readmission (p = 0.08), reoperation (p = 0.54), and complication rates were similar. Post-operative myocardial infarction (p = 0.03) and wound infection (p = 0.02) were more commonly observed in the obese cohort (BMI≥30) but readmission (p = 0.18), reoperation (p = 0.44), and complication rates were similar to those with BMI<30. Severely obese patients (BMI≥35) also had higher rates of deep vein thrombosis (p = 0.004). Frailty score 0 (n=921), 1 (n=375), and 2-4 (n=109) was associated with LOS (4.7±3.5 vs. 5.3 ± 4.1 vs. 6.7 ± 6.6 days, p < 0.001) and prolonged intubation rates (1.0 % vs. 2.4 % vs. 3.7 %; p = 0.03). CONCLUSIONS Increased age, BMI, and frailty among VS patients were associated with different post-operative complication rates, operation time, or LOS. Knowledge of these can optimize care for at-risk patients.
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11
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Bretonnier M, Bernard F, Tinois J, Troude L, Cebula H, Godey B, Morandi X. Functional sparing surgery policy for giant vestibular schwannomas. Clin Otolaryngol 2020; 45:762-767. [DOI: 10.1111/coa.13588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Florian Bernard
- Department of Neurosurgery Angers University Hospital Angers France
| | - Julien Tinois
- Department of Neurosurgery Rennes University Hospital Rennes France
| | - Lucas Troude
- Department of Neurosurgery North University Hospital Assistance Publique ‐ Hopitaux de Marseille Marseille France
| | - Hélène Cebula
- Department of Neurosurgery HautepierreUniversity Hospital Strasbourg France
| | - Benoit Godey
- Department of Otorhinolaryngology‐Head and Neck Surgery Rennes University Hospital Rennes France
| | - Xavier Morandi
- Department of Neurosurgery Rennes University Hospital Rennes France
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Springborg JB, Lang JM, Fugleholm K, Poulsgaard L. Face-to-face four hand technique in vestibular schwannoma surgery: results from 256 Danish patients with larger tumors. Acta Neurochir (Wien) 2020; 162:61-69. [PMID: 31768756 DOI: 10.1007/s00701-019-04148-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to investigate the clinical outcome after microsurgical treatment of vestibular schwannomas using face-to-face four hand technique in 256 Danish patients treated in the Department of Neurosurgery at the Copenhagen University Hospital from 2009 to 2018. METHODS Data were retrospectively collected from patient records. RESULTS The mean tumor size was 30.6 mm and approximately 46% of the patients had tumors >30 mm. In around 1/3 of the patients a retrosigmoid approach was used and in 2/3 a translabyrinthine. In 50% of the patients, the tumor was completely removed, and in 38%, only smaller remnants were left to preserve facial function. The median operative time was approximately 2.5 h for retrosigmoid approach, and for translabyrinthine approach, it was around 3.5 h. One year after surgery, 84% of the patients had a good facial nerve function (House-Brackmann grade 1-2). In tumors ≤ 30 mm approximately 89% preserved good facial function, whereas this was only the case for around 78% of the patients with tumors > 30 mm. In 60% of the patients who had poor facial nerve function at hospital discharge, the function improved to good facial function within the 1 year follow-up period. Four patients died within 30 days after surgery, and 6% underwent reoperation for cerebrospinal fluid leakage. CONCLUSION Surgery for vestibular schwannomas using face-to-face four hand technique may reduce operative time and can be performed with lower risk and excellent facial nerve outcome. The risk of surgery increases with increasing tumor size.
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Affiliation(s)
| | - Jeppe Mathias Lang
- Department of Neurosurgery, Copenhagen University Hospital, DK-2100, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital, DK-2100, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Copenhagen University Hospital, DK-2100, Copenhagen, Denmark
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Drusin MA, Lubor B, Losenegger T, Selesnick S. Trends in hearing rehabilitation use among vestibular schwannoma patients. Laryngoscope 2019; 130:1558-1564. [DOI: 10.1002/lary.28316] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/30/2019] [Accepted: 08/27/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Madeleine A. Drusin
- Department of Otolaryngology–Head and Neck SurgeryWeill Cornell Medical College New York New York U.S.A
| | - Brienne Lubor
- Weill Cornell Medical College New York New York U.S.A
| | | | - Samuel Selesnick
- Department of Otolaryngology–Head and Neck SurgeryWeill Cornell Medical College New York New York U.S.A
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Delayed Tumor Growth in Vestibular Schwannoma: An Argument for Lifelong Surveillance. Otol Neurotol 2019; 40:1224-1229. [DOI: 10.1097/mao.0000000000002337] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Macielak RJ, Harris MS, Mattingly JK, Shah VS, Prevedello LM, Adunka OF. Can an Imaging Marker of Consistency Predict Intraoperative Experience and Clinical Outcomes for Vestibular Schwannomas? A Retrospective Review. J Neurol Surg B Skull Base 2019; 82:251-257. [PMID: 33777640 DOI: 10.1055/s-0039-1697026] [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: 02/03/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022] Open
Abstract
Objective The main purpose of this article is to determine if vestibular schwannoma consistency as determined by tissue intensity on T2-weighted magnetic resonance imagings (MRIs) is predictive of intraoperative experience and postoperative clinical outcomes. Study Design Retrospective chart review. Setting Tertiary referral center. Patients Seventy-seven patients diagnosed with vestibular schwannomas who were treated with microsurgical resection. Intervention Diagnostic. Main Outcome Measures Intraoperative measures include totality of resection, surgical time and cranial nerve VII stimulation and postoperative measures include House-Brackmann grade and perioperative complications. Results Tumor consistency determined via tissue intensity on MRI was only found to correlate with surgical time, with a softer tumor being associated with a longer surgical time ( p < 0.0001). However, this was primarily driven by tumor volume with larger tumors being associated with longer surgical time based on multivariate analysis. None of the other intraoperative or postoperative measures considered were found to correlate with tumor consistency. Conclusions Tumor consistency determined by MRI is not predictive of intraoperative experience or postoperative outcomes in vestibular schwannomas. Tumor volume is the strongest driver of these outcome measures as opposed to tumor consistency.
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Affiliation(s)
- Robert J Macielak
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael S Harris
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Jameson K Mattingly
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Varun S Shah
- College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Luciano M Prevedello
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Oliver F Adunka
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
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Sabab A, Sandhu J, Bacchi S, Jukes A, Zacest A. Postoperative headache following treatment of vestibular schwannoma: A literature review. J Clin Neurosci 2018; 52:26-31. [PMID: 29656878 DOI: 10.1016/j.jocn.2018.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 03/01/2018] [Accepted: 04/02/2018] [Indexed: 01/04/2023]
Abstract
Vestibular schwannoma (VS) is a brain tumour arising from Schwann cells that is typically closely associated with the vestibulocochlear nerve. Post-operative headaches (POH) are a potentially common complication of surgery for VS. Greatly differing rates of POH have previously been reported, particularly with different surgical approaches. The aim of this review is to identify and summarise the available peer-reviewed evidence on rates of POH following operative (or radiosurgery) treatment for VS, in addition to information about the treatment and prognosis of POH in these patients. A systematic search was conducted of Pubmed, Medline, Scopus and EMBASE in April 2017 using the medical subject headings (acoustic neuroma OR vestibular schwannoma) AND headache. Eligibility determination and data extraction were performed in duplicate with standardised forms. POH is common following surgery for VS. Differing rates of POH have been reported with different management approaches, patient age and tumour size. There are relatively few studies that have directly compared the rates of POH with different surgical approaches. The retrosigmoid approach with craniotomy appears to have lower rates of POH than when the retrosigmoid approach is performed with craniectomy. Patients under the age of 65 and with tumours <1.5 cm in size appear to have a higher risk of POH. The most commonly documented management of POH involves simple analgesia, although the majority of patients report this treatment is of only minimal benefit. Further prospective studies comparing rates of POH following different surgical approaches and radiosurgery are required.
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Affiliation(s)
- Ahad Sabab
- Adelaide Medical School, University of Adelaide, South Australia, Australia.
| | - Jaspreet Sandhu
- Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - Alistair Jukes
- Department of Neurosurgery, Royal Adelaide Hospital, South Australia, Australia
| | - Andrew Zacest
- Department of Neurosurgery, Royal Adelaide Hospital, South Australia, Australia
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Surgical treatment of large vestibular schwannomas in patients with neurofibromatosis type 2: outcomes on facial nerve function and hearing preservation. J Neurooncol 2018; 138:417-424. [DOI: 10.1007/s11060-018-2812-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/22/2018] [Indexed: 01/16/2023]
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Macielak RJ, Harris MS, Kirsch CF, Prevedello LM, Adunka OF. Influence of Posterior Fossa Volume on Clinical Outcomes After Vestibular Schwannoma Resection. Otol Neurotol 2017; 37:1155-61. [PMID: 27362739 DOI: 10.1097/mao.0000000000001128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the influence of posterior fossa dimensions on surgical outcomes after vestibular schwannoma management. STUDY DESIGN Retrospective chart review. SETTING Tertiary care academic medical center. PATIENTS Patients with sporadic vestibular schwannomas who underwent surgical resection via retrosigmoid or translabyrinthine techniques. INTERVENTIONS Diagnostic. MAIN OUTCOME MEASURES One and two-way analysis of variance (ANOVAs) of the cohort based on volumetric and clinical outcome groupings. RESULTS A total of 95 patients were identified. A one-way ANOVA looking at the entire cohort of patients showed that outcomes like surgical time (p < 0.001) and whether a Good Outcome (House-Brackmann score of 1 or 2, no complications, and a complete resection) was achieved (p = 0.009) correlated very well with preoperative tumor volume, but not with posterior fossa volume (p = 0.412 and p = 0.345, respectively). However, in medium sized tumors, House-Brackmann group was correlated with posterior fossa volume (p = 0.032). CONCLUSIONS The present data suggest a small effect of posterior fossa size on some clinical outcomes in medium sized vestibular schwannomas.
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Affiliation(s)
- Robert J Macielak
- *The Ohio State University College of Medicine †Department of Otolaryngology-Head & Neck Surgery, Neurotology Division, The Ohio State University ‡Department of Radiology, Division of Neuroradiology, The Ohio State University, Columbus, Ohio
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Hummel M, Perez J, Hagen R, Gelbrich G, Ernestus RI, Matthies C. Auditory Monitoring in Vestibular Schwannoma Surgery: Intraoperative Development and Outcome. World Neurosurg 2016; 96:444-453. [PMID: 27647030 DOI: 10.1016/j.wneu.2016.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/03/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The auditory brainstem response (ABR) may be a predictor of postoperative cochlear nerve function. In this study, the course of intraoperative ABR monitoring was analyzed to find predictive markers for postoperative hearing function. PATIENTS AND METHODS From 2010 to 2012, 46 patients who had had vestibular schwannoma surgery were investigated by intraoperative ABR monitoring. The type of ABR development was identified: type A, improved or stable ABR; type B, fluctuating or deteriorated ABR; and type C, slow or sudden ABR loss. Hearing function was correlated with ABR monitoring. RESULTS The different types of ABR development showed a strong correlation with postoperative hearing (P < 0.001). ABR quality after 60% tumor removal was independently significant for hearing outcome. Possible interpretations are: 1) Independent of positive factors at the start of surgery at the final phase of tumor resection, what mattered for hearing outcome was the ABR quality (P < 0.001). 2) Dependence on ABR quality in the last phase might be a result of what the cochlear nerve has endured during resection. 3) The importance of ABR quality in the last phase might be because the tumor capsule is dissected from the nerves in that final phase. ANALYSIS of critical actions with incidence of ABR impairment showed that dissection in the internal auditory canal and drilling were most critical. CONCLUSIONS Intraoperative ABR development is a predictive factor for postoperative hearing outcome. Deterioration should be avoided, because ABR improvement as a result of good status at the beginning of surgery could not be assumed.
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Affiliation(s)
- Maria Hummel
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany.
| | - Jose Perez
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Rudolf Hagen
- Department of Otolaryngology, University Hospital Würzburg, Würzburg, Germany
| | - Götz Gelbrich
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians University Würzburg, Würzburg, Germany
| | - Ralf-Ingo Ernestus
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Cordula Matthies
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
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When Does Hearing Loss Occur in Vestibular Schwannoma Surgery? Importance of Auditory Brainstem Response Changes in Early Postoperative Phase. World Neurosurg 2016; 95:91-98. [PMID: 27495840 DOI: 10.1016/j.wneu.2016.07.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/22/2016] [Accepted: 07/23/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Some patients suffer postoperative hearing loss even when the intraoperative auditory brainstem response (ABR) is preserved during vestibular schwannomas surgery. This study was conducted to evaluate whether there are dynamic changes of the ABR after surgery. PATIENTS AND METHODS In a prospective study from 2010-2012, 46 patients (24 female and 22 male) with vestibular schwannomas were investigated by intraoperative and postoperative ABR monitoring. Development of ABR quality during and after surgery (Class 1 normal, Class 5 complete loss) was correlated to auditory outcome. RESULTS At the end of surgery, 17 patients had an ABR Class 1-4 and 29 had Class 5. Four hours after surgery, 9 of 23 (39%) patients showed an ABR quality change, and 24 hours after surgery, 15 of 30 (50%) had undergone ABR quality changes. Four different types of postoperative ABR courses could be distinguished-Course 1: stable with reproducible ABR, Course 2: unstable with reproducible ABR, Course 3: unstable with ABR loss, and Course 4: stable with ABR loss. These courses correlated highly significantly with the intraoperative development (P < 0.001) and with hearing outcome (P = 0.003). CONCLUSION The study identifies ongoing changes of ABR quality and hearing function after the end of vestibular schwannoma surgery. Therefore it seems worthwhile to continue ABR monitoring in the postoperative phase in order to identify patients who are at risk of a secondary hearing deterioration and start therapeutic interventions in a timely manner.
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Brathwaite J, Mendiratta P. Radio Surgical Ablation of Acoustic Neuromas: A Unique Treatment Modality for an Elderly Woman. J Am Geriatr Soc 2016; 64:446-7. [PMID: 26889853 DOI: 10.1111/jgs.13979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jasmine Brathwaite
- Department of Geriatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Priya Mendiratta
- Department of Geriatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Tveiten OV, Carlson ML, Goplen F, Vassbotn F, Link MJ, Lund-Johansen M. Long-term Auditory Symptoms in Patients With Sporadic Vestibular Schwannoma: An International Cross-Sectional Study. Neurosurgery 2016; 77:218-27; discussion 227. [PMID: 25850598 DOI: 10.1227/neu.0000000000000760] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are limited data on the long-term auditory symptoms in patients with sporadic small- and medium-sized vestibular schwannoma (VS). The initial treatment strategy for VS is controversial. OBJECTIVE To characterize auditory symptoms in a large cohort of patients with VS. METHODS Patients with ≤3 cm VS who underwent primary microsurgery, gamma knife surgery, or observation between 1998 and 2008 at 2 independent hospitals were identified. Clinical data were extracted from existing VS databases. At a mean time of 7.7 years after initial treatment, patients were surveyed via mail with the use of the Hearing Handicap Inventory for Adults (HHIA) and the Tinnitus Handicap Inventory. RESULTS The response rate was 79%; a total of 539 respondents were analyzed. Overall, the hearing prognosis was poor, because more than 75% of all patients had nonserviceable hearing at the last clinical follow-up. Good baseline hearing proved to be a strong predictor for maintained serviceable hearing. Treatment modality was independently associated with both audiometric outcome and HHIA results. Active treatment with microsurgery or gamma knife surgery did not appear to be protective, because patients who were observed had the greatest probability of durable hearing. Patients in the surgical series had the greatest hearing loss. Tinnitus Handicap Inventory results were less predictable. The only predictors of tinnitus handicap were age and HHIA score. CONCLUSION The overall prognosis for hearing in sporadic VS is poor regardless of treatment strategy. Treatment modality was an independent predictor of hearing status; observation was associated with the highest rate of hearing preservation. .
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Affiliation(s)
- Oystein Vesterli Tveiten
- *Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway; ‡Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota; §Department of Otorhinolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway; ¶Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota; ‖Department of Clinical Medicine, University of Bergen, Bergen, Norway
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