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Vaz MAS, Gonçalves RF, Lavinsky J, Rassier Isolan G. Non-Hodgkin Lymphoma Mimicking Vestibular Schwannoma. Cureus 2023; 15:e50965. [PMID: 38249266 PMCID: PMC10800159 DOI: 10.7759/cureus.50965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Progressive unilateral hearing loss and an MRI are usually enough to diagnose vestibular schwannoma (VS). We were consulted by a 45-year-old man with otalgia and left-sided hearing loss as well as ipsilateral facial paralysis that had begun two weeks prior. Due to a possible atypical presentation of VS, an MRI was ordered, which revealed an intracanalicular lesion occupying the left cerebellopontine angle cistern. With no signs of systemic disease and considering the total left ear deafness, the patient underwent retrolabyrinthine mastoidectomy. During the procedure, a mass incompatible with VS was found and a biopsy was performed, which led to a diagnosis of non-Hodgkin's lymphoma (NHL). The patient was referred to an oncologist for treatment and, in time, achieved complete remission of the lesion. This case shows us that symptoms of VS may vary in tumor size and location and that atypical presentations warrant investigation. Non-Hodgkin's lymphoma (NHL), although not among the most common differential diagnoses, should be remembered due to its varied clinical presentation broadly dependent on its subtype and dissemination.
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Affiliation(s)
- Marco Antônio S Vaz
- Department of Neurosurgery, The Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, BRA
| | - Rafaela F Gonçalves
- Department of Neurology, The Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, BRA
| | - Joel Lavinsky
- Department of Morphological Sciences, Federal University of Rio Grande do Sul, Porto Alegre, BRA
| | - Gustavo Rassier Isolan
- Department of Neurosurgery, The Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, BRA
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Joudar I, Nasri S, Aichouni N, Kamaoui I, Skiker I. Is vestibular schwannoma really a benign tumor? Case report and review. Ann Med Surg (Lond) 2023; 85:6206-6210. [PMID: 38098578 PMCID: PMC10718345 DOI: 10.1097/ms9.0000000000001418] [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: 06/12/2023] [Accepted: 10/09/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Vestibular schwannoma (VS) is a benign tumor that develops from Schwann cells of the eighth cranial pair, mainly in the cerebellopontine angle. Case Presentation We report the case of a 30-year-old female patient who developed left otalgia associated with neglected tinnitus, the evolution of which was marked by the development of a static cerebellar syndrome and a behavioral disorder, whose brain MRI revealed a locally advanced process in the cerebellopontine angle at the expense of the vestibulocochlear nerve, in favor of a VS, complicated by involvement of the tonsils, which unfortunately led to the patient's death. Discussion VS, formerly known as acoustic neuroma, is an extra-axial intracranial tumor that accounts for over 80% of pontocerebellar angle tumors, and is secondary in the majority of cases to inactivation of the neurofibromatosis type 2 (NF2) tumor suppressor gene, either by mutation of the NF2 gene or loss of chromosome 22q. In the majority of cases, it is unilateral and solitary, but in almost 8% of cases, it is associated with NF2. Cerebral MRI is the examination of choice for the detection, characterization, and diagnosis of VS without the need for biopsy, mainly with T1-weighted sequences before and after gadolinium injection. Treatment is based essentially on surgery or radiosurgery, depending on the size, impact, and expertise of the treatment team. Conclusion VS remains an important intracranial tumor entity, which can be life-threatening in cases of advanced local invasion.
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Affiliation(s)
- Imane Joudar
- Faculty of Medicine and Pharmacy
- Department of Radiology, Mohammed VI University Hospital, Mohammed I University
| | - Siham Nasri
- Faculty of Medicine and Pharmacy
- Department of Radiology, Mohammed VI University Hospital, Mohammed I University
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
| | - Narjisse Aichouni
- Faculty of Medicine and Pharmacy
- Department of Radiology, Mohammed VI University Hospital, Mohammed I University
| | - Imane Kamaoui
- Faculty of Medicine and Pharmacy
- Department of Radiology, Mohammed VI University Hospital, Mohammed I University
| | - Imane Skiker
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
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Silva VAR, Lavinsky J, Pauna HF, Vianna MF, Santos VM, Ikino CMY, Sampaio ALL, Tardim Lopes P, Lamounier P, Maranhão ASDA, Soares VYR, Polanski JF, Denaro MMDC, Chone CT, Bento RF, Castilho AM. Brazilian Society of Otology task force - Vestibular Schwannoma ‒ evaluation and treatment. Braz J Otorhinolaryngol 2023; 89:101313. [PMID: 37813009 PMCID: PMC10563065 DOI: 10.1016/j.bjorl.2023.101313] [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: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE To review the literature on the diagnosis and treatment of vestibular schwannoma. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. CONCLUSIONS Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO
| | - Joel Lavinsky
- Sociedade Brasileira de Otologia - SBO; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Ciências Morfológicas, Porto Alegre, RS, Brazil
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Melissa Ferreira Vianna
- Sociedade Brasileira de Otologia - SBO; Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Vanessa Mazanek Santos
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Cláudio Márcio Yudi Ikino
- Universidade Federal de Santa Catarina, Hospital Universitário, Departamento de Cirurgia, Florianópolis, SC, Brazil
| | - André Luiz Lopes Sampaio
- Sociedade Brasileira de Otologia - SBO; Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Paula Tardim Lopes
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Pauliana Lamounier
- Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), Departamento de Otorrinolaringologia, Goiânia, GO, Brazil
| | - André Souza de Albuquerque Maranhão
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Vitor Yamashiro Rocha Soares
- Hospital Flavio Santos e Hospital Getúlio Vargas, Grupo de Otologia e Base Lateral do Crânio, Teresina, PI, Brazil
| | - José Fernando Polanski
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil; Faculdade Evangélica Mackenzie do Paraná, Faculdade de Medicina, Curitiba, PR, Brazil
| | | | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Ricardo Ferreira Bento
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO.
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Cho KR, Choi JH, Kim BY, Chang YS. Unilateral sudden sensorineural hearing loss with vertigo as a first symptom of bilateral internal auditory canal metastases: a case report. J Int Med Res 2021; 49:3000605211053553. [PMID: 34693781 PMCID: PMC8642159 DOI: 10.1177/03000605211053553] [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] [Indexed: 11/16/2022] Open
Abstract
There have been relatively few reports of bilateral internal auditory canal metastases of asymptomatic primary pulmonary adenocarcinoma presenting as unilateral sudden sensorineural hearing loss and vertigo. We report a case of a 60-year-old male patient who complained of sudden hearing loss in the right ear and vertigo. Upon a physical examination, no definite neurological signs or nystagmus were observed. Pure-tone audiometry showed deafness in the right ear at all frequencies and high-frequency sensorineural hearing loss in the left ear. The video head impulse test suggested bilateral vestibulopathy. Magnetic resonance imaging of the brain (with gadolinium contrast) revealed bilateral internal auditory canal enhancement and a variable-sized nodular and peripheral-enhancing lesion in the cerebrum and the right cerebellum. A computed tomographic and bronchoscopic biopsy identified asymptomatic primary pulmonary adenocarcinoma in the left upper lobe of the lungs. This is a rare report of bilateral internal auditory canal metastases in an asymptomatic patient with primary pulmonary adenocarcinoma who initially presented with symptoms of unilateral sudden sensorineural hearing loss with vertigo.
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Affiliation(s)
- Kyoung Rai Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Jeong Hwan Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Bo Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Young-Soo Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
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Renzi S, Michaeli O, Salvador H, Alderete D, Ponce NF, Zapotocky M, Hansford JR, Malalasekera VS, Toledano H, Maguire B, Bouffet E, Ramaswamy V, Baroni LV. Bevacizumab for NF2-associated vestibular schwannomas of childhood and adolescence. Pediatr Blood Cancer 2020; 67:e28228. [PMID: 32124552 DOI: 10.1002/pbc.28228] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/24/2020] [Accepted: 02/04/2020] [Indexed: 11/05/2022]
Abstract
Seventeen children at six institutions with neurofibromatosis type 2 (NF2)-related vestibular schwannomas received bevacizumab. Eight of the 13 patients with initial hearing loss (61%) showed objective hearing improvement within six months of treatment. No patients showed hearing deterioration during therapy; however, only two patients showed objective radiological response. Seven of eight patients had tumor progression or worsening hearing loss upon cessation of treatment. Bevacizumab was well tolerated with no patients discontinuing therapy. Bevacizumab appears to postpone hearing loss in childhood NF2-associated vestibular schwannomas, but responses are not durable, suggesting that either longer maintenance therapy or new strategies are required.
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Affiliation(s)
- Samuele Renzi
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Orli Michaeli
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Haematology/Oncology, Schneider Medical Center of Israel, Petah Tikva, Israel
| | - Hector Salvador
- Pediatric Oncology Department, Neurocutaneous Disorders and Cancer Predisposition Unit, Sant Joan de Deu, Barcelona, Spain
| | - Daniel Alderete
- Service of Hematology/Oncology, Hospital JP Garrahan, Buenos Aires, Argentina
| | | | - Michal Zapotocky
- Department of Paediatric Haematology and Oncology, Second Medical School, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jordan R Hansford
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia.,Division of Cancer, Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Helen Toledano
- Division of Haematology/Oncology, Schneider Medical Center of Israel, Petah Tikva, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Bryan Maguire
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics and Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Lorena V Baroni
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Service of Hematology/Oncology, Hospital JP Garrahan, Buenos Aires, Argentina
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Scholte M, Hentschel M, Kunst H, Steens S, Rovers M, Grutters J. Potential savings in the diagnosis of vestibular schwannoma. Clin Otolaryngol 2017; 43:285-290. [DOI: 10.1111/coa.12973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2017] [Indexed: 11/27/2022]
Affiliation(s)
- M. Scholte
- Department of Operating Rooms; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - M.A. Hentschel
- Department of Otolaryngology; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - H.P. Kunst
- Department of Otolaryngology; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - S.C.A. Steens
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - M.M. Rovers
- Department of Operating Rooms; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Health Evidence; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - J.P.C. Grutters
- Department of Operating Rooms; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Health Evidence; Radboud Institute of Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
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Crowson MG, Rocke DJ, Hoang JK, Weissman JL, Kaylie DM. Cost-effectiveness analysis of a non-contrast screening MRI protocol for vestibular schwannoma in patients with asymmetric sensorineural hearing loss. Neuroradiology 2017. [PMID: 28623482 DOI: 10.1007/s00234-017-1859-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to determine if a non-contrast screening MRI is cost-effective compared to a full MRI protocol with contrast for the evaluation of vestibular schwannomas. METHODS A decision tree was constructed to evaluate full MRI and screening MRI strategies for patients with asymmetric sensorineural hearing loss. If a patient were to have a positive screening MRI, s/he received a full MRI. Vestibular schwannoma prevalence, MRI specificity and sensitivity, and gadolinium anaphylaxis incidence were obtained through literature review. Institutional charge data were obtained using representative patient cohorts. One-way and probabilistic sensitivity analyses were completed to determine CE model threshold points for MRI performance characteristics and charges. RESULTS The mean charge for a full MRI with contrast was significantly higher than a screening MRI ($4089 ± 1086 versus $2872 ± 741; p < 0.05). The screening MRI protocol was more cost-effective than a full MRI protocol with a willingness-to-pay from $0 to 20,000 USD. Sensitivity analyses determined that the screening protocol dominated when the screening MRI charge was less than $4678, and the imaging specificity exceeded 78.2%. The screening MRI protocol also dominated when vestibular schwannoma prevalence was varied between 0 and 1000 in 10,000 people. CONCLUSION A screening MRI protocol is more cost-effective than a full MRI with contrast in the diagnostic evaluation of a vestibular schwannoma. A screening MRI likely also confers benefits of shorter exam time and no contrast use. Further investigation is needed to confirm the relative performance of screening protocols for vestibular schwannomas.
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Affiliation(s)
- Matthew G Crowson
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Daniel J Rocke
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Jenny K Hoang
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Jane L Weissman
- Professor Emerita of Diagnostic Radiology, Oregon Health Sciences University, Portland, OR, USA
| | - David M Kaylie
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA
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Skolnik AD, Loevner LA, Sampathu DM, Newman JG, Lee JY, Bagley LJ, Learned KO. Cranial Nerve Schwannomas: Diagnostic Imaging Approach. Radiographics 2016; 36:1463-77. [PMID: 27541436 DOI: 10.1148/rg.2016150199] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Schwannomas are benign nerve sheath tumors that may arise along the complex course of the cranial nerves (CNs), anywhere in the head and neck. Sound knowledge of the CN anatomy and imaging features of schwannomas is paramount for making the correct diagnosis. In this article, we review approaches to diagnosing CN schwannomas by describing their imaging characteristics and the associated clinical presentations. Relevant anatomic considerations are highlighted by using illustrative examples and key differential diagnoses categorized according to regions, which include the anterior skull base, orbit, cavernous sinus, basal cisterns, and neck. The clinical presentations associated with CN schwannomas vary and range from no symptoms to symptoms caused by mass effect or CN deficits. Individuals with the inherited disorder neurofibromatosis type 2 are predisposed to multiple schwannomas. When a lesion follows the course of a CN, the radiologist's roles are to confirm the imaging features of schwannoma and exclude appropriate differential considerations. The characteristic imaging features of CN schwannomas reflect their slow growth as benign neoplasms and include circumscribed margins, displacement of local structures, and smooth expansion of osseous foramina. These neoplasms exhibit various degrees of solid enhancement, often with internal cystic spaces on magnetic resonance (MR) and computed tomographic (CT) images and heterogeneous high signal intensity specifically on T2-weighted MR images. Clinical and/or imaging evidence of end-organ compromise of the involved CN may exist and aid in the identification of the nerve of origin. With a detailed understanding of the course of the CNs, the diagnostic features of CN schwannomas, and the correlation between these data and the associated clinical presentations of these tumors, the radiologist can have a key role in the diagnosis of CN schwannomas and the treatment planning for affected patients. (©)RSNA, 2016.
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Affiliation(s)
- Aaron D Skolnik
- From the Departments of Radiology (A.D.S., L.A.L., D.M.S., L.J.B., K.O.L.), Otorhinolaryngology (J.G.N.), and Neurosurgery (J.Y.L.), University of Pennsylvania Health System, Hospital of the University of Pennsylvania, 3400 Spruce St, 2 Dulles Room 219, Philadelphia, PA 19104
| | - Laurie A Loevner
- From the Departments of Radiology (A.D.S., L.A.L., D.M.S., L.J.B., K.O.L.), Otorhinolaryngology (J.G.N.), and Neurosurgery (J.Y.L.), University of Pennsylvania Health System, Hospital of the University of Pennsylvania, 3400 Spruce St, 2 Dulles Room 219, Philadelphia, PA 19104
| | - Deepak M Sampathu
- From the Departments of Radiology (A.D.S., L.A.L., D.M.S., L.J.B., K.O.L.), Otorhinolaryngology (J.G.N.), and Neurosurgery (J.Y.L.), University of Pennsylvania Health System, Hospital of the University of Pennsylvania, 3400 Spruce St, 2 Dulles Room 219, Philadelphia, PA 19104
| | - Jason G Newman
- From the Departments of Radiology (A.D.S., L.A.L., D.M.S., L.J.B., K.O.L.), Otorhinolaryngology (J.G.N.), and Neurosurgery (J.Y.L.), University of Pennsylvania Health System, Hospital of the University of Pennsylvania, 3400 Spruce St, 2 Dulles Room 219, Philadelphia, PA 19104
| | - John Y Lee
- From the Departments of Radiology (A.D.S., L.A.L., D.M.S., L.J.B., K.O.L.), Otorhinolaryngology (J.G.N.), and Neurosurgery (J.Y.L.), University of Pennsylvania Health System, Hospital of the University of Pennsylvania, 3400 Spruce St, 2 Dulles Room 219, Philadelphia, PA 19104
| | - Linda J Bagley
- From the Departments of Radiology (A.D.S., L.A.L., D.M.S., L.J.B., K.O.L.), Otorhinolaryngology (J.G.N.), and Neurosurgery (J.Y.L.), University of Pennsylvania Health System, Hospital of the University of Pennsylvania, 3400 Spruce St, 2 Dulles Room 219, Philadelphia, PA 19104
| | - Kim O Learned
- From the Departments of Radiology (A.D.S., L.A.L., D.M.S., L.J.B., K.O.L.), Otorhinolaryngology (J.G.N.), and Neurosurgery (J.Y.L.), University of Pennsylvania Health System, Hospital of the University of Pennsylvania, 3400 Spruce St, 2 Dulles Room 219, Philadelphia, PA 19104
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The role of preoperative imaging for cochlear implantation in postlingually deafened adults. Otol Neurotol 2015; 35:1536-40. [PMID: 25032941 DOI: 10.1097/mao.0000000000000499] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preoperative imaging is standard practice for cochlear implant candidacy. Postlingually deafened adults rarely have temporal bone abnormalities that alter management. OBJECTIVES/HYPOTHESIS To determine the role of preoperative imaging for cochlear implantation in postlingually deafened adults. We hypothesize that imaging does not alter management in the absence of history or physical examination findings suggestive of an anatomic abnormality. STUDY DESIGN Nested case-control study. METHODS We identified postlingually deafened adults with preoperative imaging and cochlear implantation at our institution from 1995 to 2008. Controls had a negative history and normal exam. Cases had suggestive history or exam. Imaging studies and operative records were reviewed. RESULTS Approximately 164 patients met inclusion criteria-59 cases and 109 controls. Mean age at onset of hearing loss was 30.4 years (range, 0-73 yr), mean age at onset of deafness was 54.1 years (range, 9-89 yr), and mean age at implantation was 61.5 years (range, 20.6-89.7 yr). Twenty cases (34%) and 17 controls (16%) had abnormal imaging (p = 0.001). Six cases (8.5%) and 2 controls (1.8%) had changes in their management as a result of the imaging findings (p = 0.023). Both control patients had incidentally detected acoustic neuromas, which altered the side of the cochlear implantation. There was a strong association between preoperative history and exam findings and abnormality on imaging (p = 0.007). Abnormalities were 3 times more likely in patients with a positive history or exam (OR = 2.98; 95% CI, 1.36-6.54). CONCLUSION In patients with a negative history and examination, imaging rarely alters management. MRI may detect incidental vestibular schwannomas in patients with asymmetric hearing losses. LEVEL OF EVIDENCE 3b, Individual case-control study.
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Abstract
Auditory processing can be disrupted by brainstem lesions. It is estimated that approximately 57% of brainstem lesions are associated with auditory disorders. However diseases of the brainstem usually involve many structures, producing a plethora of other neurologic deficits, often relegating "auditory symptoms in the background." Lesions below or within the cochlear nuclei result in ipsilateral auditory-processing abnormalities detected in routine testing; disorders rostral to the cochlear nuclei may result in bilateral abnormalities or may be silent. Lesions in the superior olivary complex and trapezoid body show a mixture of ipsilateral, contralateral, and bilateral abnormalities, whereas lesions of the lateral lemniscus, inferior colliculus, and medial geniculate body do not affect peripheral auditory processing and result in predominantly subtle contralateral abnormalities that may be missed by routine auditory testing. In these cases psychophysical methods developed for the evaluation of central auditory function should be employed (e.g., dichotic listening, interaural time perception, sound localization). The extensive connections of the auditory brainstem nuclei not only are responsible for binaural interaction but also assure redundancy in the system. This redundancy may explain why small brainstem lesions are sometimes clinically silent. Any disorder of the brainstem (e.g., neoplasms, vascular disorders, infections, trauma, demyelinating disorders, neurodegenerative diseases, malformations) that involves the auditory pathways and/or centers may produce hearing abnormalities.
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Kulwin CG, Cohen-Gadol AA. Technical nuances of resection of giant (> 5 cm) vestibular schwannomas: pearls for success. Neurosurg Focus 2012; 33:E15. [DOI: 10.3171/2012.7.focus12177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Removal of vestibular schwannomas (VSs, or acoustic neuromas) remains one of the most challenging operations in neurosurgery. Giant or huge tumors (> 5 cm) heighten these challenges, and technical nuances play a special role in maximizing tumor resection while minimizing complications. In this article, the senior author describes his technical experience with microsurgical excision of giant VSs. The accompanying video further illustrates these details.
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Nikolaou G, Röösli C, Huber A, Probst R. Neuromuscular Choristoma of the Internal Auditory Meatus. ACTA ACUST UNITED AC 2012; 74:246-9. [DOI: 10.1159/000342793] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 08/20/2012] [Indexed: 11/19/2022]
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