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Shi X, Liu Y, Zhang Z, Tao B, Zhang D, Jiang Q, Chen G, Ma H, Feng Y, Xie J, Zheng X, Zhang J. The value of radiographic features in predicting postoperative facial nerve function in vestibular schwannoma patients: A retrospective study and nomogram analysis. CNS Neurosci Ther 2024; 30:e14526. [PMID: 37990346 PMCID: PMC11017437 DOI: 10.1111/cns.14526] [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: 08/20/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE The purpose of this study was to identify significant prognostic factors associated with facial paralysis after vestibular schwannoma (VS) surgery and develop a novel nomogram for predicting facial nerve (FN) outcomes. METHODS Retrospective data were retrieved from 355 patients who underwent microsurgery via the retrosigmoid approach for VS between December 2017 and December 2022. Univariate and multivariate logistic regression analysis were used to construct a radiographic features-based nomogram to predict the risk of facial paralysis after surgery. RESULTS Following a thorough screening process, a total of 185 participants were included. The univariate and multivariate logistic regression analysis revealed that tumor size (p = 0.005), fundal fluid cap (FFC) sign (p = 0.014), cerebrospinal fluid cleft (CSFC) sign (p < 0.001), and expansion of affected side of internal auditory canal (IAC) (p = 0.033) were independent factors. A nomogram model was constructed based on these indicators. When applied to the validation cohort, the nomogram demonstrated good discrimination and favorable calibration. Then we generated a web-based calculator to facilitate clinical application. CONCLUSION Tumor size, FFC and CSFC sign, and the expansion of the IAC, serve as good predictors of postoperative FN outcomes. Based on these factors, the nomogram model demonstrates good predictive performance.
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Affiliation(s)
- Xudong Shi
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Yuyang Liu
- Department of Neurosurgery920th Hospital of Joint Logistics Support ForceKunmingChina
| | - Zehan Zhang
- Department of Neurosurgerythe Air Force Hospital of Southern Theater CommandGuangzhouChina
| | - Bingyan Tao
- Department of Neurosurgery961th Hospital of Joint Logistics Support ForceQiqiharChina
| | - Ding Zhang
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Qingyu Jiang
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Guilin Chen
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Hengchao Ma
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Yaping Feng
- Department of Neurosurgery920th Hospital of Joint Logistics Support ForceKunmingChina
| | - Jiaxin Xie
- Department of Neurosurgery920th Hospital of Joint Logistics Support ForceKunmingChina
| | - Xuan Zheng
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
| | - Jun Zhang
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
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Machetanz K, Lee L, Wang SS, Tatagiba M, Naros G. Trading mental and physical health in vestibular schwannoma treatment decision. Front Oncol 2023; 13:1152833. [PMID: 37434979 PMCID: PMC10332305 DOI: 10.3389/fonc.2023.1152833] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/08/2023] [Indexed: 07/13/2023] Open
Abstract
Objective Observation, radiotherapy and surgery are treatment options in vestibular schwannomas (VS). Decision making differs between centers and is usually based on tumor characteristics (e.g., size) and the expected physical health (PH) outcome (i.e., hearing and facial function). However, mental health (MH) is often under-reported. The objective of the present study was to ascertain the impact of VS treatment on PH and MH. Methods PH and MH were assessed in a prospective cross-sectional study including 226 patients with unilateral sporadic VS before and after surgical removal (SURG). Quality-of-life (QoL) was estimated by self-rating questionnaires: general Short-Form Health Survey (SF-36), Penn Acoustic Neuroma Quality-of-Life Scale (PANQOL), Dizziness Handicap Inventory (DHI), Hearing Handicap Inventory (HHI), Tinnitus Handicap Inventory (THI), and Facial Disability Index (FDI). QoL changes over time as well as predictive factors were accessed by multivariate analyses of covariance (MANCOVA). Results In total, 173 preoperative and 80 postoperative questionnaires were analyzed. There was a significant PH deterioration related to facial function (FDI, PANQOL-face) after surgery. In line with facial rehabilitation, however, FDI improved within the first five years after surgery and did not differ compared to the preoperative patient cohort, eventually. In contrast, MH (i.e., PANQOL-anxiety) and general health (i.e., PANQOL-GH) improved with surgery and correlated with the extent-of-resection. Conclusion Physical and mental health is significantly influenced by VS surgery. While PH might decrease after surgery, MH potentially increases when patient is cured. Practitioners should take MH into account before advising an incompletely VS treatment (e.g., subtotal resection, observation or radiosurgery).
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Affiliation(s)
- Kathrin Machetanz
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Larissa Lee
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Sophie S Wang
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Marcos Tatagiba
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Georgios Naros
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
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Erickson NJ, Mooney JH, Walters BC, Agee B, Fisher WS. The Validity of the Koos Classification System With Respect to Facial Nerve Function. Neurosurgery 2021; 88:E523-E528. [PMID: 33862623 DOI: 10.1093/neuros/nyab086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Koos classification of vestibular schwannomas is designed to stratify tumors based on extrameatal extension and compression of the brainstem. Our prior study demonstrated excellent reliability. No study has yet assessed its validity. OBJECTIVE To present a retrospective study designed to assess the validity of the Koos grading system with respect to facial nerve function following treatment of 81 acoustic schwannomas. METHODS We collected data retrospectively from 81 patients with acoustic schwannomas of various Koos grades who were treated with microsurgical resection or stereotactic radiosurgery. House-Brackmann (HB) scores were used to assess facial nerve function and obtained at various time points following treatment. We generated Spearman's rho and Kendall's tau correlation coefficients along with a logistic regression curve. RESULTS We found no significant difference in the presence or absence of facial dysfunction by Koos classification when looking at all patients. There was a positive but fairly weak correlation between HB score and Koos classification, which was only significant at the first postoperative clinic appointment. There was a statistically significant difference in the presence or absence of facial dysfunction between patients treated with surgery vs radiation, which we expected. We found no statistically significant difference when comparing surgical approaches. Logistic regression modeling demonstrated a poor ability of the Koos grading system to predict facial nerve dysfunction following treatment. CONCLUSION The Koos grading system did not predict the presence of absence of facial nerve dysfunction in our study population. There were trends within subgroups that require further exploration.
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Affiliation(s)
- Nicholas J Erickson
- Department of Neurological Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James H Mooney
- Department of Neurological Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Beverly C Walters
- Department of Neurological Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bonita Agee
- Department of Neurological Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Winfield S Fisher
- Department of Neurological Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Behling F, Suhm E, Ries V, Gonçalves VM, Tabatabai G, Tatagiba M, Schittenhelm J. COX2 expression is associated with preoperative tumor volume but not with volumetric tumor growth in vestibular schwannoma. Neurol Res Pract 2021; 3:11. [PMID: 33641674 PMCID: PMC7919305 DOI: 10.1186/s42466-021-00111-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Vestibular schwannomas (VS) are benign slow growing tumors arising from the vestibular nerve. The role of cyclooxygenase 2 (COX2) in tumor development of growth has been addressed in a few studies with contradictory results and suggestions. We recently analyzed the immunohistochemical expression of COX2 in 1044 VS samples and described an association of higher COX2 expression with proliferation but found no influence by regular intake of acetylsalicylic acid. We now collected volumetric radiographic data of the preoperative tumor volume and growth to further test the role of COX2 in VS growth. METHODS Preoperative images of 898 primary sporadic vestibular schwannomas were assessed, and sufficient preoperative imaging was used for the volumetric measurement preoperative tumor volume (n = 747) and preoperative relative tumor growth (n = 171). Clinical parameters and results of the immunohistochemical expression of COX2 and MIB1 in resected tumor tissue samples were obtained from our prior study. ANOVA, CART-analysis and multivariate nominal logistic regression were used for statistical analysis. RESULTS Larger preoperative tumor volumes were observed with tumors of younger patients (p = 0.0288) and with higher COX2 expression scores (p < 0.0001). Higher MIB1 expression was associated with smaller tumors (p = 0.0149) but with increased radiographic tumor growth (p = 0.0003). Patients of older age had tumors with slower growth rates (p = 0.0311). In the multivariate analysis only MIB1 expression was an independent significant factor regarding tumor growth (p = 0.0002). CONCLUSIONS Higher expression of COX2 in schwannoma is associated with an increased preoperative tumor volume but not with radiographic tumor growth over time.
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Affiliation(s)
- Felix Behling
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler Street 3, Tübingen, Germany. .,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen - Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.
| | - Elisa Suhm
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler Street 3, Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen - Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Vanessa Ries
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler Street 3, Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen - Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Vítor Moura Gonçalves
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler Street 3, Tübingen, Germany.,Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - Ghazaleh Tabatabai
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler Street 3, Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen - Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.,Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.,Hertie Institute for Clinical Brain Research, Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler Street 3, Tübingen, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen - Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Jens Schittenhelm
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen - Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.,Department of Neuropathology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
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Kunigelis KE, Hosokawa P, Arnone G, Raban D, Starr A, Gurau A, Sunshine A, Bunn J, Thaker AA, Youssef AS. The predictive value of preoperative apparent diffusion coefficient (ADC) for facial nerve outcomes after vestibular schwannoma resection: clinical study. Acta Neurochir (Wien) 2020; 162:1995-2005. [PMID: 32440924 DOI: 10.1007/s00701-020-04338-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/07/2020] [Indexed: 02/07/2023]
Abstract
OBJECT Diffusion MRI has been used to predict intraoperative consistency of tumors. Apparent diffusion coefficient (ADC) has shown predictive value as an imaging biomarker in many CNS tumors but has not been studied in a large cohort of patients with vestibular schwannoma. In this study, we examine the utility of ADC as a predictive biomarker for intraoperative tumor characteristics and postoperative facial nerve outcome. METHODS A retrospective review of patients who underwent vestibular schwannoma resection at our institution from 2008 to 2018 yielded 87 patients, of which 72 met inclusion criteria. Operative reports and clinical records were reviewed for clinical data; MRI data were interpreted in a blinded fashion for qualitative and quantitative biomarkers, including tumor ADC. RESULTS Mean tumor ADC values did not predict intraoperative consistency or adherence (p = 0.63). Adherent tumors were associated with worse facial nerve outcomes (p = 0.003). Regression tree analysis identified 3 ADC categories with statistically different facial nerve outcomes. The categories identified were ADC < 1006.04 × 10-6 mm2/s; ADC 1006.04-1563.93 × 10-6 mm2/s and ADC ≥ 1563.94 × 10-6 mm2/s. Postoperative and final House-Brackmann (HB) scores were significantly higher in the intermediate ADC group (2.3, p = 0.0038). HB outcomes were similar between the group with ADC < 1006.04 × 10-6 mm2/s and ≥ 1563.94 × 10-6 mm2/s (1.3 vs 1.3). CONCLUSIONS Middle-range preoperative ADC in vestibular schwannoma suggests a less favorable postoperative HB score. Preoperative measurement of ADC in vestibular schwannoma may provide additional information regarding prognostication of facial nerve outcomes.
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Affiliation(s)
- Katherine E Kunigelis
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Patrick Hosokawa
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, USA
| | - Gregory Arnone
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - David Raban
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Adam Starr
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Andrei Gurau
- University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Alexis Sunshine
- University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Jason Bunn
- University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Ashesh A Thaker
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - A Samy Youssef
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
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Facial Nerve Outcomes Following Total Excision of Vestibular Schwannoma by the Enlarged Translabyrinthine Approach. Otol Neurotol 2020; 40:226-235. [PMID: 30570604 DOI: 10.1097/mao.0000000000002068] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the early and late facial nerve (FN) outcomes in different tumor classes in addition to determining the predictive factors for the same. STUDY DESIGN A retrospective clinical study. SETTING A quaternary referral otology and skull base center. PATIENTS AND METHODS A retrospective study of 1983 cases of vestibular schwannomas (VSs) with preoperative normal FN function, undergoing total excision with anatomical preservation of the nerve by enlarged translabyrinthine approach (ETLA) were included. FN status was recorded postoperatively at day 1, at discharge, and at 1-year follow-up and were analyzed in different tumor sizes. RESULTS At 1 year, 988 patients with House-Brackmann (H-B) grade I and II FN at day 1 after surgery, 958 (96.9%) maintained their status up-to 1 year. Of the 216 patients with H-B grade III at day 1 after surgery, 113 (52.3%) improved to H-B grade I and II. Similarly, of the 779 patients with H-B grade IV and VI FN function at day 1 after surgery, improvement to H-B III and H-B I and II were noted in 442 (56.7%) and 80 (10.3%) of patients, respectively. Intrameatal and extrameatal tumors upto 2 cm showed better recovery from H-B grade III to H-B I and II and from H-B grade IV and VI to H-B I and III when compared with extrameatal tumors >2 cm (p = 0.001). CONCLUSION Tumors of smaller sizes have good immediate postoperative FN results and recover well at the end of 1 year while more than 3 cm have poor outcomes and recover poorly at the end of 1 year. When the VSs reaches more than 1 cm, the HB I and II outcomes drop significantly.
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Bunevicius A, Schregel K, Sinkus R, Golby A, Patz S. REVIEW: MR elastography of brain tumors. NEUROIMAGE-CLINICAL 2019; 25:102109. [PMID: 31809993 PMCID: PMC6909210 DOI: 10.1016/j.nicl.2019.102109] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 12/28/2022]
Abstract
MR elastography allows non-invasive quantification of the shear modulus of tissue. MRE correlates with intra-operative consistency of meningiomas, pituitary adenomas. Reported shear modulus values are widely distributed and overlap. Meningiomas were the stiffest tumor-type relative to normal appearing white matter. Studies are needed to determine clinical applications of MRE in neuro-oncology.
MR elastography allows non-invasive quantification of the shear modulus of tissue, i.e. tissue stiffness and viscosity, information that offers the potential to guide presurgical planning for brain tumor resection. Here, we review brain tumor MRE studies with particular attention to clinical applications. Studies that investigated MRE in patients with intracranial tumors, both malignant and benign as well as primary and metastatic, were queried from the Pubmed/Medline database in August 2018. Reported tumor and normal appearing white matter stiffness values were extracted and compared as a function of tumor histopathological diagnosis and MRE vibration frequencies. Because different studies used different elastography hardware, pulse sequences, reconstruction inversion algorithms, and different symmetry assumptions about the mechanical properties of tissue, effort was directed to ensure that similar quantities were used when making inter-study comparisons. In addition, because different methodologies and processing pipelines will necessarily bias the results, when pooling data from different studies, whenever possible, tumor values were compared with the same subject's contralateral normal appearing white matter to minimize any study-dependent bias. The literature search yielded 10 studies with a total of 184 primary and metastatic brain tumor patients. The group mean tumor stiffness, as measured with MRE, correlated with intra-operatively assessed stiffness of meningiomas and pituitary adenomas. Pooled data analysis showed significant overlap between shear modulus values across brain tumor types. When adjusting for the same patient normal appearing white matter shear modulus values, meningiomas were the stiffest tumor-type. MRE is increasingly being examined for potential in brain tumor imaging and might have value for surgical planning. However, significant overlap of shear modulus values between a number of different tumor types limits applicability of MRE for diagnostic purposes. Thus, further rigorous studies are needed to determine specific clinical applications of MRE for surgical planning, disease monitoring and molecular stratification of brain tumors.
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Affiliation(s)
- Adomas Bunevicius
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States; Harvard Medical School, Boston, MA, United States.
| | - Katharina Schregel
- Institute of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Ralph Sinkus
- Inserm U1148, LVTS, University Paris Diderot, University Paris 13, Paris, France
| | - Alexandra Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States; Harvard Medical School, Boston, MA, United States; Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Samuel Patz
- Harvard Medical School, Boston, MA, United States; Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, United States.
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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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Ryu SM, Kim SK, Park JH, Lee SH, Eoh W, Kim ES. Subtotal Resection of Cervical Dumbbell Schwannomas: Radiographic Predictors for Surgical Considerations. World Neurosurg 2018; 121:e661-e669. [PMID: 30292040 DOI: 10.1016/j.wneu.2018.09.186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Currently, radiologic predictors for the resectability of cervical dumbbell schwannomas remain unknown. To identify radiologic predictors for resectability, we retrospectively reviewed data from 72 patients. METHODS From January 1995 to June 2017, 72 patients who underwent surgical treatment for cervical dumbbell schwannomas were enrolled. We focused on the relationship between preoperative magnetic resonance imaging (MRI) features and the extent of tumor removal. The MRI features evaluated were tumor size, tumor level, Eden classification, degree of vertebral artery (VA) involvement, and signal intensity (SI) on T2-weighted images (WIs). RESULTS Among the 72 patients, gross total resection (GTR) and subtotal resection (STR) were achieved in 37 (51.4%) and 35 (48.6%) patients, respectively. Mean maximal tumor size (P = 0.011), mean size of foraminal and extraforaminal portion (P = 0.017), tumor level (P < 0.001), VA involvement (P < 0.001), and SI on T2-WIs (P = 0.006) were significantly different between the GTR and STR groups. Univariate analyses demonstrated that maximal tumor size (odds ratio [OR]: 0.93, P = 0.012), high cervical level (OR: 11.37, P < 0.001), pushed VA (OR: 0.11, P = 0.002), encased VA (OR: 0.02, P < 0.001), and hyper-SI on T2-WIs (OR: 12.46, P = 0.020) were significant predictors for GTR. In the multivariate analysis, only high cervical level (OR: 5.48, P = 0.033) and encased VA (OR: 0.07, P = 0.014) were significant predictors for GTR. CONCLUSIONS The resectability of cervical dumbbell schwannomas may be predicted by MRI features, including tumor size, tumor level, and degree of VA involvement.
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Affiliation(s)
- Sung Mo Ryu
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Kook Kim
- Department of Spine Center, Himchan Hospital, Incheon, Korea
| | - Jong-Hyeok Park
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Whan Eoh
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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