1
|
Zhang W, Shi J, Yin Y, Ma M, Lyu J, Yang J, Zhao W, Yuan Y. Audiological Characteristics of Vestibular Schwannoma Patients With Normal Pure-Tone Audiometry. Otolaryngol Head Neck Surg 2024; 171:502-510. [PMID: 38667629 DOI: 10.1002/ohn.783] [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: 10/23/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To investigate the audiological characteristics of vestibular schwannoma (VS) patients with normal pure-tone audiometry (PTA) results. STUDY DESIGN A retrospective study. SETTING Forty-two VS patients with normal PTA results from October 2016 to October 2022 were included. METHODS Normal PTA was defined when the hearing threshold is ≤25 dB hearing loss (HL) in each test frequency and the PTA is ≤25 dB HL. Results of multiple audiological tests such as the auditory brainstem response (ABR), distortion product otoacoustic emission (DPOAE), multiple auditory steady-state responses threshold (ASSR), and speech discrimination score were retrospectively reviewed. Demographic data of these patients were also been collected. RESULTS According to our results, the ABR and average ASSR threshold of the affected side were statistically significantly higher in VS patients with normal PTA. ABR waveforms on the affected side also showed more abnormalities. The DPOAE pass rates of the affected side were lower than the unaffected side while the amplitude and signal-to-noise ratio rate was also lower. In addition, we used magnetic resonance imaging 3-dimensional reconstruction images to measure the volume of tumors in these patients. We also found that higher ABR threshold means lager tumor size in patients with normal PTA. CONCLUSION VS patients with normal PTA result cannot be assumed to have no impairment of hearing function. ABR, DPOAE, and ASSR results showed the characteristic changes in the affect ear. ABR threshold has the highest sensitivity for hearing abnormalities and is strong relative with tumor size in patients with normal PTA.
Collapse
Affiliation(s)
- Weixun Zhang
- Department of Otorhinolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
- Research Institute of Otolaryngology, Fudan University, Shanghai, China
- Lateral Skull Base Diagnosis and Treatment Center, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | | | - Yanbo Yin
- Department of Otorhinolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
- Research Institute of Otolaryngology, Fudan University, Shanghai, China
- Lateral Skull Base Diagnosis and Treatment Center, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Mengye Ma
- Department of Otorhinolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
- Research Institute of Otolaryngology, Fudan University, Shanghai, China
- Lateral Skull Base Diagnosis and Treatment Center, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Jihan Lyu
- Department of Otorhinolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
- Research Institute of Otolaryngology, Fudan University, Shanghai, China
- Lateral Skull Base Diagnosis and Treatment Center, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Juanmei Yang
- Department of Otorhinolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
- Research Institute of Otolaryngology, Fudan University, Shanghai, China
- Lateral Skull Base Diagnosis and Treatment Center, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Weidong Zhao
- Department of Otorhinolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
- Research Institute of Otolaryngology, Fudan University, Shanghai, China
- Lateral Skull Base Diagnosis and Treatment Center, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Yasheng Yuan
- Department of Otorhinolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
- Research Institute of Otolaryngology, Fudan University, Shanghai, China
- Lateral Skull Base Diagnosis and Treatment Center, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| |
Collapse
|
2
|
Ölander C, Feychting M, Eriksson PO, Laurell G, Talbäck M, Ek S. Fall-related injury among patients with vestibular schwannoma. PLoS One 2024; 19:e0304184. [PMID: 38875269 PMCID: PMC11178211 DOI: 10.1371/journal.pone.0304184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/06/2024] [Indexed: 06/16/2024] Open
Abstract
Vestibular schwannoma can cause vestibular dysfunction; however, conflicting evidence exists regarding whether this affects the incidence of fall-related injuries in this patient population. This matched cross-sectional and cohort study assess the risk of fall-related injuries in patients with vestibular schwannoma. The study included patients with vestibular schwannoma treated at a tertiary referral hospital in Sweden between 1988 and 2014. Information on fall-related injuries was obtained from the National Patient Register, and matched population comparisons were randomly selected in a 1:25 ratio. Fall-related injuries occurring pre- (within 5 years before the diagnosis of vestibular schwannoma) and post-diagnostically (up to 3 years after diagnosis or intervention) were registered. The association between vestibular schwannoma and fall-related injuries was estimated using logistic regression and Cox proportional hazards analyses. We identified 1153 patients with vestibular schwannoma (569 [49%] women and 584 [51%] men), and 28815 population comparisons. Among the patients, 9% and 7% had pre- and post-diagnostic fall-related injuries, respectively, and among the comparisons, 8% and 6% had pre- and post-diagnostic fall-related injuries, respectively. There was no increased risk of pre- (OR 1.14; CI 0.92-1.41) or post-diagnostic 1 year (HR 1.16; CI 0.87-1.54) or 3 years (HR 1.11; CI 0.89-1.29) fall-related injury among the total patient cohort. In age-stratified analyses, we found an increased risk of pre-diagnostic fall-related injury among patients aged 50-69 years (OR 1.42; CI 1.10-1.88). Patients who underwent middle fossa surgery, regardless of age, had an increased risk of post-surgery fall-related injury within 3 years of follow-up (HR 2.68; CI 1.06-6.81). We conclude that patients with vestibular schwannoma have a low risk of enduring fall-related injuries. Middle-aged patients with dizziness and fall-related injuries should be considered for a vestibular clinical evaluation. Our results highlight the importance of rehabilitation in avoiding future fall-related injuries among patients undergoing middle fossa surgery.
Collapse
Affiliation(s)
- Christine Ölander
- Department of Surgical Sciences, Section of Otolaryngology and Head Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Per Olof Eriksson
- Department of Surgical Sciences, Section of Otolaryngology and Head Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otolaryngology and Head Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
3
|
King AM, Cooper JN, Oganezova K, Mittal J, McKenna K, Godur DA, Zalta M, Danesh AA, Mittal R, Eshraghi AA. Vestibular Schwannoma and Tinnitus: A Systematic Review of Microsurgery Compared to Gamma Knife Radiosurgery. J Clin Med 2024; 13:3065. [PMID: 38892775 PMCID: PMC11173275 DOI: 10.3390/jcm13113065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Vestibular schwannoma (VS) is a benign tumor of the eighth cranial nerve formed from neoplastic Schwann cells. Although VS can cause a variety of symptoms, tinnitus is one of the most distressing symptoms for patients and can greatly impact quality of life. The objective of this systematic review is to comprehensively examine and compare the outcomes related to tinnitus in patients undergoing treatment for VS. Specifically, it evaluates patient experiences with tinnitus following the removal of VS using the various surgical approaches of traditional surgical resection and gamma knife radiosurgery (GKS). By delving into various aspects such as the severity of tinnitus post-treatment, the duration of symptom relief, patient quality of life, new onset of tinnitus after VS treatment, and any potential complications or side effects, this review aims to provide a detailed analysis of VS treatment on tinnitus outcomes. Methods: Following PRISMA guidelines, articles were included from PubMed, Science Direct, Scopus, and EMBASE. Quality assessment and risk of bias analysis were performed using a ROBINS-I tool. Results: Although VS-associated tinnitus is variable in its intensity and persistence post-resection, there was a trend towards a decreased tinnitus burden in patients. Irrespective of the surgical approach or the treatment with GKS, there were cases of persistent or worsened tinnitus within the studied cohorts. Conclusion: The findings of this systematic review highlight the complex relationship between VS resection and tinnitus outcomes. These findings underscore the need for individualized patient counseling and tailored treatment approaches in managing VS-associated tinnitus. The findings of this systematic review may help in guiding clinicians towards making more informed and personalized healthcare decisions. Further studies must be completed to fill gaps in the current literature.
Collapse
Affiliation(s)
- Ava M. King
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Jaimee N. Cooper
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Karina Oganezova
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Jeenu Mittal
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Keelin McKenna
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Dimitri A. Godur
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Max Zalta
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Ali A. Danesh
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
- Department of Communication Sciences and Disorders, Florida Atlantic University, Boca Raton, FL 33431, USA
- Department of Integrated Medical Sciences, Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Rahul Mittal
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Adrien A. Eshraghi
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33143, USA
| |
Collapse
|
4
|
Pontillo V, Foscolo V, Salonna F, Barbara F, Bozzi MT, Messina R, Signorelli F, Quaranta NAA. Hearing preservation surgery for vestibular schwannoma: a systematic review and meta-analysis. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:S86-S93. [PMID: 38745520 PMCID: PMC11098544 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/31/2024] [Indexed: 05/16/2024]
Abstract
The aim of this systematic review is to analyse the role of hearing preservation surgery for vestibular schwannoma. The complications and hearing outcomes of the single surgical techniques were investigated and compared with those of less invasive strategies, such as stereotactic radiotherapy and wait and scan policy. This systematic review and meta-analysis was performed according to the PRISMA guidelines. All included studies were published in English between 2000 and 2022. Literature data show that hearing preservation is achieved in less than 25% of patients after surgery and in approximately half of cases after stereotactic radiotherapy, even if data on long-term preservation are currently not available.
Collapse
Affiliation(s)
- Vito Pontillo
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Valentina Foscolo
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Francesco Salonna
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Francesco Barbara
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Maria Teresa Bozzi
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Raffaella Messina
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Francesco Signorelli
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| | - Nicola Antonio Adolfo Quaranta
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, Bari, Italy
| |
Collapse
|
5
|
West NC, Groth JB, Cayé-Thomasen P. Does Location of Intralabyrinthine Vestibular Schwannoma Determine Objective and Subjective Vestibular Function? Otol Neurotol 2024; 45:319-325. [PMID: 38291789 DOI: 10.1097/mao.0000000000004115] [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: 02/01/2024]
Abstract
BACKGROUND AND OBJECTIVE The incidence of intralabyrinthine schwannomas is increasing, and a growing attention is given to the detrimental effects on hearing function. On the contrary, the vestibular profile of intralabyrinthine vestibular schwannomas (VSs) is still not well understood. We aimed to investigate and report the observed relationships between the intralabyrinthine location of the schwannomas and objective and subjective vestibular profile of the patients. METHODS Retrospective cohort study of 20 consecutive individuals with sporadic intralabyrinthine schwannomas and grouped according to the intralabyrinthine location of the schwannomas. Vestibular testing consisted of the video head impulse test of all three semicircular canals, the caloric test, cervical and ocular vestibular evoked myogenic potentials, and the dizziness handicap inventory. A nonparametric unpaired t test was performed to compare groups, and Fisher's exact test was used for categorical data. RESULTS The median video head impulse test gains (lateral, anterior, posterior) were 0.40, 0.50, and 0.75 for intravestibular schwannomas and 0.93, 1.52, and 0.91 for intracochlear schwannomas ( p = 0.0001, p = 0.009, p = 0.33), respectively. Caloric unilateral weakness had a median of 100% for intravestibular schwannomas and 14% for intracochlear schwannomas ( p = 0.0001). The mean dizziness handicap inventory was 21 for intravestibular schwannomas and 1 for cochlear schwannomas ( p = 0.02). There were no significant differences in vestibular evoked myogenic potentials according to intralabyrinthine location. CONCLUSION By both objective and subjective measures, intralabyrinthine schwannomas with an intravestibular component has significantly worse vestibular function than schwannomas with purely cochlear involvement.
Collapse
Affiliation(s)
- Niels Cramer West
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen
| | - Jane Bjerg Groth
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen
| | | |
Collapse
|
6
|
Tozzi A, Castellucci A, Ferrulli G, Brandolini C, Piras G, Martellucci S, Malara P, Ferri GG, Ghidini A, Marchioni D, Presutti L. Audiovestibular Findings in Patients with Concurrent Superior Canal Dehiscence and Vestibular Schwannoma. Otol Neurotol 2024; 45:299-310. [PMID: 38291792 DOI: 10.1097/mao.0000000000004117] [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: 02/01/2024]
Abstract
OBJECTIVE To describe the clinical-instrumental findings in case of concurrent superior canal dehiscence (SCD) and ipsilateral vestibular schwannoma (VS), aiming to highlight the importance of an extensive instrumental assessment to achieve a correct diagnosis. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Five patients with concurrent SCD and VS. INTERVENTION Clinical-instrumental assessment and imaging. MAIN OUTCOME MEASURE Clinical presentation, audiovestibular findings, and imaging. RESULTS The chief complaints were hearing loss (HL) and unsteadiness (80%). Other main symptoms included tinnitus (60%) and pressure-induced vertigo (40%). Mixed-HL was identified in three patients and pure sensorineural-HL in 1, including a roll-over curve in speech-audiometry in two cases. Vibration-induced nystagmus was elicited in all cases, whereas vestibular-evoked myogenic potentials showed reduced thresholds and enhanced amplitudes on the affected side in three patients. Ipsilesional weakness on caloric testing was detected in three patients and a bilateral hyporeflexia in one. A global canal impairment was detected by the video-head impulse test in one case, whereas the rest of the cohort exhibited a reduced function for the affected superior canal, together with ipsilateral posterior canal impairment in two cases. All patients performed both temporal bones HRCT scan and brain-MRI showing unilateral SCD and ipsilateral VS, respectively. All patients were submitted to a wait-and-scan approach, requiring VS removal only in one case. CONCLUSION Simultaneous SCD and VS might result in subtle clinical presentation with puzzling lesion patterns. When unclear symptoms and signs occur, a complete audiovestibular assessment plays a key role to address imaging and diagnosis.
Collapse
Affiliation(s)
- Andrea Tozzi
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Ferrulli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Cristina Brandolini
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Gianluca Piras
- Department of Otology and Skull Base Surgery, Casa Di Cura Privata "Piacenza" S.P.A., Gruppo Otologico, Piacenza-Rome, Italy
| | | | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, Bellinzona, Switzerland
| | - Gian Gaetano Ferri
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Daniele Marchioni
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| |
Collapse
|
7
|
Thompson HL, Grabowski J, Franklin B, Koetsier KS, Welling DB. Patient-reported measures of tinnitus for individuals with neurofibromatosis type 2-related schwannomatosis: Recommendations for clinical trials. Clin Trials 2024; 21:18-28. [PMID: 38321701 PMCID: PMC10865763 DOI: 10.1177/17407745231217279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Neurofibromatosis type 2-related schwannomatosis is a genetic disease characterized by the development of bilateral vestibular schwannomas, ependymomas, meningiomas, and cataracts. Mild to profound hearing loss and tinnitus are common symptoms reported by individuals with neurofibromatosis type 2. While tinnitus is known to have a significant and negative impact on the quality of life of individuals from the general population, the impact on individuals with neurofibromatosis type 2 is unknown. Consensus regarding the selection of suitable patient-reported outcome measures for assessment could advance further research into tinnitus in neurofibromatosis type 2 patients. The purpose of this work is to achieve a consensus recommendation by the Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration for patient-reported outcome measures used to evaluate quality of life in the domain of tinnitus for neurofibromatosis type 2 clinical trials. METHODS The Response Evaluation in Neurofibromatosis and Schwannomatosis Patient-Reported Outcomes Communication Subgroup systematically evaluated patient-reported outcome measures of quality of life in the domain of tinnitus for individuals with neurofibromatosis type 2 using previously published Response Evaluation in Neurofibromatosis and Schwannomatosis rating procedures. Of the 19 identified patient-reported outcome measures, 3 measures were excluded because they were not validated as an outcome measure or could not have been used as a single outcome measure for a clinical trial. Sixteen published patient-reported outcome measures for the domain of tinnitus were scored and compared on their participant characteristics, item content, psychometric properties, and feasibility for use in clinical trials. RESULTS The Tinnitus Functional Index was identified as the most highly rated measure for the assessment of tinnitus in populations with neurofibromatosis type 2, due to strengths in the areas of item content, psychometric properties, feasibility, and available scores. DISCUSSION Response Evaluation in Neurofibromatosis and Schwannomatosis currently recommends the Tinnitus Functional Index for the assessment of tinnitus in neurofibromatosis type 2 clinical trials.
Collapse
Affiliation(s)
- Heather L Thompson
- Department of Communication Sciences and Disorders, California State University, Sacramento, Sacramento, CA, USA
| | - Jane Grabowski
- Mimi Hearing Technologies, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | | | - Kimberley S Koetsier
- Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - D Bradley Welling
- Harvard Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
8
|
West N, Sørensen RS, Kressner AA, Bille M, Marozeau J, Cayé-Thomasen P. Cochlear Implantation in Sporadic Intralabyrinthine Schwannomas with Single-Sided Deafness: Implications for Binaural Hearing. Otol Neurotol 2024; 45:128-135. [PMID: 38206060 DOI: 10.1097/mao.0000000000004079] [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: 01/12/2024]
Abstract
BACKGROUND AND OBJECTIVE Intralabyrinthine schwannomas (ILSs) may have detrimental effects on ipsilateral hearing, commonly leading to single-sided deafness (SSD). Cochlear implantation in patients with ILSs is an option to partly restore ipsilateral hearing; however, the available literature fails to account for the binaural hearing benefits of a cochlear implant (CI) for ILSs. METHODS We prospectively evaluated SSD patients with sporadic ILS undergoing cochlear implantation with simultaneous tumor resection (n = 10) or with tumor observation (n = 1). Patients completed the Speech, Spatial and Qualities Questionnaire (SSQ12) and the Nijmegen Cochlear Implant Questionnaire (NCIQ) pre- and postoperatively, as well as the Bern Benefit in Single-Sided Deafness (BBSSD) questionnaire postoperatively. Patients were also tested postoperatively with and without their CI to measure the effect on localization ability and binaural summation, squelch, and head shadow. RESULTS Evaluation was completed for nine and six patients (subjective and objective data, respectively). The CI significantly improved the speech reception threshold (SRT) in the head shadow condition where the target signal was presented to the CI side and the noise to the front (SCIN0). On the other hand, the SRTs in the colocated condition (S0N0) and the condition where the target signal was presented to the front and the noise to the CI side (S0NCI) were unaffected by the CI. The mean localization error decreased significantly from 102° to 61° (p = 0.0031) with the addition of a CI. The scores from SSQ12 demonstrated nonsignificant changes. For NCIQ, the self-esteem and the social interaction domains increased significantly but insignificantly for the remaining domains. The BBSSD responses ranged from +0.5 to +3.5 points. CONCLUSION After implantation, patients achieved significantly better scores across some of the patient-reported and objective parameters. In addition to reporting on a number of ILS cases where implantation was performed, the study is the first of its kind to document patient-reported and objective binaural hearing improvement after cochlear implantation in patients with ILS and, thereby, lends support to the active management of ILS.
Collapse
Affiliation(s)
- Niels West
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Copenhagen Hearing and Balance Center, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | - Rikke Skovhøj Sørensen
- Hearing Systems Section, Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | | | - Michael Bille
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Copenhagen Hearing and Balance Center, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | - Jeremy Marozeau
- Hearing Systems Section, Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | | |
Collapse
|
9
|
Potdar T, Kontorinis G. Pre-habilitation with intratympanic gentamicin in vestibular schwannomas: a systematic review. J Laryngol Otol 2023; 137:985-991. [PMID: 37185086 DOI: 10.1017/s0022215123000725] [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] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To assess whether pre-habilitation with intratympanic gentamicin can accelerate vestibular compensation following vestibular schwannoma resection. METHODS Seventeen studies were retrieved from the databases Medline, PubMed, Frontiers, Cochrane Library, Cambridge Core and ScienceDirect. Eight of the 17 studies met our criteria; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Heterogeneity, risk of bias and effect on post-operative recovery were assessed. RESULTS Four of the eight studies showed a statistically positive effect of pre-habilitation with gentamicin on the post-operative recovery process; the remainder also reported benefits, although not statistically significant. No study reported negative effects. Limitations were linked mostly to the limited number of enrolled patients and the outcome assessment methods. CONCLUSION Fifty per cent of the studies found a statistically positive effect of pre-habilitation with gentamicin prior to vestibular schwannoma resection. While the results are promising, due to the limited numbers further prospective studies are required to strengthen the evidence.
Collapse
Affiliation(s)
- T Potdar
- Medical School, University of Glasgow, Scotland, UK
| | - G Kontorinis
- Medical School, University of Glasgow, Scotland, UK
- Department of Otorhinolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| |
Collapse
|
10
|
Anschuetz L, Ermiş E, Gebhart I, Stalder O, Raabe A, Mantokoudis G, Caversaccio M, Hermann E, Wagner F, Vibert D. Vestibular Schwannoma: Long-term Outcome of the Vestibular Function After Stereotactic Radiosurgery. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e038. [PMID: 38515641 PMCID: PMC10950146 DOI: 10.1097/ono.0000000000000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/12/2023] [Indexed: 03/23/2024]
Abstract
Objective Evaluation at long term of the impact of the stereotactic surgery (SRS) on the vestibular function in vestibular schwannoma (VS) patients. Study design and setting Retrospective study in a tertiary referral center. Patients Fifty-one VS patients were included (34 females;17 males), aged from 41 to 78 years treated exclusively with SRS. Intervention Vestibular function was assessed before SRS and with median time interval of 14 (FU1) and 25 (FU2) months after treatment. Vestibular evaluation included: history, clinical vestibular examination, videonystagmography, head impulse test (v-HIT) and cervical vestibular evoked myogenic potentials (c-VEMPS). Results Before SRS, caloric testing (Caloric) was impaired in 77%; after treatment, in 92% (FU1) and 77% (FU2). Lateral HIT was decreased in 22% before SRS, in 39% at FU1 and FU2. C-VEMPS were absent in 50% before SRS, in 76% at FU1 and, FU2. Before SRS, no statistically significant association was found between asymptomatic and symptomatic patients with respect to the results of Caloric, v-HIT and c-VEMPS. This lack of association was also seen after SRS, at FU1 and FU2. Conclusion Our study showed that the impairment of the vestibular function might be attributed to the VS itself as well as to the radiation of the inner ear during SRS. The lateral SSC at low frequencies and the saccular function seem to be more involved with the time.
Collapse
Affiliation(s)
- Lukas Anschuetz
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Ekin Ermiş
- Department of Radiation-Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Isabel Gebhart
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | | | - Andreas Raabe
- Department of Neurosurgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Evelyne Hermann
- Department of Radiation-Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Dominique Vibert
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| |
Collapse
|
11
|
Moshtaghi O, Dixon PR, Claussen AD, La Monte O, Tadano A, Gillette D, Tawfik K, Schwartz MS, Friedman RA. The Effect of Immediate Microsurgical Resection of Vestibular Schwannoma on Hearing Preservation. Otol Neurotol 2023; 44:600-604. [PMID: 37205868 DOI: 10.1097/mao.0000000000003893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Evaluate for differences in postoperative hearing in patients who undergo immediate versus delayed hearing preservation microsurgical resection of vestibular schwannomas (VS). STUDY DESIGN Retrospective single-institution cohort study spanning November 2017 to November 2021. SETTING Single-institution tertiary care hospital. PATIENTS Sporadic VS in patients with American Academy of Otolaryngology-Head and Neck Surgery hearing classification A or B, with tumor size less than or equal to 2 cm and undergoing hearing preservation microsurgical resection. INTERVENTIONS Delayed surgical intervention defined by time from first diagnostic MRI to date of surgery being greater than 3 months. MAIN OUTCOME MEASURES Preoperative and postoperative audiometric performance. RESULTS In total, 193 patients met inclusion criteria. Within the cohort, 70 (36%) proceeded with surgery within 3 months of diagnostic MRI with a mean observation time of 62 days, whereas 123 (63%) underwent surgery after 3 months with a mean observation time of 301 days. There was no difference in preoperative hearing between the two groups with word recognition score 99% in early intervention group and 100% in delayed intervention group ( p = 0.6). However, 64% of those who proceeded with immediate surgery had successful hearing preservation, compared to a 42% of those who had delayed intervention ( p < 0.01). In a multivariable logistic regression accounting for preoperative word recognition score, tumor size, and age at diagnosis, the odds of hearing preservation were lower in those who delayed surgery compared to immediate surgery (odds ratio, 0.31; 95% confidence interval, 0.15-0.61). CONCLUSIONS Patients who underwent microsurgical resection within 3 months of diagnosis demonstrated a hearing preservation advantage compared to those who did not. Findings of this study highlight the counseling challenges associated with the timing of surgical treatment of VS in patients presenting with good preoperative hearing and small tumors.
Collapse
Affiliation(s)
- Omid Moshtaghi
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Peter R Dixon
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Alexander D Claussen
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Olivia La Monte
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Ashley Tadano
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Dominique Gillette
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Kareem Tawfik
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Marc S Schwartz
- Department of Neurological Surgery, University of California-San Diego, San Diego, California
| | - Rick A Friedman
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| |
Collapse
|
12
|
Fan Z, Fan Z, Li Z, Zhang H, Hu L, Qiu T, Zhu W. Cognitive Performance in Patients With Sporadic Vestibular Schwannoma. Neurosurgery 2023; 93:224-232. [PMID: 36862952 DOI: 10.1227/neu.0000000000002407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/12/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND To date, few data are available on the cognitive function of patients with vestibular schwannoma (VS) before treatment. OBJECTIVE To provide a cognitive profile of patients with VS. METHODS This cross-sectional observational study recruited 75 patients with an untreated VS and 60 age-, sex-, and education-matched healthy control subjects. A set of neuropsychological tests were administered to each participant. RESULTS Compared with the matched controls, patients with VS exhibited impaired general cognitive function, memory, psychomotor speed, visuospatial ability, attention and processing speed, and executive function. The subgroup analyses displayed that patients with severe-to-profound unilateral hearing loss were more cognitively impaired than patients with no-to-moderate unilateral hearing loss. In addition, patients with right-sided VS scored worse than those with left-sided VS on tests of memory, attention and processing speed, and executive function. No differences were observed in cognitive performance between patients with or without brainstem compression and those with or without tinnitus. We also found that worse hearing and longer hearing loss duration were associated with poorer cognitive performance in patients with VS. CONCLUSION The findings of this study provide evidence for cognitive impairment in patients with untreated VS. It can thus be said that including cognitive assessment in the routine clinical management of patients with VS may facilitate more appropriate clinical decision-making and improve patients' quality of life.
Collapse
Affiliation(s)
- Zhiyuan Fan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
| | - Zhen Fan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
| | - Zongze Li
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
| | - Hongfei Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
| | - Liuxun Hu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
| | - Tianming Qiu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
| |
Collapse
|
13
|
Leong S, Teh BM, Duong T, Hu D, Chui A, Chen JS, Sisti MB, Wang TJ, Zanotto D, Lalwani AK. Instrumented insoles for assessment of gait in patients with vestibular schwannoma. WEARABLE TECHNOLOGIES 2023; 4:e14. [PMID: 38487773 PMCID: PMC10936291 DOI: 10.1017/wtc.2023.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 03/17/2024]
Abstract
Background Imbalance and gait disturbances are common in patients with vestibular schwannoma (VS) and can result in significant morbidity. Current methods for quantitative gait analysis are cumbersome and difficult to implement. Here, we use custom-engineered instrumented insoles to evaluate the gait of patients diagnosed with VS. Methods Twenty patients with VS were recruited from otology, neurosurgery, and radiation oncology clinics at a tertiary referral center. Functional gait assessment (FGA), 2-minute walk test (2MWT), and uneven surface walk test (USWT) were performed. Custom-engineered instrumented insoles, equipped with an 8-cell force sensitive resistor (FSR) and a 9-degree-of-freedom inertial measurement unit (IMU), were used to collect stride-by-stride spatiotemporal gait parameters, from which mean values and coefficients of variation (CV) were determined for each patient. Results FGA scores were significantly correlated with gait metrics obtained from the 2MWT and USWT, including stride length, stride velocity, normalized stride length, normalized stride velocity, stride length CV, and stride velocity CV. Tumor diameter was negatively associated with stride time and swing time on the 2MWT; no such association existed between tumor diameter and FGA or DHI. Conclusions Instrumented insoles may unveil associations between VS tumor size and gait dysfunction that cannot be captured by standardized clinical assessments and self-reported questionnaires.
Collapse
Affiliation(s)
- Stephen Leong
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Bing M. Teh
- Department of Otolaryngology—Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Otolaryngology—Head & Neck Surgery, Monash Health; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VC, Australia
| | - Ton Duong
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Diane Hu
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander Chui
- Department of Biological Sciences, Columbia University, New York, NY, USA
| | - Jocelyn S. Chen
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Michael B. Sisti
- Department of Otolaryngology—Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurological Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Radiation Oncology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Tony J.C. Wang
- Department of Neurological Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Radiation Oncology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Damiano Zanotto
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Anil K. Lalwani
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Department of Otolaryngology—Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| |
Collapse
|
14
|
Hypofractionated stereotactic radiotherapy for large vestibular schwannomas and the impact of pre-radiation debulking surgery on dosimetry and clinical outcomes. JOURNAL OF RADIOTHERAPY IN PRACTICE 2023. [DOI: 10.1017/s1460396922000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Abstract
Introduction:
This study was aimed to evaluate the outcomes of patients with large (>2 cm in great diameter) vestibular schwannomas (VSs) treated with hypofractionated stereotactic radiotherapy (HFSRT) compared to small (<2 cm) ones and the impact of debulking surgery prior to radiation for large VSs.
Methods:
Fifty-nine patients with VSs treated with HFSRT (25 Gy in 5 fractions) were evaluated by tumour size and surgical status. Patients were divided based on tumour size: small VSs (n = 42) and large VSs (n = 17). The large group was further divided into the groups of pre-treatment debulking surgery (n = 8) and no surgery (n = 9). Rates of tumour control, brainstem necrosis and neurologic dysfunction were assessed following treatment. Pre-surgical magnetic resonance imaging (MRI) were used to generate hypothetical HFSRT plans to compare the effect of debulking surgery on dosimetry. Normal tissue complication probability (NTCP) modelling was performed to compare toxicity probabilities with and without surgical debulking in large VSs.
Results:
There was no statistical difference of tumour control rate between small and large VSs with 100% for small tumours and 94·1% for large tumours (p = 0·12), respectively. In large VSs patient, the tumour control rate of HFSRT was 100% (8/8) for surgically debulked patients and 89% (8/9) for non-surgically debulked patients (p = 0·35). There were no patients who experienced brainstem necrosis or progression of facial and trigeminal nerve symptoms after HFSRT in the entire groups of patients. Surgical debulking large VSs did not change the maximum point dose of brainstem (p = 0·98), but significantly decreased volumes of VSs and changed the minimum dose to the hottest 0·5 cc of tumour (p = 0·016) as well as the volume receiving at least 23 Gy (p = 0·023). NTCP modelling revealed very low rates (average < 1%) of brainstem toxicity with or without surgical debulking, but there was a significant difference favoring surgery (p < 0·05).
Conclusions:
HFSRT is a safe and effective treatment for both small and large VSs and is a viable option for patients with large VSs who cannot undergo surgery, if NTCP of pre-debulking HFSRT dosimetry is lower.
Collapse
|
15
|
Berger A, Alzate JD, Bernstein K, Mullen R, McMenomey S, Jethanemest D, Friedmann DR, Smouha E, Sulman EP, Silverman JS, Roland JT, Golfinos JG, Kondziolka D. Modern Hearing Preservation Outcomes After Vestibular Schwannoma Stereotactic Radiosurgery. Neurosurgery 2022; 91:648-657. [PMID: 35973088 PMCID: PMC10553130 DOI: 10.1227/neu.0000000000002090] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND For patients with vestibular schwannoma (VS), stereotactic radiosurgery (SRS) has proven effective in controlling tumor growth while hearing preservation remains a key goal. OBJECTIVE To evaluate hearing outcomes in the modern era of cochlear dose restriction. METHODS During the years 2013 to 2018, 353 patients underwent Gamma knife surgery for VS at our institution. We followed 175 patients with pre-SRS serviceable hearing (Gardner-Robertson Score, GR 1 and 2). Volumetric and dosimetry data were collected, including biological effective dose, integral doses of total and intracanalicular tumor components, and hearing outcomes. RESULTS The mean age was 56 years, 74 patients (42%) had a baseline GR of 2, and the mean cochlear dose was 3.5 Gy. The time to serviceable hearing loss (GR 3-4) was 38 months (95% CI 26-46), with 77% and 62% hearing preservation in the first and second years, respectively. Patients optimal for best hearing outcomes were younger than 58 years with a baseline GR of 1, free canal space ≥0.041 cc (diameter of 4.5 mm), and mean cochlear dose <3.1 Gy. For such patients, hearing preservation rates were 92% by 12 months and 81% by 2 years, staying stable for >5 years post-SRS, significantly higher than the rest of the population. CONCLUSION Hearing preservation after SRS for patients with VS with serviceable hearing is correlated to the specific baseline GR score (1 or 2), age, cochlear dose, and biological effective dose. Increased tumor-free canal space correlates with better outcomes. The most durable hearing preservation correlates with factors commonly associated with smaller tumors away from the cochlea.
Collapse
Affiliation(s)
- Assaf Berger
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Juan Diego Alzate
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Kenneth Bernstein
- Department of Radiation Oncology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Reed Mullen
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Sean McMenomey
- Department of Otolaryngology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Daniel Jethanemest
- Department of Otolaryngology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - David R. Friedmann
- Department of Otolaryngology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Eric Smouha
- Department of Otolaryngology, Mount Sinai Beth Israel, The Mount Sinai Hospital, New York, New York, USA
| | - Erik P. Sulman
- Department of Radiation Oncology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Joshua S. Silverman
- Department of Radiation Oncology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - J. Thomas Roland
- Department of Otolaryngology, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - John G. Golfinos
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Douglas Kondziolka
- Department of Neurological Surgery, NYU Langone Health, Grossman School of Medicine, New York University, New York, New York, USA
| |
Collapse
|
16
|
Sergi B, Settimi S, Federici G, Galloni C, Cantaffa C, De Corso E, Lucidi D. Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review. J Pers Med 2022; 12:jpm12101616. [PMID: 36294756 PMCID: PMC9605318 DOI: 10.3390/jpm12101616] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Management of vestibular schwannoma (VS) is a complex process aimed at identifying a clinical indication for fractionated stereotactic radiotherapy (sRT) or microsurgical resection or wait and scan (WS). The aim of the review was to clarify which patient and tumor parameters may lead to different therapeutic choices, with a view to a personalized VS approach. A systematic review according to Preferred Reporting Items for Systematic Review and Meta-Analysis criteria was conducted between February and March 2022. The authors defined six parameters that seemed to influence decision-making in VS management: 1-incidental VS; 2-tumor size; 3-tumor regrowth after sRT; 4-subtotal resection; 5-patients' age; 6-symptoms. The initial search yielded 3532 articles, and finally, 812 articles were included. Through a qualitative synthesis of the included studies, management strategies were evaluated and discussed. An individualized proposal of procedures is preferable as compared to a single gold-standard approach in VS decision-making. The most significant factors that need to be considered when dealing with a VS diagnosis are age, tumor size and hearing preservation issues.
Collapse
Affiliation(s)
- Bruno Sergi
- Department of Head, Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Unit of Otorhinolaryngology-Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Settimi
- Department of Head, Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Unit of Otorhinolaryngology-Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-0630154439
| | - Gaia Federici
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Costanza Galloni
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Carla Cantaffa
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Eugenio De Corso
- Unit of Otorhinolaryngology-Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| |
Collapse
|
17
|
Ong V, Zhang AB, Wilson B, Brown NJ, Lien BV, Shahrestani S, Yang I. The 100 Most Highly Cited Publications on Hearing Preservation for Vestibular Schwannomas. World Neurosurg 2022; 165:115-130. [PMID: 35779753 DOI: 10.1016/j.wneu.2022.06.120] [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: 05/21/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Vestibular schwannomas are benign, slow-growing tumors that often reduce patient quality of life by compressing nearby nerves. Neurological function preservation is one of the indicators of treatment success, with hearing preservation being the most difficult to obtain. This paper provides a bibliometric analysis of hearing preservation in treating acoustic neuromas and a greater understanding of the most highly cited articles, which have enhanced our understanding of this topic. METHODS Key terms of "acoustic neuroma," "vestibular schwannoma," and "hearing preservation" were queried through Web of Science. Articles were sorted by citation frequency, and the top 100 articles were recorded for title, name of first author, journal title, year of publication, total number of citations (and associated rank), average number of citations per year, country of the first author's associated institution, and type of study. RESULTS The top 100 cited articles were published from 1980 to 2014. The United States had the highest involvement as a country (55%), the University of Pittsburgh as an institution (13%), and The Journal of Neurosurgery as a publishing source (27%). Fourteen were reviews, and 86 were clinical papers. Of the 86, 73 were retrospective studies. CONCLUSION Bibliometric analyses summarize and assess potential areas of strength and knowledge gaps within the literature. Studies on hearing preservation in vestibular schwannomas mostly consist of retrospective reviews that assess postoperative outcomes of microsurgery and radiosurgery. Prospective studies and novel treatment options for hearing preservation in vestibular schwannomas are needed to increase current literature diversity.
Collapse
Affiliation(s)
- Vera Ong
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Ashley B Zhang
- Department of Neurological Surgery, University of California, Los Angeles, California, USA
| | - Bayard Wilson
- Department of Neurological Surgery, University of California, Los Angeles, California, USA
| | - Nolan J Brown
- University of California, Irvine, School of Medicine, Irvine, California, USA
| | - Brian V Lien
- University of California, Irvine, School of Medicine, Irvine, California, USA
| | - Shane Shahrestani
- Keck School of Medicine of USC, Los Angeles, California, USA; Department of Medical Engineering, California Institute of Technology, Pasadena, California, USA
| | - Isaac Yang
- Department of Neurological Surgery, University of California, Los Angeles, California, USA.
| |
Collapse
|
18
|
Nisenbaum E, Misztal C, Szczupak M, Thielhelm T, Peña S, Mei C, Goncalves S, Bracho O, Ma R, Ivan ME, Morcos J, Telischi F, Liu XZ, Fernandez-Valle C, Dinh CT. Tumor-Associated Macrophages in Vestibular Schwannoma and Relationship to Hearing. OTO Open 2021; 5:2473974X211059111. [PMID: 34870062 PMCID: PMC8638079 DOI: 10.1177/2473974x211059111] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 01/15/2023] Open
Abstract
Objective (1) Characterize the distribution of M1 and M2 macrophages in vestibular
schwannomas by hearing status. (2) Develop assays to assess monocyte
migration and macrophage polarization in cocultures with vestibular
schwannoma cells. Study Design Basic and translational science. Setting Tertiary care center. Methods A retrospective chart review of 30 patients with vestibular schwannoma (VS)
was performed. Patients were stratified into serviceable and unserviceable
hearing groups. Immunohistochemistry for CD80+ M1 and
CD163+ M2 macrophages was conducted. Primary VS cultures (n =
4) were developed and cocultured with monocytes. Immunohistochemistry for
macrophage markers was performed to assess monocyte migration and macrophage
polarization. Results Although tumors associated with unserviceable hearing had higher levels of
CD80 and CD163 than those with serviceable hearing, the relationship was
only significant with CD163 (P = .0161). However, CD163
level did not remain a significant predictor variable associated with
unserviceable hearing on multivariate analysis when adjusted for other
variables. In vitro assays show that VS cells induced monocyte migration and
polarization toward CD80+ M1 or CD163+ M2 macrophage
phenotypes, with qualitative differences in CD163+ macrophage
morphologies between serviceable and unserviceable hearing groups. Conclusion Vestibular schwannomas express varying degrees of CD80+ M1 and
CD163+ M2 macrophages. We present evidence that higher
expression of CD163+ may contribute to poorer hearing outcomes in
patients with VS. We also describe in vitro assays in a proof-of-concept
investigation that VS cells can initiate monocyte migration and macrophage
polarization. Future investigations are warranted to explore the
relationships between tumor, macrophages, secreted cytokines, and hearing
outcomes in patients with VS.
Collapse
Affiliation(s)
- Eric Nisenbaum
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Carly Misztal
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mikhaylo Szczupak
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Torin Thielhelm
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stefanie Peña
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Christine Mei
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stefania Goncalves
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Olena Bracho
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ruixuan Ma
- Department of Biostatistics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jacques Morcos
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Fred Telischi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Xue-Zhong Liu
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Cristina Fernandez-Valle
- Burnett School of Biomedical Sciences, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Christine T Dinh
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
19
|
Gurewitz J, Schnurman Z, Nakamura A, Navarro RE, Patel DN, McMenomey SO, Roland JT, Golfinos JG, Kondziolka D. Hearing loss and volumetric growth rate in untreated vestibular schwannoma. J Neurosurg 2021; 136:768-775. [PMID: 34416729 DOI: 10.3171/2021.2.jns203609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study, the authors aimed to clarify the relationship between hearing loss and tumor volumetric growth rates in patients with untreated vestibular schwannoma (VS). METHODS Records of 128 treatment-naive patients diagnosed with unilateral VS between 2012 and 2018 with serial audiometric assessment and MRI were reviewed. Tumor growth rates were determined from initial and final tumor volumes, with a median follow-up of 24.3 months (IQR 8.5-48.8 months). Hearing changes were based on pure tone averages, speech discrimination scores, and American Academy of Otolaryngology-Head and Neck Surgery hearing class. Primary outcomes were the loss of class A hearing and loss of serviceable hearing, estimated using the Kaplan-Meier method and with associations estimated from Cox proportional hazards models and reported as hazard ratios. RESULTS Larger initial tumor size was associated with an increased risk of losing class A (HR 1.5 for a 1-cm3 increase; p = 0.047) and serviceable (HR 1.3; p < 0.001) hearing. Additionally, increasing volumetric tumor growth rate was associated with elevated risk of loss of class A hearing (HR 1.2 for increase of 100% per year; p = 0.031) and serviceable hearing (HR 1.2; p = 0.014). Hazard ratios increased linearly with increasing growth rates, without any evident threshold growth rate that resulted in a large, sudden increased risk of hearing loss. CONCLUSIONS Larger initial tumor size and faster tumor growth rates were associated with an elevated risk of loss of class A and serviceable hearing.
Collapse
Affiliation(s)
| | | | | | | | | | - Sean O McMenomey
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York
| | - J Thomas Roland
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York
| | | | | |
Collapse
|
20
|
Thompson HL, Blanton A, Franklin B, Merker VL, Franck KH, Welling DB. Patient Report of Hearing in Neurofibromatosis Type 2: Recommendations for Clinical Trials. Neurology 2021; 97:S64-S72. [PMID: 34230203 PMCID: PMC8594003 DOI: 10.1212/wnl.0000000000012424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/03/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To systematically evaluate published patient-reported outcome measures for the assessment of hearing function and hearing-related quality of life (QoL) and recommend measures selected by the Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration (REiNS) as endpoints for clinical trials in neurofibromatosis type 2 (NF2). METHODS The REiNS Patient-Reported Outcomes Working Group systematically evaluated published patient-reported outcome measures of (1) hearing function and (2) hearing-related QoL for individuals with hearing loss of various etiologies using previously published REiNS rating procedures. Ten measures of hearing functioning and 11 measures of hearing-related QoL were reviewed. Measures were numerically scored and compared primarily on their participant characteristics (including participant age range and availability of normative data), item content, psychometric properties, and feasibility for use in clinical trials. RESULTS The Self-Assessment of Communication and the Self-Assessment of Communication-Adolescent were identified as most useful for adult and pediatric populations with NF2, respectively, for the measurement of both hearing function and hearing-related QoL. Measures were selected for their strengths in participant characteristics, item content, psychometric properties, and feasibility for use in clinical trials. CONCLUSIONS REiNS recommends the Self-Assessment of Communication adult and adolescent forms for the assessment of patient-reported hearing function and hearing-related QoL for NF2 clinical trials. Further work is needed to demonstrate the utility of these measures in evaluating pharmacologic or behavioral interventions.
Collapse
Affiliation(s)
- Heather L Thompson
- From the Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Department of Communication Disorders and Sciences (A.B.), SUNY Cortland, NY; REiNS Patient Representative for NF2 (B.F.); Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston (V.L.M.); Center for Healthcare Organization and Implementation Research (CHOIR) (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; and Departments of Audiology (K.H.F.) and Otolaryngology and Head and Neck Surgery (D.B.W.), Massachusetts Eye and Ear Hospital and Massachusetts General Hospital, Boston.
| | - Ann Blanton
- From the Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Department of Communication Disorders and Sciences (A.B.), SUNY Cortland, NY; REiNS Patient Representative for NF2 (B.F.); Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston (V.L.M.); Center for Healthcare Organization and Implementation Research (CHOIR) (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; and Departments of Audiology (K.H.F.) and Otolaryngology and Head and Neck Surgery (D.B.W.), Massachusetts Eye and Ear Hospital and Massachusetts General Hospital, Boston
| | - Barbara Franklin
- From the Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Department of Communication Disorders and Sciences (A.B.), SUNY Cortland, NY; REiNS Patient Representative for NF2 (B.F.); Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston (V.L.M.); Center for Healthcare Organization and Implementation Research (CHOIR) (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; and Departments of Audiology (K.H.F.) and Otolaryngology and Head and Neck Surgery (D.B.W.), Massachusetts Eye and Ear Hospital and Massachusetts General Hospital, Boston
| | - Vanessa L Merker
- From the Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Department of Communication Disorders and Sciences (A.B.), SUNY Cortland, NY; REiNS Patient Representative for NF2 (B.F.); Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston (V.L.M.); Center for Healthcare Organization and Implementation Research (CHOIR) (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; and Departments of Audiology (K.H.F.) and Otolaryngology and Head and Neck Surgery (D.B.W.), Massachusetts Eye and Ear Hospital and Massachusetts General Hospital, Boston
| | - Kevin H Franck
- From the Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Department of Communication Disorders and Sciences (A.B.), SUNY Cortland, NY; REiNS Patient Representative for NF2 (B.F.); Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston (V.L.M.); Center for Healthcare Organization and Implementation Research (CHOIR) (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; and Departments of Audiology (K.H.F.) and Otolaryngology and Head and Neck Surgery (D.B.W.), Massachusetts Eye and Ear Hospital and Massachusetts General Hospital, Boston
| | - D Bradley Welling
- From the Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Department of Communication Disorders and Sciences (A.B.), SUNY Cortland, NY; REiNS Patient Representative for NF2 (B.F.); Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston (V.L.M.); Center for Healthcare Organization and Implementation Research (CHOIR) (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; and Departments of Audiology (K.H.F.) and Otolaryngology and Head and Neck Surgery (D.B.W.), Massachusetts Eye and Ear Hospital and Massachusetts General Hospital, Boston
| |
Collapse
|
21
|
Evaluation of Vestibular Function in Diagnosis of Vestibular Schwannomas. Curr Med Sci 2021; 41:661-666. [PMID: 34403089 DOI: 10.1007/s11596-021-2407-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Vestibular schwannomas (VS) are benign tumors of the vestibular nerve. The common first symptoms are hearing loss and tinnitus, followed by imbalance, vertigo, and facial nerve involvement. The subjective symptoms of VS patients are not consistent with the severity of vestibular lesions and the results of vestibular tests, which often interfere with clinicians' diagnoses. Thus, the main screening and diagnostic methods for VS are audiometry and magnetic resonance imaging (MRI), ignoring the evaluation of vestibular function at the source of pathological lesions. With the development and improvement of vestibular evaluation technology and its wide application in the clinic, modern vestibular examination technology can reflect the severity and frequency of vestibular lesions and compensation from multiple perspectives, providing an objective basis for the diagnosis and treatment of vestibular diseases. In this report, we review the results and characteristics of vestibular tests in VS patients and further clarify the clinical value of vestibular function assessment in the diagnosis and treatment of VS.
Collapse
|
22
|
Feasibility of Preoperative Video Head Impulse Test to Predict the Nerve of Origin in Patients with Vestibular Schwannomas. J Clin Med 2021; 10:jcm10122677. [PMID: 34204494 PMCID: PMC8234018 DOI: 10.3390/jcm10122677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/04/2022] Open
Abstract
Vestibular schwannoma (VS) originates from Schwann cells in the superior or inferior vestibular nerve. Identifying the precise origin will help in determining the optimal surgical approach. We retrospectively analyzed the preoperative vestibular function test according to VS origin to determine whether the test is a valuable indicator of tumor origin. Forty-seven patients with VS (male:female = 18:29, mean age: 54.06 ± 13.50 years) underwent the cochleovestibular function test (pure-tone audiometry, caloric test, video head impulse test (vHIT), cervical and ocular vestibular-evoked myogenic potential, and posturography). All patients then underwent surgical removal of VS, and the schwannoma origin was confirmed. The tumor originated from the superior vestibular nerve (SVN group) in 21 patients, the inferior vestibular nerve (IVN group) in 26 patients, and an undetermined site in eight patients. The only value that differed significantly among the groups was the gain of the vestibular-ocular reflex (VOR) in the ipsilesional posterior canal (iPC) during the vHIT. Our results indicate that VOR gain in the iPC may be used to predict the nerve origin in patients with VS. Other cochleovestibular function tests have limited value to discriminate nerve origins, especially in cases of medium to large VS.
Collapse
|
23
|
Postural Sway Predicts Growth in Untreated Vestibular Schwannoma: A Retrospective Volumetric Study. Otol Neurotol 2021; 42:e495-e502. [PMID: 33443976 DOI: 10.1097/mao.0000000000003032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND One in three vestibular schwannomas (VS) will grow within 3 years after diagnosis, but no reliable baseline parameter has been found to predict such growth. OBJECTIVE To determine if postural sway is associated with growth of untreated VS. METHODS Patients with newly diagnosed sporadic VS assigned to a wait-and-scan protocol were identified from a prospectively maintained database. Postural sway was measured by posturography at baseline and patients were classified as steady or unsteady. Observer-blinded volumetric tumor measurements were performed on the diagnostic MRI and a 3-year control MRI. Tumor growth quantified as relative growth (%) and volume-doubling time (VDT and VDT-1) were investigated as dependent variables against baseline parameters. RESULTS Out of 204 VS patients, 53 (26%) were classified as unsteady on the platform at baseline. Median tumor volume was 0.32 cm3 (range 0.02-4.79), and 51% demonstrated significant growth within 3 years. Unsteady patients had significantly faster-growing tumors, with a mean relative growth of 172.5% compared to 79.5% in steady patients (p < 0.006). Seventy-seven percent of unsteady patients had >20% volume increase, compared to 42% in steady patients (p < 0.001). Mean VDT-1 was 0.65 doublings per year for unsteady patients, and 0.22 for steady patients (p < 0.001). Multivariate regression analysis including demographic and clinical parameters showed an OR of 5.6 (95% CI 2.6, 11.8) for growth in unsteady patients. CONCLUSIONS This is the first demonstrated association between a measurable parameter and future growth in untreated VS. Our findings may help clinicians identify patients with a higher risk for tumor growth and provide closer monitoring or early treatment.
Collapse
|
24
|
Balossier A, Régis J, Reyns N, Roche PH, Daniel RT, George M, Faouzi M, Levivier M, Tuleasca C. Repeat stereotactic radiosurgery for progressive vestibular schwannomas after previous radiosurgery: a systematic review and meta-analysis. Neurosurg Rev 2021; 44:3177-3188. [PMID: 33847846 PMCID: PMC8592961 DOI: 10.1007/s10143-021-01528-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
Vestibular schwannomas (VS) are slow-growing intracranial extraaxial benign tumors, developing from the vestibular part of the eight cranial nerves. Stereotactic radiosurgery (SRS) has now a long-term scientific track record as first intention treatment for small- to medium-sized VS. Though its success rate is very high, SRS for VS might fail to control tumor growth in some cases. However, the literature on repeat SRS after previously failed SRS remains scarce and reported in a low number of series with a limited number of cases. Here, we aimed at performing a systematic review and meta-analysis of the literature on repeat SRS for VS. Using PRISMA guidelines, we reviewed manuscripts published between January 1990 and October 2020 and referenced in PubMed. Tumor control and cranial nerve outcomes were evaluated with separate meta-analyses. Eight studies comprising 194 patients were included. The overall rate of patients treated in repeat SRS series as per overall series with first SRS was 2.2% (range 1.2–3.2%, p < 0.001). The mean time between first and second SRS was 50.7 months (median 51, range 44–64). The median marginal dose prescribed at first SRS was 12 Gy (range 8–24) and at second SRS was 12 Gy (range 9.8–19). After repeat SRS, tumor stability was reported in 61/194 patients, i.e., a rate of 29.6% (range 20.2–39%, I2 = 49.1%, p < 0.001). Tumor decrease was reported in 83/194 patients, i.e., a rate of 54.4% (range 33.7–75.1%, I2 = 89.1%, p < 0.001). Tumor progression was reported in 50/188 patients, i.e., a rate of 16.1% (range 2.5–29.7%, I2 = 87.1%, p = 0.02), rarely managed surgically. New trigeminal numbness was reported in 27/170 patients, i.e., a rate of 9.9% (range 1.4–18.3%, p < 0.02). New facial nerve palsy of worsened of previous was reported in 8/183 patients, i.e., a rate of 4.3% (range 1.4–7.2%, p = 0.004). Hearing loss was reported in 12/22 patients, i.e., a rate of 54.3% (range 24.8–83.8%, I2 = 70.7%, p < 0.001). Repeat SRS after previously failed SRS for VS is associated with high tumor control rates. Cranial nerve outcomes remain favorable, particularly for facial nerve. The rate of hearing loss appears similar to the one related to first SRS.
Collapse
Affiliation(s)
- Anne Balossier
- Functional, and Stereotactic Neurosurgery Service and Gamma Knife Unit, Assistance Publique - Hôpitaux de Marseille, Timone Hospital, Marseille, France.,Aix-Marseille University, Inserm, INS, Inst Neurosci Syst, Marseille, France
| | - Jean Régis
- Functional, and Stereotactic Neurosurgery Service and Gamma Knife Unit, Assistance Publique - Hôpitaux de Marseille, Timone Hospital, Marseille, France.,Aix-Marseille University, Inserm, INS, Inst Neurosci Syst, Marseille, France
| | - Nicolas Reyns
- University of Lille, Inserm, CHU de Lille, U1189 - ONCO-THAI -Laser Assisted Therapies and Immunotherapies for Oncology, F-59000, Lille, France.,Neurosurgery and Neurooncology Department, CHU de Lille, F-59000, Lille, France
| | - Pierre-Hugues Roche
- Neurosurgery Service, Neurochirurgie Hôpital Nord, Pôle NEUROSCIENCES, Hôpital Nord, Marseille, France
| | - Roy Thomas Daniel
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland
| | - Mercy George
- Department of Otorhinolaryngology, Head & Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Mohamed Faouzi
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), Université de Lausanne, Lausanne, Switzerland
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. .,Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland. .,Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| |
Collapse
|
25
|
van der Lubbe MFJA, Vaidyanathan A, Van Rompaey V, Postma AA, Bruintjes TD, Kimenai DM, Lambin P, van Hoof M, van de Berg R. The "hype" of hydrops in classifying vestibular disorders: a narrative review. J Neurol 2020; 267:197-211. [PMID: 33201310 PMCID: PMC7718205 DOI: 10.1007/s00415-020-10278-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/03/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
Background Classifying and diagnosing peripheral vestibular disorders based on their symptoms is challenging due to possible symptom overlap or atypical clinical presentation. To improve the diagnostic trajectory, gadolinium-based contrast-enhanced magnetic resonance imaging of the inner ear is nowadays frequently used for the in vivo confirmation of endolymphatic hydrops in humans. However, hydrops is visualized in both healthy subjects and patients with vestibular disorders, which might make the clinical value of hydrops detection on MRI questionable. Objective To investigate the diagnostic value of clinical and radiological features, including the in vivo visualization of endolymphatic hydrops, for the classification and diagnosis of vestibular disorders. Methods A literature search was performed in February and March 2019 to estimate the prevalence of various features in healthy subjects and in common vestibular disorders to make a graphical comparison between healthy and abnormal. Results Of the features studied, hydrops was found to be a highly prevalent feature in Menière’s disease (99.4%). Though, hydrops has also a relatively high prevalence in patients with vestibular schwannoma (48.2%) and in healthy temporal bones (12.5%) as well. In patients diagnosed with (definite or probable) Menière’s disease, hydrops is less frequently diagnosed by magnetic resonance imaging compared to the histological confirmation (82.3% versus 99.4%). The mean prevalence of radiologically diagnosed hydrops was 31% in healthy subjects, 28.1% in patients with vestibular migraine, and 25.9% in patients with vestibular schwannoma. An interesting finding was an absolute difference in hydrops prevalence between the two diagnostic techniques (histology and radiology) of 25.2% in patients with Menière’s disease and 29% in patients with vestibular schwannoma. Conclusions Although the visualization of hydrops has a high diagnostic value in patients with definite Menière’s disease, it is important to appreciate the relatively high prevalence of hydrops in healthy populations and other vestibular disorders. Endolymphatic hydrops is not a pathognomic phenomenon, and detecting hydrops should not directly indicate a diagnosis of Menière’s disease. Both symptom-driven and hydrops-based classification systems have disadvantages. Therefore, it might be worth to explore features “beyond” hydrops. New analysis techniques, such as Radiomics, might play an essential role in (re)classifying vestibular disorders in the future. Electronic supplementary material The online version of this article (10.1007/s00415-020-10278-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marly F J A van der Lubbe
- Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Akshayaa Vaidyanathan
- The D-Lab, department of Precision Medicine, GROW research institute for Oncology, Maastricht University, Maastricht, The Netherlands
- Research and Development, Oncoradiomics SA, Liege, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Sciences, Maastricht University, Maastricht, The Netherlands
| | - Tjasse D Bruintjes
- Department of Otorhinolaryngology, Gelre Hospital, Apeldoorn, The Netherlands
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorien M Kimenai
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Philippe Lambin
- The D-Lab, department of Precision Medicine, GROW research institute for Oncology, Maastricht University, Maastricht, The Netherlands
| | - Marc van Hoof
- Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Raymond van de Berg
- Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
26
|
Sadler KV, Bowers NL, Hartley C, Smith PT, Tobi S, Wallace AJ, King A, Lloyd SKW, Rutherford S, Pathmanaban ON, Hammerbeck-Ward C, Freeman S, Stapleton E, Taylor A, Shaw A, Halliday D, Smith MJ, Evans DG. Sporadic vestibular schwannoma: a molecular testing summary. J Med Genet 2020; 58:227-233. [PMID: 32576656 DOI: 10.1136/jmedgenet-2020-107022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Cases of sporadic vestibular schwannoma (sVS) have a low rate of association with germline pathogenic variants. However, some individuals with sVS can represent undetected cases of neurofibromatosis type 2 (NF2) or schwannomatosis. Earlier identification of patients with these syndromes can facilitate more accurate familial risk prediction and prognosis. METHODS Cases of sVS were ascertained from a local register at the Manchester Centre for Genomic Medicine. Genetic analysis was conducted in NF2 on blood samples for all patients, and tumour DNA samples when available. LZTR1 and SMARCB1 screening was also performed in patient subgroups. RESULTS Age at genetic testing for vestibular schwannoma (VS) presentation was younger in comparison with previous literature, a bias resulting from updated genetic testing recommendations. Mosaic or constitutional germline NF2 variants were confirmed in 2% of patients. Pathogenic germline variants in LZTR1 were found in 3% of all tested patients, with a higher rate of 5% in patients <30 years. No pathogenic SMARCB1 variants were identified within the cohort. Considering all individuals who received tumour DNA analysis, 69% of patients were found to possess two somatic pathogenic NF2 variants, including those with germline LZTR1 pathogenic variants. CONCLUSIONS Undiagnosed schwannoma predisposition may account for a significant minority of apparently sVS cases, especially at lower presentation ages. Loss of NF2 function is a common event in VS tumours and may represent a targetable common pathway in VS tumourigenesis. These data also support the multi-hit mechanism of LZTR1-associated VS tumourigenesis.
Collapse
Affiliation(s)
- Katherine V Sadler
- Manchester Centre for Genomic Medicine, The University of Manchester, Manchester, UK
| | - Naomi L Bowers
- Genetic Medicine, University of Manchester, Manchester, UK
| | - Claire Hartley
- Genetic Medicine, Regional Genetic Laboratories, Manchester, UK
| | - Philip T Smith
- Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Simon Tobi
- Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Andrew King
- Neurosurgery, Salford Royal Hospital, Manchester, UK
| | - Simon K W Lloyd
- Department of Otolaryngology, Manchester Royal Infirmary, Manchester, UK
| | | | - Omar N Pathmanaban
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, UK
| | | | | | - Emma Stapleton
- Department of Otolaryngology, Manchester Royal Infirmary, Manchester, UK
| | - Amy Taylor
- Clinical Genetics, East Anglian Medical Genetics Service, Cambridge, UK
| | - Adam Shaw
- Department of Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dorothy Halliday
- Oxford Centre for Genetic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Neurosciences, NF2 Unit, Oxford, UK
| | | | - D Gareth Evans
- Clinical Genetics, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
27
|
Chae R, McDermott M, Muacevic A, Adler JR, Sharon JD. Vestibular Migraine Following Radiosurgery for Vestibular Schwannoma. Cureus 2020; 12:e8569. [PMID: 32670705 PMCID: PMC7358935 DOI: 10.7759/cureus.8569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Vestibular schwannoma (VS) is associated with dizziness and vertigo during all stages of treatment. This report describes a patient who presented with a one-year history of intermittent motion sickness, dizziness, headache, imbalance, and nausea. MRI showed a right-side VS in the cerebellopontine angle and internal auditory canal. The patient elected to undergo Gamma Knife radiosurgery for treatment. Within two to three months, she continued to experience recurring dizziness, vertigo, neck stiffness, and head pressure. She was referred for neurotology evaluation, which led to a diagnosis of vestibular migraine (VM). Her vestibular reflexes were intact. Subsequently, she was treated with diet modification and low-dose venlafaxine. She reported dramatically improved dizziness and vertigo symptoms at six-month follow-up. VM is a very common cause of dizziness that should always be included in the differential diagnosis, even in VS patients.
Collapse
Affiliation(s)
- Ricky Chae
- Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, USA
| | | | | | - John R Adler
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA.,Radiation Oncology, Stanford University Medical Center, Stanford, USA
| | - Jeffrey D Sharon
- Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, USA
| |
Collapse
|
28
|
Schnurman Z, Golfinos JG, Epstein D, Friedmann DR, Roland JT, Kondziolka D. Comparing costs of microsurgical resection and stereotactic radiosurgery for vestibular schwannoma. J Neurosurg 2019; 131:1395-1404. [PMID: 30497146 DOI: 10.3171/2018.5.jns18508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Given rising scrutiny of healthcare expenditures, understanding intervention costs is increasingly important. This study aimed to compare and characterize costs for vestibular schwannoma (VS) management with microsurgery and radiosurgery to inform practice decisions and appraise cost reduction strategies. METHODS In conjunction with medical records, internal hospital financial data were used to evaluate costs. Total cost was divided into index costs (costs from arrival through discharge for initial intervention) and follow-up costs (through 36 months) for 317 patients with unilateral VSs undergoing initial management between June 2011 and December 2015. A retrospective matched cohort based on tumor size with 176 patients (88 undergoing each intervention) was created to objectively compare costs between microsurgery and radiosurgery. The full sample of 203 patients treated with resection and 114 patients who underwent radiosurgery was used to evaluate a broad range of outcomes and identify cost contributors within each intervention group. RESULTS Within the matched cohort, average index costs were significantly higher for microsurgery (100% by definition, because costs are presented as a percentage of the average index cost for the matched microsurgery group; 95% CI 93-107) compared to radiosurgery (38%, 95% CI 38-39). Microsurgery had higher average follow-up costs (1.6% per month, 95% CI 0.8%-2.4%) compared to radiosurgery (0.5% per month, 95% CI 0.4%-0.7%), largely due to costs incurred in the initial months after resection. A major contributor to total cost and cost variability for both resection and radiosurgery was the need for additional interventions in the follow-up period, which were necessary due to complications or persistent functional deficits. Although tumor size was not associated with increased total costs for radiosurgery, linear regression analysis demonstrated that, for patients who underwent microsurgery, each centimeter increase in tumor maximum diameter resulted in an estimated increase in total cost of 50.2% of the average index cost of microsurgery (95% CI 34.6%-65.7%) (p < 0.001, R2 = 0.17). There were no cost differences associated with the proportion of inpatient days in the ICU or with specific surgical approach for patients who underwent resection. CONCLUSIONS This study is the largest assessment to date based on internal cost data comparing VS management with microsurgery and radiosurgery. Both index and follow-up costs are significantly higher when tumors were managed with resection compared to radiosurgery. Larger tumors were associated with increased resection costs, highlighting the incremental costs associated with observation as the initial management.
Collapse
Affiliation(s)
| | | | | | - David R Friedmann
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Medical Center, New York, New York
| | - J Thomas Roland
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Medical Center, New York, New York
| | | |
Collapse
|
29
|
Dhayalan D, Lund-Johansen M, Finnkirk M, Tveiten ØV. Fatigue in patients with vestibular schwannoma. Acta Neurochir (Wien) 2019; 161:1809-1816. [PMID: 31321539 DOI: 10.1007/s00701-019-04003-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/05/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Patients with vestibular schwannoma (VS) often complain about tiredness, exhaustion, lack of energy, and strength, but such symptoms of fatigue have scarcely been objectified and analyzed in a VS population. We aimed to characterize fatigue in a cohort of patients with VS and compare such symptoms with a control group. METHODS All patients who attended an educational course for patients with VS were surveyed with validated tools for assessment of fatigue (fatigue severity scale), anxiety and depression (hospital anxiety and depression scale), sleepiness (Epworth sleepiness scale), and apathy (Starkstein apathy scale). Quality of Life was assessed with the disease-specific Penn Acoustic Neuroma Quality of Life (PANQOL). Symptom severity was estimated with a visual analog scale (VAS). The results have been compared to a control group consisting of patient companions. RESULTS Data from 88 VS patients and 49 controls were analyzed. The controls had similar age and sex distribution as patients. Fifty-seven percent of VS patients had significant fatigue, compared to 25% in the control group. The mean fatigue score was 4.1 for the patients, and 2.8 for controls. Patients with fatigue were more likely to have depression, anxiety, sleepiness, and apathy. No correlation of fatigue was found with age, gender, or treatment modality. Regression analyses revealed depression, apathy, and vertigo to be predictors of fatigue. Fatigue was strongly correlated to QoL. CONCLUSION Almost six out of ten VS patients had fatigue, significantly higher than the control group. Interest and focus on fatigue in VS patients can improve the patient's QoL.
Collapse
Affiliation(s)
- Dhanushan Dhayalan
- Department of Neurosurgery, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway.
| | - Morten Lund-Johansen
- Department of Neurosurgery, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Monica Finnkirk
- Department of Neurosurgery, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway
| | - Øystein Vesterli Tveiten
- Department of Neurosurgery, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
30
|
Nilsen KS, Lund-Johansen M, Nordahl SHG, Finnkirk M, Goplen FK. Long-term Effects of Conservative Management of Vestibular Schwannoma on Dizziness, Balance, and Caloric Function. Otolaryngol Head Neck Surg 2019; 161:846-851. [DOI: 10.1177/0194599819860831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ObjectivesTo study the development of dizziness, caloric function, and postural sway during long-term observation of untreated vestibular schwannoma patients.Study DesignRetrospective review of a prospectively maintained longitudinal cohort.SettingTertiary referral hospital.Subjects and MethodsPatients with vestibular schwannoma undergoing wait-and-scan management were included—specifically, those who did not require treatment during a minimum radiologic follow-up of 1 year. Baseline data and follow-up included magnetic resonance imaging, posturography, bithermal caloric tests, and a dizziness questionnaire. Main outcomes were prevalence of moderate to severe dizziness, canal paresis, and postural instability at baseline and follow-up, as compared with McNemar’s test.ResultsOut of 433 consecutive patients with vestibular schwannoma, 114 did not require treatment during follow-up and were included. Median radiologic follow-up was 10.2 years (interquartile range, 4.5 years). Age ranged from 31 to 78 years (mean, 59 years; SD, 10 years; 62% women). Median tumor volume at baseline was 139 mm3(interquartile range, 314 mm3). This did not change during follow-up ( P = .446). Moderate to severe dizziness was present in 27% at baseline and 19% at follow-up ( P = .077). Postural unsteadiness was present in 17% at baseline and 21% at follow-up ( P = .424). Canal paresis was present in 51% at baseline and 56% at follow-up ( P = .664).ConclusionsThere was no significant change in the prevalence of dizziness, postural sway, or canal paresis during conservative management of vestibular schwannoma, while tumor volume remained unchanged. This indicates a favorable prognosis in these patients with regard to vestibular symptoms.
Collapse
Affiliation(s)
- Kathrin Skorpa Nilsen
- Norwegian National Advisory Unit on Vestibular Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Otorhinolaryngology–Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Stein Helge Glad Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Monica Finnkirk
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit on Vestibular Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Otorhinolaryngology–Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
31
|
Salem N, Galal A, Mastronardi V, Talaat M, Sobhy O, Sanna M. Audiological Evaluation of Vestibular Schwannoma Patients with Normal Hearing. Audiol Neurootol 2019; 24:117-126. [DOI: 10.1159/000500660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/29/2019] [Indexed: 11/19/2022] Open
Abstract
Objective: To evaluate the audiological aspects of vestibular schwannoma (VS) patients with normal hearing. Study Design: Retrospective study. Setting: Quaternary referral center for skull base pathologies. Patients: The records on 4,000 patients who had been diagnosed with VS between 1986 and December 2017 were retrospectively reviewed. The patients included in the study were the ones who complied with the strict audiological normality criteria, as follows: a pure tone hearing threshold (at the 6-octave-spaced frequencies from 250 to 8,000 Hz) ≤25 dBHL; a word recognition score >90%; and interaural differences ≤10 dB at each frequency. Interventions: Auditory brainstem response (ABR) testing and radiological imaging. Main Outcome Measures: The incidence of normal objective hearing among VS patients, and the diagnostic utility of the ABR and the effect of tumor size and site on the response. Results: The incidence of normal hearing among VS patients was 4.2%. Tinnitus and vertigo were the most common symptoms across tumor grades; 5.6% of the tumors were large and giant tumors. The ABR yielded a sensitivity of 73.6%, with a false negative rate of 26.3% using a cutoff point of 0.2 ms for interaural latency differences. Conclusions: The diagnosis of VS should not be based on audiometric thresholds alone. Alarming signs of VS should be clear to the physician in order not to miss or delay the diagnosis of the disease. The ABR is useful in the diagnosis of VS, but normal results do not exclude the occurrence of the disease in patients with normal hearing.
Collapse
|
32
|
Vestibular Deficits Correlating to Dizziness Handicap Inventory Score, Hearing Loss, and Tumor Size in a Danish Cohort of Vestibular Schwannoma Patients. Otol Neurotol 2019; 40:813-819. [DOI: 10.1097/mao.0000000000002236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
Goshtasbi K, Abouzari M, Moshtaghi O, Sahyouni R, Sajjadi A, Lin HW, Djalilian HR. The changing landscape of vestibular schwannoma diagnosis and management: A cross-sectional study. Laryngoscope 2019; 130:482-486. [PMID: 30953401 DOI: 10.1002/lary.27950] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/05/2019] [Accepted: 03/06/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To assess the current state of the diagnosis and management of vestibular schwannoma (VS) as well as treatment trends, and to evaluate the role of treatment setting and various specialists in treatment plan. METHODS Patients diagnosed with VS completed a voluntary and anonymous survey. The questionnaires were distributed through Acoustic Neuroma Association website, Facebook page, and e-mail newsletters from January to March 2017. RESULTS In total, 789 VS patients completed the survey. Of those, 414 (52%) underwent surgery; 224 (28%) underwent radiotherapy; and 121 (15%) were observed. General otolaryngologists diagnosed 62% of responders, followed by primary care (11%) and neurotologists (10%). Patients who underwent surgery were significantly younger and had larger tumors compared to those treated with radiation or observation. The ratio of patients having nonsurgical versus surgical resection changed from 1:2 to 1:1 for the periods of 1979 through 2006 versus 2007 through 2017, respectively. Neurosurgeons (40%) and neurotologists (38%) were the most influential in treatment discussion. Neurotologists (P < 0.001) and general otolaryngologists (P = 0.04) were more influential than neurosurgeons for the decision process in patients with smaller tumors. Patients treated at academic versus nonacademic private institutions reported similar tumor sizes (P = 0.27), treatment decisions (P = 0.09), and decision satisfaction (P = 0.78). CONCLUSION There is a continuing trend toward nonsurgical management, with approximately half of the patients opting for nonsurgical management. In this cohort, the patients commonly presented with otologic symptoms and otolaryngologists made the most diagnoses. Neurotologists and neurosurgeons were the most influential in treatment discussion. LEVEL OF EVIDENCE NA Laryngoscope, 130:482-486, 2020.
Collapse
Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Omid Moshtaghi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Ronald Sahyouni
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California, Irvine, Irvine, California, U.S.A
| | - Autefeh Sajjadi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California, Irvine, Irvine, California, U.S.A
| |
Collapse
|
34
|
Kleijwegt M, Bettink F, Malessy M, Putter H, van der Mey A. Clinical Predictors Leading to Change of Initial Conservative Treatment of 836 Vestibular Schwannomas. J Neurol Surg B Skull Base 2019; 81:15-21. [PMID: 32021745 DOI: 10.1055/s-0039-1678708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022] Open
Abstract
Objective This study was aimed to determine the role of clinical presentation and tumor characteristics in vestibular schwannoma (VS) at diagnosis, initially treated with conservative management. Design The study was designed as a retrospective chart review. Setting The study was prepared at national tertiary referral center for VS patients. Participants A total of 836 VS patients, initially treated conservatively, were included. Main Outcome Measures Patient characteristics: age at diagnosis, gender, frequency, and duration of, hearing loss, tinnitus, balance disorder (unsteadiness, dizziness, and vertigo), respectively; and tumor characteristics: laterality, growth, cystic component, and location were analyzed in relation to tumor size at diagnosis and change in treatment strategy. Results In total, 169 (20%) patients had a change in treatment strategy. Factors at diagnosis that had a high influence on intervention were a short duration of hearing loss (hazard ratio [HR]: 4.8, p < 0.001) and cystic tumors (HR = 2.6, p < 0.001). Balance disorders and extracanalicular (EC) tumor location have a medium influence on intervention (HR = 1.6, p < 0.01). Tumour growth was seen in 55% of the intervention group; we found a significant correlation with a short duration of hearing loss. Cystic VS was significantly higher between the medium and large tumors, 24.3% and 38.1%. ( p = 0.001), respectively. Conclusions Patients with a short duration of hearing loss, balance disorders, EC located tumors, and cystic tumors have a significantly higher chance of a change in treatment strategy. Large tumor size at diagnosis and a cystic component were related to age > 65 years at diagnosis.
Collapse
Affiliation(s)
- Maarten Kleijwegt
- Department of ENT, Leiden University Medical Center, Leiden, The Netherlands
| | - Floris Bettink
- Department of ENT, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn Malessy
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Andel van der Mey
- Department of ENT, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
35
|
Ungar OJ, Franck M, Nadol JB, Santos F. Arachnoid cysts of the internal auditory canal: An underappreciated entity? Laryngoscope 2018; 129:1667-1674. [DOI: 10.1002/lary.27601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Omer J. Ungar
- Department of Otolaryngology–Head and Neck Surgery
- Department of Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of MedicineTel Aviv University Tel Aviv Israel
| | - Madeline Franck
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts U.S.A
| | - Joseph B. Nadol
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts U.S.A
| | - Felipe Santos
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts U.S.A
| |
Collapse
|
36
|
Abstract
OBJECTIVE To report findings from a cohort of vestibular schwannoma (VS) patients presenting with vertigo from a secondary comorbid vestibular disorder; and to discuss management strategies for this subset of patients presenting with both episodic vertigo and VS. PATIENTS All VS patients who presented with vertigo as the primary symptom from 2012 to 2015 and endorsing no other major complaints were examined. INTERVENTION Treatment with migraine lifestyle and prophylactic therapy, or Epley maneuver. MAIN OUTCOME MEASURE Resolution of vertigo following medical treatment alone. RESULTS Of the nine patients studied, seven (78%) suffered from vestibular migraine, and two (22%) experienced benign positional vertigo. All patients experienced complete resolution of symptoms after treatment. As a result of symptomatic improvement, seven patients (78%) avoided surgery in favor of observation, while two patients (22%) underwent radiosurgery due to continued tumor growth and other nonvertigo symptoms. CONCLUSION VS patients can sometimes present with a history of recurrent episodic vertigo. The etiology of the vertigo could be due to the tumor itself or may be due to an underlying comorbidity such as vestibular migraine or benign positional vertigo. VS patients presenting with vertigo should undergo a standard vertigo history and examination to identify other potential causes of vertigo. Most VS patients in our cohort avoided intervention and had resolution of their vertigo.
Collapse
|
37
|
Silent Vestibulopathy in Asymmetric Hearing Loss Can Be a Sign of a Cerebellopontine Angle Tumor. JOURNAL OF OTORHINOLARYNGOLOGY, HEARING AND BALANCE MEDICINE 2018. [DOI: 10.3390/ohbm1010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
38
|
Transcanal Transpromontorial Acoustic Neuroma Surgery: Results and Facial Nerve Outcomes. Otol Neurotol 2018; 39:242-249. [DOI: 10.1097/mao.0000000000001658] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Nam GS, Jung CM, Kim JH, Son EJ. Relationship of Vertigo and Postural Instability in Patients With Vestibular Schwannoma. Clin Exp Otorhinolaryngol 2018; 11:102-108. [PMID: 29307173 PMCID: PMC5951069 DOI: 10.21053/ceo.2017.01277] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/01/2017] [Accepted: 11/08/2017] [Indexed: 12/26/2022] Open
Abstract
Objectives Growth of vestibular schwannomas (VS) causes progressive vestibular symptoms and postural instability. Since the tumor grows slowly, compensation of decaying vestibular input may decrease subjective symptoms of dizziness. This study aims to estimate the relationship of subjective vestibular symptoms and objective postural instability in patients with VS. Methods A retrospective review of 18 patients newly diagnosed with VS and with subjective vertigo symptoms was performed. The results of vestibular function tests including the sensory organization test (SOT) using computerized dynamic posturography, caloric test, and self-report measures of subjective dizziness handicap (Dizziness Handicap Inventory) and visual analogue scale were compared according to the onset of vertigo symptoms. Results In VS patients, SOT showed decreased equilibrium score for all vestibular function related conditions, condition (C) 5 and 6, and composite (COMP) score. COMP scores were not correlated with visual analogue scale or Dizziness Handicap Inventory scores. Acute onset group included six patients and insidious onset group, 12 patients. Equilibrium scores for C5 and C6, and COMP scores were lower for insidious onset group, but the difference was not statistically significant. Conclusion Our findings confirmed postural instability is prevalent in VS patients. SOT parameters did not differ significantly between acute onset and insidious onset groups, but increased tumor size and canal weakness were noted in the insidious onset group. Clinicians should consider that postural instability is likely present even in patients who do not complain of acute vertigo, and appropriate counseling should be discussed with the patients.
Collapse
Affiliation(s)
- Gi-Sung Nam
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Min Jung
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyung Kim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jin Son
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
40
|
Ehret F, Muacevic A. A Suspected Vestibular Schwannoma with Uncharacteristic Growth Dynamic and Symptom Severity: A Case Report. Cureus 2018. [PMID: 29531877 PMCID: PMC5837235 DOI: 10.7759/cureus.2024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Vestibular schwannomas are mostly sporadic, neuroectodermal, benign tumors of the myelin-forming cells of the vestibulocochlear nerve. Typical initial symptoms of vestibular schwannomas often include unilateral hearing loss, tinnitus, vertigo, and headaches. As schwannomas characteristically show a slow growth rate and various symptoms, different therapeutic approaches are possible, ranging from a watchful waiting strategy to radiation therapy and neurosurgical tumor removal. In addition, these treatment options should be evaluated carefully and assigned individually to the patients’ needs and symptoms while respecting the feasibility and possible outcome of the chosen treatment. We present a 69-year-old patient with an atypical, severe symptom constellation and tumor growth dynamic. The planned treatment of the schwannoma with radiosurgery revealed an unforeseen change of focus. Most notably, this case emphasizes the importance of a thorough radiological and patient-orientated assessment.
Collapse
Affiliation(s)
- Felix Ehret
- Radiation Oncology, European CyberKnife Center Munich
| | | |
Collapse
|
41
|
Could IGF-I levels play a neuroprotective role in patients with large vestibular schwannomas? Future Sci OA 2017; 4:FSO260. [PMID: 29379636 PMCID: PMC5778376 DOI: 10.4155/fsoa-2017-0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 09/29/2017] [Indexed: 11/17/2022] Open
Abstract
Aim To evaluate the possible superiority of outcome in patients with elevated IGF-I levels after vestibular schwannoma (VS) resection. Patients & methods This retrospective study included 65 patients (34 male, 52.3%) with VS operated in between January 2009 and April 2014 (follow-up 3.2 ± 0.7 years). Preoperative or postoperative IGF-I levels were identified for each patient. Results Patients were divided into two groups: Group A (small size tumor), 56 patients; and Group B (large size tumor), 9 cases. IGF-I levels in Group A (195.8 ± 32.9 ng/ml) were compared with those of Group B (242.2 ± 22.2 ng/ml) and were found to have statistically significant difference (p = 0.001). Conclusion Increased IGF-I levels could hold a key role in nerve recovery in patients undergoing surgical resection of large VS.
Collapse
|
42
|
Samii M, Metwali H, Gerganov V. Efficacy of microsurgical tumor removal for treatment of patients with intracanalicular vestibular schwannoma presenting with disabling vestibular symptoms. J Neurosurg 2017; 126:1514-1519. [DOI: 10.3171/2016.4.jns153020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe aim of this study was to analyze the efficacy and risks of microsurgery via the hearing-preserving retrosigmoid approach in patients with intracanalicular vestibular schwannoma (VS) suffering from disabling vestibular symptoms, with special attention to vertigo.METHODSThis is a retrospective analysis of 19 patients with intracanalicular VS and disabling vestibular dysfunction as the main or only symptom (Group A). All of the patients reported having had disabling vertigo attacks. Subjective evaluation of the impairment of patients was performed before surgery, 3 weeks after surgery, 3 months after surgery, and 1 year after surgery, using the Dizziness Handicap Inventory (DHI). The main outcome measures were improvement in quality of life as measured using the DHI, and general and functional outcomes, in particular facial function and hearing. Patient age, preoperative tumor size, preoperative DHI score, and preservation of the nontumorous vestibular nerve were tested using a multivariate regression analysis to determine factors affecting the postoperative DHI score. The Mann-Whitney U-test was used to compare the postoperative DHI score at 3 weeks, 3 months, and 1 year after surgery with a control group of 19 randomly selected patients with intracanalicular VSs, who presented without vestibular symptoms (Group B). The occurrence of early postoperative discrete vertigo attacks was also compared between groups.RESULTSThe preoperative DHI score was ≥ 54 in all patients. All patients reported having had disabling rotational vertigo before surgery. The only significant factor to affect the DHI outcome 3 weeks and 3 months after surgery was the preoperative DHI score. The DHI outcome after 1 year was not affected by the preoperative DHI score. Compared with the control group, the DHI score at 3 weeks and 3 months after surgery was significantly worse. There was no significant difference between the groups after 1 year. Vertigo was improved in all patients and completely resolved after 1 year in 17 patients.CONCLUSIONSDisabling vestibular dysfunction that affects quality of life should be considered an indication for surgery, even in otherwise asymptomatic patients with intracanalicular VS. Surgical removal of the tumor is safe and very effective in regard to symptom relief. All patients had excellent facial nerve function within 1 year after surgery, with a very good chance of hearing preservation.
Collapse
|
43
|
Ribeyre L, Spitz E, Frère J, Gauchard G, Parietti-Winkler C. Correlations between postural control and psychological factors in vestibular schwannoma patients. J Vestib Res 2016; 26:387-394. [DOI: 10.3233/ves-160588] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Laurence Ribeyre
- University of Lorraine, University of Paris Descartes, Apemac EA 4360, Metz, France
- Department of ENT, University Hospital of Nancy, Nancy, France
| | - Elisabeth Spitz
- University of Lorraine, University of Paris Descartes, Apemac EA 4360, Metz, France
| | - Julien Frère
- University of Lorraine, DevAH EA3450, Vandoeuvre Les Nancy, France
| | - Gerome Gauchard
- University of Lorraine, DevAH EA3450, Vandoeuvre Les Nancy, France
| | - Cécile Parietti-Winkler
- University of Lorraine, DevAH EA3450, Vandoeuvre Les Nancy, France
- Department of ENT, University Hospital of Nancy, Nancy, France
| |
Collapse
|
44
|
|
45
|
Cerebellopontine angle meningioma mimicking vestibular paroxysmia. J Neurol 2015; 263:168-70. [DOI: 10.1007/s00415-015-7972-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 11/27/2022]
|
46
|
Kim SH, Lee SH, Choi SK, Lim YJ, Na SY, Yeo SG. Audiologic evaluation of vestibular schwannoma and other cerebellopontine angle tumors. Acta Otolaryngol 2015; 136:149-53. [PMID: 26479426 DOI: 10.3109/00016489.2015.1100326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Otologic accompanying symptoms, audiogram patterns, and hearing levels according to tumor size differed in patients with CPA tumors classified as VS and non-VS types. OBJECTIVES The diagnosis of CPA tumors is often delayed. Late-diagnosed tumors can grow until they compress and damage vital structures. This study evaluated the otologic symptoms and results of audiologic tests in patients with vestibular schwannomas (VS) and other types of CPA tumors. METHODS This study included 171 patients with otologic symptoms who were diagnosed with CPA tumors, including 116 with VS and 55 with other types of CPA tumors. Factors analyzed retrospectively included tumor type, size, and location and the results of audiometric examinations. RESULTS The most common chief complaint in patients diagnosed with CPA tumors was asymmetrical hearing loss, with most frequent accompanying symptoms being tinnitus in patients with VS and dizziness in those with other types of CPA tumor. The most frequent patterns of hearing loss were the descending type in patients with VS and the flat type in patients with non-VS tumors (p < 0.05). Pure tone thresholds tended to increase more in patients with VS than non-VS tumors according to tumor size, and pure tone averages were significantly higher in patients with VS than non-VS tumors of 11-25 mm in size (p < 0.05).
Collapse
Affiliation(s)
- Sang Hoon Kim
- a Department of Otorhinolaryngology-Head and Neck Surgery
| | - Sung Ho Lee
- b Department of Neurosurgery, School of Medicine , Kyung Hee University , Seoul , Korea
| | - Seok Keun Choi
- b Department of Neurosurgery, School of Medicine , Kyung Hee University , Seoul , Korea
| | - Young Jin Lim
- b Department of Neurosurgery, School of Medicine , Kyung Hee University , Seoul , Korea
| | - Se Young Na
- a Department of Otorhinolaryngology-Head and Neck Surgery
| | - Seung Geun Yeo
- a Department of Otorhinolaryngology-Head and Neck Surgery
| |
Collapse
|
47
|
Abstract
OBJECTIVES To evaluate the cost-effectiveness of obtaining a magnetic resonance imaging (MRI) in patients with abnormal electronystagmography (ENG) or videonystagmography (VNG) results. STUDY DESIGN Retrospective chart review. SETTINGS Academic specialty center. PATIENTS Patients presenting with vertigo between January 1, 2010, and August 30, 2013. METHODS Patients who fit the following abnormal criteria were included in the study: unilateral caloric weakness (≥20%), abnormal ocular motor testing, and nystagmus on positional testing. Patients with abnormal findings who then underwent MRI with gadolinium were evaluated. RESULTS Of the 1,996 charts reviewed, there were 1,358 patients who met the inclusion criteria. The average age of these patients was 62 years (12-94 yr). The male:female ratio was approximately 1:2. Of the 1,358 patients, 253 received an MRI with the following pathologies: four vestibular schwannomas, three subcortical/periventricular white matter changes suspicious for demyelinating disease, four acute cerebellar/posterior circulation infarct, two vertebral artery narrowing, one pseudomeningocele of internal auditory canal, and two white matter changes indicative of migraines. The positive detection rate on MRI was 5.5% based on MRI findings of treatable pathologies causing vertigo. Average cost of an MRI is $1,200, thereby making the average cost of identifying a patient with a positive MRI finding $15,180. CONCLUSION In our study, those patients with a positive MRI had a constellation of symptoms and findings (asymmetric sensorineural hearing loss, tinnitus, vertigo, and abnormal ENG/VNG). Cost-effectiveness can be improved by ordering an MRI only when clinical examination and VNG point toward a central pathology. Clinical examination and appropriate testing should be factored when considering the cost-effectiveness of obtaining an MRI in patients with abnormal ENG/VNG findings.
Collapse
|
48
|
|
49
|
Dayal M, Perez-Andujar A, Chuang C, Parsa AT, Barani IJ. Management of vestibular schwannoma: focus on vertigo. CNS Oncol 2015; 2:99-104. [PMID: 25054360 DOI: 10.2217/cns.12.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This article reviews published literature on vertigo and a 'sense of imbalance' affecting patients who are treated with radiosurgery (RS) for vestibular schwannoma. This is a relatively understudied complaint, along with tinnitus, in this patient population, despite its significant impact on quality of life. It is also a symptom that is most inconsistently impacted by either RS or surgery. This article aims to highlight the importance of this symptom in patients managed for vestibular schwannoma primarily with RS to encourage a more systematic study of vertigo as an outcome measure and to help elucidate its potential etiology.
Collapse
Affiliation(s)
- Manisha Dayal
- Department of Radiation Oncology, University of California at San Francisco, 505 Parnassus Avenue, Room L-08 (Box 0226), San Francisco, CA 94143-0226, USA
| | | | | | | | | |
Collapse
|
50
|
von Brevern M, von Stuckrad-Barre S, Fetter M. [Assessment of driving in patients with vertigo and dizziness]. DER NERVENARZT 2014; 85:841-6. [PMID: 24906537 DOI: 10.1007/s00115-014-4011-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The driving performance of patients with dizziness and vertigo has gained only minor attention so far. Patients with permanent vestibular loss or with episodic vestibular symptoms can experience difficulties in driving a motor vehicle. The presence of a chronic or episodic syndrome presenting with dizziness and/or vertigo does not automatically exclude the ability to drive. Assessment of driving performance should consider the degree of the deficits and compensation in chronic dysfunction and the severity and frequency of attacks, prodromes and triggers of symptoms in episodic disorders.
Collapse
Affiliation(s)
- M von Brevern
- Abteilung für Neurologie, Park-Klinik Weissensee, Schönstr. 80, 13086, Berlin, Deutschland,
| | | | | |
Collapse
|