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Long R, Liu Z, Li J, Zhang Y, Yu H. HCG11 up-regulation induced by ELK4 suppressed proliferation in vestibular schwannoma by targeting miR-620/ELK4. Cancer Cell Int 2021; 21:5. [PMID: 33402177 PMCID: PMC7786942 DOI: 10.1186/s12935-020-01691-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/01/2020] [Indexed: 01/16/2023] Open
Abstract
Background Vestibular schwannoma (VS) is a kind of benign tumor deriving from the acoustic nerve sheath. Substantial long non-coding RNAs (lncRNAs) were illustrated to have crucial roles in multiple cancers. However, few lncRNAs were elucidated in VS. Methods HCG11, miR-620 and ELK4 expression were tested by RT-qPCR. Gain-of-function experiments were conducted to confirm the effect of HCG11 on VS. Results HCG11 possessed a low expression in VS cell lines. Overexpression of HCG11 repressed cell proliferation but accelerated apoptosis of VS cells. Moreover, we identified ELK4 stimulated the transcription of HCG11 and their affinity was verified by ChIP assays. MiR-620 was chosen to be a target of HCG11 and it was tested to have a high expression in VS cell lines. Moreover, depletion of miR-620 could inhibit cell proliferative ability while fostering apoptosis rate of VS cells. ELK4 was low expressed in VS cell lines and knockdown of ELK4 could rescue the effects made by HCG11 overexpression on progression of VS. Conclusions HCG11 could inhibit the growth of VS by targeting miR-620/ELK4 in VS cells. HCG11 was a novel therapeutic target for VS treatment.
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Affiliation(s)
- Ruiqing Long
- Otolaryngology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Zhuohui Liu
- Otolaryngology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Jinghui Li
- Neurosurgery Department, The First Affiliated Hospital of Kunming Medical University, No. 1 Building, No. 295 Xichang Road, Kunming, 650032, Yunnan, China
| | - Yuan Zhang
- Otolaryngology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Hualin Yu
- Neurosurgery Department, The First Affiliated Hospital of Kunming Medical University, No. 1 Building, No. 295 Xichang Road, Kunming, 650032, Yunnan, China.
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Ferreira CJA, Sherer M, Anetakis K, Crammond DJ, Balzer JR, Thirumala PD. Neurophysiological Characteristics of Cranial Nerves V- and VII-Triggered EMG in Endoscopic Endonasal Approach Skull Base Surgery. J Neurol Surg B Skull Base 2020; 82:e342-e348. [PMID: 34306959 DOI: 10.1055/s-0040-1701649] [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: 04/05/2018] [Accepted: 12/24/2019] [Indexed: 10/24/2022] Open
Abstract
Objective This study proposes to present reference parameters for trigeminal (V) and facial (VII) cranial nerves (CNs)-triggered electromyography (tEMG) during endoscopic endonasal approach (EEA) skull base surgeries to allow more precise and accurate mapping of these CNs. Study Design We retrospectively reviewed EEA procedures performed at the University of Pittsburgh Medical Center between 2009 and 2015. tEMG recorded in response to stimulation of CN V and VII was analyzed. Analysis of tEMG waveforms included latencies and amplitudes. Medical records were reviewed to determine the presence of perioperative neurologic deficits. Results A total of 28 patients were included. tEMG from 34 CNs (22 V and 12 VII) were analyzed. For CN V, the average onset latency was 2.9 ± 1.1 ms and peak-to-peak amplitude was 525 ± 436.94 μV ( n = 22). For CN VII, the average onset latency and peak-to-peak amplitude were 5.1 ± 1.43 ms and 315 ± 352.58 μV for the orbicularis oculi distribution ( n = 09), 5.9 ± 0.67 ms and 517 ± 489.07 μV on orbicularis oris ( n = 08), and 5.3 ± 0.98 ms 303.1 ± 215.3 μV on mentalis ( n = 07), respectively. Conclusion Our data support the notion that onset latency may be a feasible parameter in the differentiation between the CN V and VII during the crosstalk phenomenon in EEA surgeries but the particularities of this type of procedure should be taken into consideration. A prospective analysis with a larger data set is necessary.
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Affiliation(s)
- Carla J A Ferreira
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Marcus Sherer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Katherine Anetakis
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Donald J Crammond
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Jeffrey R Balzer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Parthasarathy D Thirumala
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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Patibandla MR, Panigrahi MK, Gurram PL, Thotakura AK, Kulkarni D. Morphometric analysis of posterior fossa in Indian CP angle acoustic schwannoma patients. Asian J Neurosurg 2016; 11:255-60. [PMID: 27366252 PMCID: PMC4849294 DOI: 10.4103/1793-5482.145308] [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: 11/04/2022] Open
Abstract
AIM To study the morphometry of posterior fossa in Indian CP angle schwannoma patients in order to know its influence on the extent of excision of the CP angle acoustic schwannomas. MATERIALS AND METHODS One hundred cases of cerebellopontine angle schwannomas treated surgically by the senior author and 20 controls between January 2006 and June 2011 were consecutively investigated with computed tomography (CT) using the high-resolution CT bone windows before surgery. Evaluation of anatomic parameters of the petrous bone and posterior fossa cavity were done in all patients and controls. Data were entered in Excel software and were analyzed using NCSS software. All possible regression analysis was done to select the important variables to be included in the model to predict the excision of tumor with these variables. A prediction model was developed defining the binary outcome as total excision or subtotal excision as dependent variable and the morphometric data and grading of tumor as independent variables. RESULTS Interpetrous distance (IP) is the distance between the two petrous apices. Sigmoid distance (IS) distance is the distance between the two sigmoid points. Sigmoid point is the point at which the scalloped impression of the sigmoid sinus straightens to join the occipital bone posteriorly. SAG is the distance between the mid IP point and the mid-point on the inner wall of the occipital bone. The PM angle was 47.8±4.14 degrees (38-58), the PA angle was 42.68±4.47 degrees (34-53), the IP distance was 2.07±0.13 cm (1.5-2.8), the sagittal diameter of posterior fossa was 6.22±0.73 cm (5.1-9.8) and the intersigmoid distance was 9.45±0.73 cm (7.4-11). There was no significant gender difference in the posterior fossa morphometry between patients and controls. Inter-sigmoid distance and the petrous-apex angle were more in the Indians when compared to the European population mentioned in the Mathies and Samii study. CONCLUSIONS The posterior fossa morphological parameters of the Indian and European population differ significantly. Inter-sigmoid distance and the petrous-apex angle were more in the Indians when compared to the Europeans. There is no significant gender difference in the morphometry of the Indians. There is no significant difference between the patients and the control groups. In our study the adhesions with surrounding structures along with the posterior fossa morphometry significantly affect the extent of excision.
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Affiliation(s)
- Mohana Rao Patibandla
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Manas K Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Paniraj L Gurram
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Amit Kumar Thotakura
- Department of Neurosurgery, NRI Academy of Sciences, Mangalagiri, Andhra Pradesh, India
| | - Dilip Kulkarni
- Department of Anasthesiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Wang ZM, Yang ZJ, Zhao F, Wang B, Wang XC, Qu PR, Liu PN. Auditory Rehabilitation in Rhesus Macaque Monkeys (Macaca mulatta) with Auditory Brainstem Implants. Chin Med J (Engl) 2016; 128:1363-9. [PMID: 25963359 PMCID: PMC4830318 DOI: 10.4103/0366-6999.156783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The auditory brainstem implants (ABIs) have been used to treat deafness for patients with neurofibromatosis Type 2 and nontumor patients. The lack of an appropriate animal model has limited the study of improving hearing rehabilitation by the device. This study aimed to establish an animal model of ABI in adult rhesus macaque monkey (Macaca mulatta). Methods: Six adult rhesus macaque monkeys (M. mulatta) were included. Under general anesthesia, a multichannel ABI was implanted into the lateral recess of the fourth ventricle through the modified suboccipital-retrosigmoid (RS) approach. The electrical auditory brainstem response (EABR) waves were tested to ensure the optimal implant site. After the operation, the EABR and computed tomography (CT) were used to test and verify the effectiveness via electrophysiology and anatomy, respectively. The subjects underwent behavioral observation for 6 months, and the postoperative EABR was tested every two weeks from the 1st month after implant surgery. Result: The implant surgery lasted an average of 5.2 h, and no monkey died or sacrificed. The averaged latencies of peaks I, II and IV were 1.27, 2.34 and 3.98 ms, respectively in the ABR. One-peak EABR wave was elicited in the operation, and one- or two-peak waves were elicited during the postoperative period. The EABR wave latencies appeared to be constant under different stimulus intensities; however, the amplitudes increased as the stimulus increased within a certain scope. Conclusions: It is feasible and safe to implant ABIs in rhesus macaque monkeys (M. mulatta) through a modified suboccipital RS approach, and EABR and CT are valid tools for animal model establishment. In addition, this model should be an appropriate animal model for the electrophysiological and behavioral study of rhesus macaque monkey with ABI.
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Affiliation(s)
| | | | | | | | | | | | - Pi-Nan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; Department of Neural Reconstruction, Beijing Neurosurgical Institute, Beijing 100050, China
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G RSK, Jagadish J. A STUDY OF THE INCID ENCE OF CEREBELLOPON TINE ANGLE TUMORS AND THEIR MAN AGEMENT IN A TERTIAR Y CARE HOSPITAL. ACTA ACUST UNITED AC 2015. [DOI: 10.18410/jebmh/2015/366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rocha-Filho PAS. Post-Craniotomy Headache: A Clinical View With a Focus on the Persistent Form. Headache 2015; 55:733-8. [DOI: 10.1111/head.12563] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 01/03/2023]
Affiliation(s)
- Pedro Augusto Sampaio Rocha-Filho
- Department of Neuropsychiatry; Universidade Federal de Pernambuco; Recife PE Brazil
- Headache Clinic; Hospital Universitário Osvaldo Cruz; Universidade de Pernambuco; Recife PE Brazil
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Kulwin CG, Cohen-Gadol AA. Technical nuances of resection of giant (> 5 cm) vestibular schwannomas: pearls for success. Neurosurg Focus 2012; 33:E15. [DOI: 10.3171/2012.7.focus12177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Removal of vestibular schwannomas (VSs, or acoustic neuromas) remains one of the most challenging operations in neurosurgery. Giant or huge tumors (> 5 cm) heighten these challenges, and technical nuances play a special role in maximizing tumor resection while minimizing complications. In this article, the senior author describes his technical experience with microsurgical excision of giant VSs. The accompanying video further illustrates these details.
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Mehrotra N, Behari S, Pal L, Banerji D, Sahu RN, Jain VK. Giant vestibular schwannomas: focusing on the differences between the solid and the cystic variants. Br J Neurosurg 2009; 22:550-6. [DOI: 10.1080/02688690802159031] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Guo L, Jasiukaitis P, Pitts LH, Cheung SW. Optimal Placement of Recording Electrodes for Quantifying Facial Nerve Compound Muscle Action Potential. Otol Neurotol 2008; 29:710-3. [DOI: 10.1097/mao.0b013e318171975e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jackler RK, Pitts LH. Selection of Surgical Approach to Acoustic Neuroma. Neurosurg Clin N Am 2008; 19:217-38, vi. [DOI: 10.1016/j.nec.2008.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sahu RN, Mehrotra N, Tyagi I, Banerji D, Jain VK, Behari S. Management strategies for bilateral vestibular schwannomas. J Clin Neurosci 2007; 14:715-22. [PMID: 17577524 DOI: 10.1016/j.jocn.2006.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 05/17/2006] [Accepted: 05/17/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bilateral vestibular schwannomas (VS) are rare. Most patients in India present late in the course of illness with large tumors and disabling deafness. Clinical presentation and management goals are different from that of unilateral VS. AIMS To highlight the differences in clinical presentations and surgical results of bilateral VS compared to unilateral VS; and, to propose a management strategy for these tumors with reference to tumor size, extent of growth and the presence or absence of hearing impairment. METHOD This is a retrospective study of 16 patients with bilateral VS treated over 10 years in a tertiary referral hospital. Assessment of VIIth and VIIIth cranial nerve function, tumor size, volume and extent of growth was performed in all patients. The management strategy was based on Samii's classification of tumor extent. All patients were operated using a retromastoid suboccipital approach. Postoperative results were analyzed and compared with those of unilateral VS. RESULTS The mean age of presentation was 25.7 years. Hearing impairment was the commonest symptom. Headache with features of raised intracranial pressure were present in 10 (62.5%) patients. Giant tumors were present in seven (43.7%) patients; large tumors in eight (50%) and a medium-sized tumor in one (6.3%). Total tumor resection was achieved in 13 patients and subtotal resection in two. One patient was managed conservatively and followed up with serial CT scans. On the contralateral side, one large tumor required total excision. One medium sized tumor underwent sub-capsular excision in an attempt to preserve hearing. The facial nerve was anatomically preserved in seven (46.7%) patients and in one, the cochlear nerve was anatomically preserved. There was no peri-operative mortality. CONCLUSIONS Patients with bilateral schwannomas are younger, have larger lesions, poorer preoperative hearing and are more likely to lose either auditory and/or facial nerve function during attempted total resection of the tumor. Classifying the tumors into two groups by extent, that is, tumors extending to the cerebellopontine angle cistern (T1-T3a) and, tumors extending to or compressing the brainstem (T3b to T4b), allows the surgical strategy to be defined.
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Affiliation(s)
- Rabi N Sahu
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow 226014, India
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Litre CF, Gourg GP, Tamura M, Mdarhri D, Touzani A, Roche PH, Régis J. Gamma Knife Surgery for Facial Nerve Schwannomas. Neurosurgery 2007; 60:853-9; discussion 853-9. [PMID: 17460520 DOI: 10.1227/01.neu.0000249282.46514.da] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Radical resection of facial nerve schwannomas classically implies a high risk of severe facial palsy. Owing to the rarity of facial palsy after gamma knife surgery (GKS) of vestibular schwannomas, functional evaluation after GKS seems rational in this specific group of patients. To our knowledge, no previous similar evaluation exists in the literature.
METHODS
Of 1783 schwannomas of the cerebellopontine angles treated by GKS at Timone University Hospital between July 1992 and May 2003, 11 were diagnosed as originating from the facial nerve. Criteria for this diagnosis were the involvement of the tympanic or mastoid segment of the facial nerve (n = 9) and/or preoperative observation of a facial nerve deficit that had occurred during previous microsurgery (two patients). The rare occurrence of facial palsy after vestibular schwannoma radiosurgery, usually within 18 months of treatment, has been considered only in the patients with more than 2 years of follow-up (n = 9).
RESULTS
Six of these patients experienced a previous spontaneous facial palsy on one (n = 4) or several occasions (n = 2). A normal motor facial function was observed in only three patients before GKS (House-Brackmann Grade II in six patients, Grade III in one patient, Grade IV in one patient). The median follow-up period was 39 months (range, 18–84 mo). At the time of the last follow-up examination, no patients had developed a new facial palsy or experienced deterioration of a preexisting facial palsy and three patients had improvement of a preoperative facial palsy. Ten out of the 11 tumors are stable or decreased in size; in the other, a microsurgical resection of the tumor had been recommended owing to the development of a cyst. Clinical management owing to the specificity and heterogeneity of this group of patients has required the development of an original classification of four anatomic subtypes presenting different clinical and surgical difficulties.
CONCLUSION
This first study demonstrates that radiosurgery allows treatment of these patients while preserving normal motor facial function. Such an advantage should lead to the consideration of GKS as a first treatment option for small- to medium-size facial nerve schwannomas.
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Coulson SE, O'dwyer NJ, Adams RD, Croxson GR. Expression of emotion and quality of life after facial nerve paralysis. Otol Neurotol 2005; 25:1014-9. [PMID: 15547436 DOI: 10.1097/00129492-200411000-00026] [Citation(s) in RCA: 201] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the facial expression of emotion and quality of life in patients after long-term facial nerve paralysis. STUDY DESIGN Cross-sectional. SETTING Facial nerve paralysis clinic. PATIENTS Twenty-four patients with facial nerve paralysis and 24 significant others (partner, relative, friend). INTERVENTION Patients were assessed using Sunnybrook, Sydney, and House-Brackmann grading scales and SF-36, Glasgow Benefit Inventory, and Facial Disability Index quality-of-life measures. RESULTS When patients identified themselves as either effective or not effective at facially communicating each of Ekman's primary emotions (happiness, disgust, surprise, anger, sadness, and fear), 50% classified themselves as not effective at expressing one or more of the six emotions. Significant others of the not effective patients rated the emotions as more difficult for their partner-patients to communicate facially than did the significant others of effective patients. The SF-36 quality-of-life survey revealed lower social functioning relative to physical functioning for not effective patients. From the Sunnybrook Facial Grading System, more synkinesis was found for those patients not effective at expressing happiness, less brow and eye movement for patients not effective at expressing sadness, and less voluntary movement for those not effective with surprise. CONCLUSION Movement deficits associated with expressing specific emotions and an association with quality-of-life measures were identified in patients with long-term facial nerve paralysis who saw themselves as not effective at facial expression of emotions. To improve management of emotional expression in patients with facial nerve paralysis, a broader approach is recommended, linking the practitioner's treatment goals with patient-driven outcome goals.
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Affiliation(s)
- Susan E Coulson
- School of Physiotherapy, The University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia.
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Khurana VG, Link MJ, Driscoll CLW, Beatty CW. Evolution of a cochlear schwannoma on clinical and neuroimaging studies. J Neurosurg 2003; 99:779-82. [PMID: 14567617 DOI: 10.3171/jns.2003.99.4.0779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The authors report on a patient with a rare schwannoma that arose from the cochlear division of the vestibulocochlear nerve. Distinctively, the lesion appeared to arise from the cochlea itself and was monitored with clinical and neuroimaging studies for 12 years before it was diagnosed and treated. The atypical occurrence of schwannomas of the vestibulocochlear nerve originating in the inner ear structures underscores the high level of clinical suspicion required for the diagnosis of these lesions in patients presenting with persistent auditory and vestibular symptoms.
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Affiliation(s)
- Vini G Khurana
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Colletti V, Fiorino F, Carner M, Sacchetto L, Miorelli V, Orsi A. Auditory brainstem implantation: the University of Verona experience. Otolaryngol Head Neck Surg 2002; 127:84-96. [PMID: 12161736 DOI: 10.1067/mhn.2002.126723] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to describe the advantages of the retrosigmoid-transmeatal (RS-TM) approach in the application of auditory brainstem implants (ABIs) in adults with monolateral and bilateral vestibular schwannoma (VS) and in children with cochlear nerve aplasia. STUDY DESIGN We conducted a retrospective case review. SETTING The study was conducted at the ENT Department of the University of Verona, Italy. PATIENTS Six adult patients (5 men and 1 woman) with neurofibromatosis type 2 (NF2) were operated on for VS removal with ABI. An additional patient had a unilateral VS in the only hearing ear. Tumor size ranged from 12 to 40 mm. In addition, 2 children received ABIs for bilateral cochlear nerve aplasia. INTERVENTION An RS-TM approach was used in all VS patients, and an RS approach was used in the subjects with cochlear nerve aplasia. After tumor excision, landmarks (VII, VIII and IX cranial nerves, choroid plexus) for the foramen of Luschka were carefully identified. The choroid plexus was then partially removed and the tela choroidea divided and bent back; the floor of the lateral recess of the fourth ventricle and the convolution of the dorsal cochlear nucleus became visible. In the 2 subjects with no cochlear nerve, the choroid plexus and VII and IX cranial nerves were used as landmarks. The electrode array was then inserted into the lateral recess and the correct position was monitored with the aid of electrically evoked auditory brainstem responses (EABR) and neural response telemetry (NRT). RESULTS Correct implantation was possible in all patients. Auditory sensations were induced in all patients with various numbers of electrodes. Different pitch sensations could be identified with different electrode stimulation. CONCLUSIONS We believe that the RS approach is the route of choice for patients who are candidates for ABI due to the easy and clear access to the cochlear nucleus area. This route avoids some of the drawbacks of the translabyrinthine approach, such as mastoidectomy, labyrinthectomy, sealing of the cavity and posterior fossa with abdominal fat, and contamination from the middle ear. For this reason, it is the route of choice in children with cochlear nerve aplasia or severe cochlear malformation and in adults with complete ossification of the cochlea or cochlear nerve disruption due to cranial trauma.
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Lanman TH, Brackmann DE, Hitselberger WE, Subin B. Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach. J Neurosurg 1999; 90:617-23. [PMID: 10193604 DOI: 10.3171/jns.1999.90.4.0617] [Citation(s) in RCA: 143] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The choice of approach for surgical removal of large acoustic neuromas is still controversial. The authors reviewed the results in a series of patients who underwent removal of large tumors via the translabyrinthine approach. METHODS The authors conducted a database analysis of 190 patients (89 men and 101 women) with acoustic neuromas 3 cm or greater in size. The mean age of these patients was 46.1+/-15.6 years. One hundred seventy-eight patients underwent primary translabyrinthine surgical removal and 12 underwent surgery for residual tumor. Total tumor removal was accomplished in 183 cases (96.3%). The tumor was adherent to the facial nerve to some degree in 64% of the cases, but the facial nerve was preserved anatomically in 178 (93.7%) of the patients. Divided nerves were repaired by primary attachment or cable graft. Facial nerve function was assessed immediately after surgery, at the time of discharge, and at 3 to 4 weeks and 1 year after discharge. Excellent function (House-Brackmann facial nerve Grade I or II) was present in 55%, 33.9%, 38.8%, and 52.6% of the patients for each time interval, respectively, with acceptable function (Grades I-IV) in 81% at 1 year. Cerebrospinal fluid leakage that required surgical repair occurred in only 1.1% of the patients and meningitis in 3.7%. There were no deaths. CONCLUSIONS Use of the translabyrinthine approach for removal of large tumors resulted in good anatomical and functional preservation of the facial nerve, with minimum incidence of morbidity and no incidence of mortality. The authors continue to recommend use of this approach for acoustic tumors larger than 3 cm and for smaller tumors when hearing preservation is not an issue.
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Affiliation(s)
- T H Lanman
- Neurosurgical Associates, Los Angeles, California, USA
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Lanman TH, Brackmann DE, Hitselberger WE, Subin B. Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach. Neurosurg Focus 1999. [DOI: 10.3171/foc.1999.6.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The choice of approach for surgical removal of large acoustic neuromas is still controversial. The authors reviewed the results in a series of patients who underwent removal of large tumors via the translabyrinthine approach.
Methods
The authors conducted a database analysis of 190 patients (89 men and 101 women) with acoustic neuromas 3 cm or greater in size. The mean age of these patients was 46.1 ± 15.6 years. One hundred seventy-eight patients underwent primary translabyrinthine surgical removal and 12 underwent surgery for residual tumor. Total tumor removal was accomplished in 183 cases (96.3%). The tumor was adherent to the facial nerve to some degree in 64% of the cases, but the facial nerve was preserved anatomically in 178 (93.7%) of the patients. Divided nerves were repaired by primary attachment or cable graft. Facial nerve function was assessed immediately after surgery, at the time of discharge, and at 3 to 4 weeks and 1 year after discharge. Excellent function (House-Brackmann facial nerve Grade I or II) was present in 55%, 33.9%, 38.8%, and 52.6% of the patients for each time interval, respectively, with acceptable function (Grades I–IV) in 81% at 1 year. Cerebrospinal fluid leakage that required surgical repair occurred in only 1.1% of the patients and meningitis occurred in 3.7%. There were no deaths.
Conclusions
Use of the translabyrinthine approach for removal of large tumors resulted in good anatomical and functional preservation of the facial nerve, with minimum incidence of morbidity and no incidence of mortality. The authors continue to recommend use of this approach for acoustic tumors larger than 3 cm and for smaller tumors when hearing preservation is not an issue.
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Colletti V, Fiorino FG. Retrosigmoid-transmeatal en bloc removal of small to medium-sized acoustic neuromas. Otolaryngol Head Neck Surg 1999; 120:122-8. [PMID: 9914562 DOI: 10.1016/s0194-5998(99)70382-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
One hundred three subjects with acoustic neuroma (AN) underwent surgery--involving a retrosigmoid-transmeatal approach--between January 1990 and December 1995. All the intracanalar tumors (n = 18) and 70 of the intra- and extracanalar neuromas with an extracanalar neuroma size less than 25 mm--a total of 88 patients--constituted the final study population. The first 48 patients were operated on with the use of classic procedures described in the literature, characterized by limited exposure of the internal auditory canal and removal of the tumor after debulking. Surgery in the next 40 subjects was conducted according to the technique of en bloc removal of the tumor. The main features of this technique are continuous direct recording of cochlear and facial-nerve action potentials, wide opening of the internal auditory canal with lateral extension to the fundus, and removal of the tumor following the capsular lining without debulking. Statistical analysis of the results of the en bloc removal, compared with the previously used debulking technique, showed improvement in postoperative outcome for both auditory and facial-nerve function.
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Affiliation(s)
- V Colletti
- Ear-Nose-Throat Department, University of Verona, Italy
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Abstract
Unilateral acoustic tumors rarely recur after total translabyrinthine removal. Review of the patient records of the House Ear Clinic revealed five recurrent tumors, for an approximate incidence of 0.3%. A questionnaire was mailed to 857 patients who were at least 9 years postoperative and failed to find any additional recurrent tumors. No preoperative or intraoperative factors were identified to predict recurrence. The average time interval from initial removal to recurrence was approximately 10 years. Flow cytometric analysis did not reveal any fundamental differences between the recurrent acoustic tumor group and a larger group of 112 acoustic tumors. Based on observed growth rates of the recurrent acoustic tumors, a single gadolinium-enhanced magnetic resonance image 5 years after surgery is advised. To prevent recurrence, a margin of normal-appearing proximal eighth cranial nerve should be removed and the nerve stump cauterized.
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Charabi S, Thomsen J, Mantoni M, Charabi B, Jørgensen B, Børgesen SE, Gyldensted C, Tos M. Acoustic Neuroma (Vestibular Schwannoma): Growth and Surgical and Nonsurgical Consequences of the Wait-And-See Policy. Otolaryngol Head Neck Surg 1995; 113:5-14. [PMID: 7603722 DOI: 10.1016/s0194-59989570138-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
A prospective study of the consequences of the wait-and-see policy in patients with neuroradiologic diagnostic evidence of having vestibular schwannoma was conducted in a series of 123 patients (127 tumors) over a 20-year period, from 1973 to 1993. The mean follow-up period was 3.4 years, mean annual growth rate was 3.2 mm/year, mean annual volume growth rate was 0.72 ml/year, and mean annual relative growth rate was 41%. Tumor growth was observed in 90 (74%) patients (94 tumors), no growth was seen in 23 (18%) patients (23 tumors), and negative tumor growth was seen in 10 (8%) patients (10 tumors). Surgery due to tumor growth was performed in 35 (28%) patients (35 tumors), 7 (6%) patients (7 tumors) were treated with γ-radiation and/or shunt insertion, 7 (6%) patients died of brain stem herniation induced by tumor compression, 9 (7%) patients died of non-tumor-related causes, 28 patients were classified as candidates for hearing preservation surgery, and 21 (75%) patients lost their candidacy during the observation period due to tumor growth and/or deterioration of hearing. The results may limit indications for allocation of patients with vestibular schwannoma to the wait-and-see group.
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Affiliation(s)
- S Charabi
- Department of Otorhinolaryngology, Head and Neck Surgery, Gentofte University Hospital, Hellerup, Denmark
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Charabi S, Rygaard J, Klinken L, Tos M, Thomsen J. Subcutaneous growth of human acoustic schwannomas in athymic nude mice. Acta Otolaryngol 1994; 114:399-405. [PMID: 7526595 DOI: 10.3109/00016489409126077] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In order to develop an in vivo model for growth of acoustic schwannomas, we studied tumor specimens from 10 patients, transplanted into a subcutaneous pocket of 67 nude mice. The number of tumors which survived or grew was 63 (94%). Obvious macroscopic growth was observed in 22 (33%), status quo in 28 (42%), and regression of tumor size in 13 (19%). The tumor disappeared in 4 cases (6%). Serial implantation was not possible due to the small amount of neuroma tissue in the surviving tumors. In animals with obvious macroscopic growth, neovascularization was clearly demonstrated. The presence of Schwann cells in the implants was confirmed immunohistochemically. The proliferative activity in the original and implanted tumors was evaluated by the proliferating cell nuclear antigen (PCNA) and Ki-67 nuclear antigen stainings and showed good correlation between primary tumors and implants. This in vivo tumor model will open new opportunities to study the biology of acoustic tumors and to test different therapeutic modalities.
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Affiliation(s)
- S Charabi
- Department of ORL, Head and Neck Surgery, Gentofte University Hospital, Hellerup, Denmark
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Goebel JA, Vollmer DG. Hearing improvement after conservative approach for large posterior fossa meningioma. Otolaryngol Head Neck Surg 1993; 109:1025-9. [PMID: 8265185 DOI: 10.1177/019459989310900609] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Hearing preservation during the posterior fossa surgery depends on many factors, including tumor size and site of origin. In many cases, regardless of the presumed tumor origin, the severity of the pure-tone loss or decline in speech discrimination on preoperative testing prompts the surgeon to choose a surgical approach (translabyrinthine or transcochlear) that negates the chance for postoperative functional hearing in the involved ear. We describe a 41-year-old woman with unilateral severe sensorineural hearing loss who experienced a remarkable recovery of hearing after combined retrolabyrinthine and retrosigmoid removal of a 4 cm petrous ridge meningioma using intraoperative cochlear monitoring. Despite the tumor size, early intraoperative loss of wave I and proximity of the tumor to the porus, complete tumor removal was accomplished with preservation of the cochleovestibular bundle. Three weeks postoperatively, the patient noted marked subjective improvement and speech audiometry demonstrated an improvement in word recognition, from 0% to 86%. This improvement has remained 1 year postoperatively, with no evidence of persistent tumor on repeat MRI scan. The case report illustrates the possibility of not just hearing preservation but improvement after removal of even large posterior fossa meningiomas that do not directly invade the cochlear nerve itself.
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Affiliation(s)
- J A Goebel
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110
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Cerullo LJ, Grutsch JF, Heiferman K, Osterdock R. The preservation of hearing and facial nerve function in a consecutive series of unilateral vestibular nerve schwannoma surgical patients (acoustic neuroma). SURGICAL NEUROLOGY 1993; 39:485-93. [PMID: 8516747 DOI: 10.1016/0090-3019(93)90036-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Between January 1981 and February 1992, 102 non-NF-2 patients underwent removal of a unilateral vesitbular schwannoma. There were 54 women and 48 men. Eighty-six percent of patients with normal facial function preoperatively retained normal function (House score 1 or 2) postoperatively. Of the 64 patients with a functional cochlear nerve preoperatively, five had normal hearing (PTA < 25 dB, SB > 70%), five had near normal hearing (PTA < 45 dB, SD > 70%), four patients had preserved hearing (PTA < 50 dB, SD > 50%), and three patients had preserved cochlear nerve function (PTA > 50 dB, SD < 50%) after surgery. Hearing preservation was obtained in patients whose tumors were larger than 3 cm. Radiological follow-up revealed 10 patients with recurrent tumor, all but one asymptomatic.
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Affiliation(s)
- L J Cerullo
- Chicago Institute for Neurosurgery and Neuroresearch, Illinois
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Amoils CP, Lanser MJ, Jackler RK. Acoustic neuroma presenting as a middle ear mass. Otolaryngol Head Neck Surg 1992; 107:478-82. [PMID: 1408241 DOI: 10.1177/019459989210700327] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- C P Amoils
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
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Lanser MJ, Sussman SA, Frazer K. Epidemiology, Pathogenesis, And Genetics Of Acoustic Tumors. Otolaryngol Clin North Am 1992. [DOI: 10.1016/s0030-6665(20)30962-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Nedzelski JM, Schessel DA, Pfleiderer A, Kassel EE, Rowed DW. Conservative Management Of Acoustic Neuromas. Otolaryngol Clin North Am 1992. [DOI: 10.1016/s0030-6665(20)30969-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Yingling CD, Gardi JN. Intraoperative Monitoring Of Facial And Cochlear Nerves During Acoustic Neuroma Surgery. Otolaryngol Clin North Am 1992. [DOI: 10.1016/s0030-6665(20)30994-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hutman S. New approaches to acoustic neuroma surgery. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 1991; 9:168-75. [PMID: 10149455 DOI: 10.1089/clm.1991.9.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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