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Hey M, Dambon J, Synowitz M, Ambrosch P. [Retrocochlear diagnostics for acute hearing loss and successful therapy]. HNO 2024; 72:44-50. [PMID: 37615685 PMCID: PMC10781830 DOI: 10.1007/s00106-023-01351-5] [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] [Accepted: 06/20/2023] [Indexed: 08/25/2023]
Abstract
A 41-year-old female patient presented due to acute onset of unilateral hearing loss 3 months previously and persistent since then. Systemic therapy with oral glucocorticoids in decreasing doses had been performed beforehand, but did not lead to any improvement. In the course of audiological diagnostics, based on subjective and objective methods, a retrocochlear hearing disorder was suspected. A meningioma was diagnosed by diagnostic imaging. Subsequent surgical removal achieved a significant hearing improvement.
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Affiliation(s)
- Matthias Hey
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, UKSH Campus Kiel, Arnold-Heller-Straße 14, 24105, Kiel, Deutschland.
| | - Jan Dambon
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, UKSH Campus Kiel, Arnold-Heller-Straße 14, 24105, Kiel, Deutschland
| | | | - Petra Ambrosch
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, UKSH Campus Kiel, Arnold-Heller-Straße 14, 24105, Kiel, Deutschland
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Lee WJ, Choi JW, Kong DS, Nam DH, Lee JI, Seol HJ. Factors Associated with Acute Obstructive Hydrocephalus After Retrosigmoid Approach for Extra-Axial Cerebellopontine Angle Tumors. World Neurosurg 2022; 166:e1-e10. [PMID: 35489600 DOI: 10.1016/j.wneu.2022.04.088] [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: 01/03/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study aimed to identify the risk factors for acute obstructive hydrocephalus (AOHCP) after extra-axial cerebellopontine angle (CPA) tumor surgery using the retrosigmoid (RS) approach. METHODS This retrospective study assessed 154 patients (100 vestibular schwannomas, 34 CPA meningiomas [MNGs], 9 trigeminal schwannomas, and 11 petroclival MNGs) who underwent surgical resection using the RS approach by a single surgeon between August 2010 and September 2019. AOHCP was defined as postoperative ventricular enlargement due to cerebrospinal fluid flow obstruction caused by surgery-related cerebellar injury within 1 week. The radiological characteristics of the tumors were classified, and the surgical outcomes were reviewed. We analyzed the impact of different factors on the development of AOHCP after surgery. RESULTS AOHCP developed in 17 (11%) patients, all of whom were treated with external ventricular drain insertion. Multivariate analysis showed that CPA MNGs (odds ratio [OR], 37.98), grade of tumor extension beyond the petroclival junction (grade 1: OR, 16.42; grade 2: OR, 17.47), major fourth ventricle compression (OR, 17.77), and surgery-related hemorrhage (OR, 7.64) were associated with AOHCP. Surgery-related hemorrhage was observed in 17 (11%) patients. 9 (6%) patients underwent ventriculoperitoneal shunt surgery because of persistent HCP. CONCLUSIONS An increased risk of AOHCP after the RS approach was observed in patients with extra-axial CPA tumors with clival extension and major fourth ventricle compression. Compulsive and meticulous hemostasis must be achieved because postoperative hemorrhage is associated with AOHCP.
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Affiliation(s)
- Won-Jae Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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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: 0] [Impact Index Per Article: 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.
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Xue YT, Chen HL, Young YH. Comorbidity of cerebellopontine angle meningioma with other primary neoplasms. Acta Otolaryngol 2021; 141:57-61. [PMID: 33043746 DOI: 10.1080/00016489.2020.1826575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Meningioma is known to be accompanied by other primary neoplasms, yet has been evaluated less than these. OBJECTIVE This study investigated comorbidity of cerebellopontine angle (CPA) meningioma with other primary neoplasms. METHODS Overall 1,085 meningioma cases including 16 meningiomas at the CPA were enrolled for investigating the presence of other primary neoplasms. Another 16 age-, sex-, and size-matched CPA schwannoma were also included for comparison. RESULTS Of a data-base cohort study of overall 1085 meningioma cases, 165 cases (15%) were associated with other primary neoplasms. In contrast, 8 (50%) of 16 CPA meningioma and one (8%) of 16 CPA schwannoma showed other primary neoplasms. Except for one patient who had oral cancer prior to the diagnosis of CPA meningioma by 4 years, the interval from diagnosis of CPA meningioma to that of other primary neoplasm ranged 0-6 (mean, 3.1 ± 2.5) years. CONCLUSION Prevalence of comorbidity with other primary neoplasms is significantly higher in CPA meningioma (50%) than overall meningioma (15%) and CPA schwannoma (8%). In addition to follow-up MR imaging to visualize both residual tumor and regional brain environment after treatment of CPA meningioma, long-term systemic screening for other primary neoplasm is also mandatory.
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Affiliation(s)
- Yi-Ting Xue
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Lin Chen
- Department of Otolaryngology, National Taiwan University Hospital, Hsin-Chu, Taiwan
- Graduate Institute of Biochemistry and Molecular Biology, College of Medicine, National Taiwan University, Hsin-Chu, Taiwan
| | - Yi-Ho Young
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
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Papathanasiou E, Straumann D. Why and when to refer patients for vestibular evoked myogenic potentials: A critical review. Clin Neurophysiol 2019; 130:1539-1556. [DOI: 10.1016/j.clinph.2019.04.719] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/08/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
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von Kirschbaum C, Gürkov R. Audiovestibular Function Deficits in Vestibular Schwannoma. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4980562. [PMID: 27747231 PMCID: PMC5055915 DOI: 10.1155/2016/4980562] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/12/2016] [Accepted: 08/24/2016] [Indexed: 11/28/2022]
Abstract
Introduction. Vestibular schwannomas (VS) are benign tumours of the vestibular nerve and can lead to hearing loss, tinnitus, vertigo, facial palsy, and brainstem compression. Audiovestibular diagnostic tests are essential for detection and treatment planning. Methods. Medline was used to perform a systematic literature review with regard to how audiovestibular test parameters correlate with symptoms, tumour size, and tumour location. Results. The auditory brainstem response can be used to diagnose retrocochlear lesions caused by VS. Since hearing loss correlates poorly with tumour size, a retrocochlear lesion is probably not the only cause for hearing loss. Also cochlear mechanisms seem to play a role. This can be revealed by abnormal otoacoustic emissions, despite normal ABR and new MRI techniques which have demonstrated endolymphatic hydrops of the inner ear. Caloric and head impulse tests show frequency specific dynamics and vestibular evoked myogenic potentials may help to identify the location of the tumour regarding the involved nerve parts. Conclusion. In order to preserve audiovestibular function in VS, it is important to stop the growth of the tumour and to avoid degenerative changes in the inner ear. A detailed neurotological workup helps to diagnose VS of all sizes and can also provide useful prognostic information.
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Affiliation(s)
- Constantin von Kirschbaum
- Department of Otorhinolaryngology and Head and Neck Surgery, Grosshadern Medical Center, University of Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Robert Gürkov
- Department of Otorhinolaryngology and Head and Neck Surgery, Grosshadern Medical Center, University of Munich, Marchioninistr. 15, 81377 Munich, Germany
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Nozawa A, Ozeki M, Kuze B, Asano T, Matsuoka K, Fukao T. Gorham-Stout Disease of the Skull Base With Hearing Loss: Dramatic Recovery and Antiangiogenic Therapy. Pediatr Blood Cancer 2016; 63:931-4. [PMID: 26713883 DOI: 10.1002/pbc.25886] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/19/2015] [Accepted: 12/04/2015] [Indexed: 11/10/2022]
Abstract
Gorham-Stout disease (GSD) is a rare disorder of unknown etiology. We present a 6-year-old male with GSD involving the skull base who presented with recurrent cerebrospinal fluid (CSF) rhinorrhea, severe hearing loss, and facial palsy secondary to cerebellar herniation into the internal auditory canal. After 2 months of treatment with pegylated interferon (IFN) α-2b (50 μg/week), his hearing recovered dramatically. Two years later, new bone formation appeared radiologically and IFN was switched to sirolimus. One year after the switch, CSF rhinorrhea disappeared. Antiangiogenic therapy might inhibit proliferation of vascular endothelial cells in osteolytic lesions and lead to new bone formation.
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Affiliation(s)
- Akifumi Nozawa
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Michio Ozeki
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Bunya Kuze
- Department of Otolaryngology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Takahiko Asano
- Department of Radiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Kentaro Matsuoka
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Toshiyuki Fukao
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
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Lucieer F, Vonk P, Guinand N, Stokroos R, Kingma H, van de Berg R. Bilateral Vestibular Hypofunction: Insights in Etiologies, Clinical Subtypes, and Diagnostics. Front Neurol 2016; 7:26. [PMID: 26973594 PMCID: PMC4777732 DOI: 10.3389/fneur.2016.00026] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/19/2016] [Indexed: 01/03/2023] Open
Abstract
Objective To evaluate the different etiologies and clinical subtypes of bilateral vestibular hypofunction (BVH) and the value of diagnostic tools in the diagnostic process of BVH. Materials and methods A retrospective case review was performed on 154 patients diagnosed with BVH in a tertiary referral center, between 2013 and 2015. Inclusion criteria comprised (1) imbalance and/or oscillopsia during locomotion and (2) summated slow phase velocity of nystagmus of less than 20°/s during bithermal caloric tests. Results The definite etiology of BVH was determined in 47% of the cases and the probable etiology in 22%. In 31%, the etiology of BVH remained idiopathic. BVH resulted from more than 20 different etiologies. In the idiopathic group, the percentage of migraine was significantly higher compared to the non-idiopathic group (50 versus 11%, p < 0.001). Among all patients, 23.4% were known with autoimmune disorders in their medical history. All four clinical subtypes (recurrent vertigo with BVH, rapidly progressive BVH, slowly progressive BVH, and slowly progressive BVH with ataxia) were found in this population. Slowly progressive BVH with ataxia comprised only 4.5% of the cases. The head impulse test was abnormal in 94% of the cases. The torsion swing test was abnormal in 66%. Bilateral normal hearing to moderate hearing loss was found in 49%. Blood tests did not often contribute to the determination of the etiology of the disease. Abnormal cerebral imaging was found in 21 patients. Conclusion BVH is a heterogeneous condition with various etiologies and clinical characteristics. Migraine seems to play a significant role in idiopathic BVH and autoimmunity could be a modulating factor in the development of BVH. The distribution of etiologies of BVH probably depends on the clinical setting. In the diagnostic process of BVH, the routine use of some blood tests can be reconsidered and a low-threshold use of audiometry and cerebral imaging is advised. The torsion swing test is not the “gold standard” for diagnosing BVH due to its lack of sensitivity. Future diagnostic criteria of BVH should consist of standardized vestibular tests combined with a history that is congruent with the vestibular findings.
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Affiliation(s)
- F Lucieer
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, School for Mental Health and Neuroscience , Maastricht , Netherlands
| | - P Vonk
- Faculty of Health, Medicine and life Sciences, University of Maastricht , Maastricht , Netherlands
| | - N Guinand
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals , Geneva , Switzerland
| | - R Stokroos
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, School for Mental Health and Neuroscience , Maastricht , Netherlands
| | - H Kingma
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands; Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands; Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
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Yamaguchi S, Takeda M, Takahashi T, Yamahata H, Mitsuhara T, Niiro T, Hanakita J, Hida K, Arita K, Kurisu K. Ginkgo leaf sign: a highly predictive imaging feature of spinal meningioma. J Neurosurg Spine 2015; 23:642-646. [DOI: 10.3171/2015.3.spine1598] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Spinal meningioma and schwannoma are the most common spinal intradural extramedullary tumors, and the differentiation of these 2 tumors by CT and MRI has been a matter of debate. The purpose of this article is to present a case series of spinal meningiomas showing unique imaging features: a combination of a fan-shaped spinal cord and a streak in the tumor. The authors termed the former imaging feature “ginkgo leaf sign” and evaluated its diagnostic value.
METHODS
The authors present 7 cases of spinal meningioma having the ginkgo leaf sign. Thirty spinal extramedullary tumors arising lateral or ventrolateral to the spinal cord were studied to evaluate the diagnostic value of the ginkgo leaf sign for spinal meningiomas. Among 30 cases, 12 tumors were spinal meningiomas and 18 tumors from the control group were all schwannomas.
RESULTS
Seven of the 12 spinal meningiomas were positive for the ginkgo leaf sign. The sign was not present in the control group tumors. The overall ability to use the ginkgo leaf sign to detect meningioma indicated a sensitivity of 58%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 78%.
CONCLUSIONS
The ginkgo leaf sign is highly specific to spinal meningiomas arising lateral or ventrolateral to the spinal cord. In the present series, the ginkgo leaf sign was perfectly predictive for spinal meningioma.
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Affiliation(s)
- Satoshi Yamaguchi
- 1Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima
| | - Masaaki Takeda
- 1Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima
| | | | - Hitoshi Yamahata
- 3Department of Neurosurgery, Kagoshima University, Graduate School of Medical and Dental Sciences, Kagoshima; and
| | - Takafumi Mitsuhara
- 1Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima
| | - Tadaaki Niiro
- 3Department of Neurosurgery, Kagoshima University, Graduate School of Medical and Dental Sciences, Kagoshima; and
| | | | - Kazutoshi Hida
- 4Sapporo Azabu Neurosurgical Hospital, Sapporo, Hokkaido, Japan
| | - Kazunori Arita
- 3Department of Neurosurgery, Kagoshima University, Graduate School of Medical and Dental Sciences, Kagoshima; and
| | - Kaoru Kurisu
- 1Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima
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Lee YF, Lee CC, Wang MC, Liu KD, Wu HM, Guo WY, Shiao AS, Pan DHC, Chung WY, Hsu SPC. Cervical vestibular-evoked myogenic potential in vestibular schwannoma after gamma-knife surgery. Auris Nasus Larynx 2015; 42:265-70. [PMID: 25666552 DOI: 10.1016/j.anl.2015.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/08/2015] [Accepted: 01/14/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Gamma-knife radiosurgery (GKS) for vestibular schwannomas (VSs) has become popular during the last two decades, and a promising tumor control rate has been reported. Therefore, the evaluation and preservation of auditory-vestibular nerve function after GKS have become more and more important in these patients with long-term survival. We have traditionally used pure-tone audiometry (PTA) for evaluation of auditory nerve function, and the caloric test for superior vestibular nerve function. Vestibular-evoked myogenic potential (VEMP) has recently emerged from various neurophysiological examinations for assessment of the integrity of the inferior vestibular nerve function. This novel tool has been established to represent a sacculo-collic reflex. By using these three tools, the auditory-vestibular nerve function of VS patients can be evaluated and monitored before and after GKS. METHODS Fourteen patients with unilateral VS that underwent GKS were prospectively recruited. All of them received a battery of auditory-vestibular function tests including PTA, caloric, and cVEMP tests before and after GKS at each time point (1, 6, and 12 months). Our data also included the tumor volumes and their relationship with the PTA, caloric, and cVEMP test results. RESULTS The PTA, caloric, and cVEMP tests showed abnormal results before GKS in 85.7%, 78.6% and 78.6% of our VS patients, respectively. The PTA, caloric, and cVEMP results did not show strong correlations between each other. However, there was a tendency that when the tumor grew larger, the auditory-vestibular function deficits became more severe. The PTA and cVEMP test results remained stable during the 1-year follow-up after GKS. However, the caloric test showed transient deterioration at the 6th month follow-up, which then recovered by the 1-year follow-up. CONCLUSION The combination of these three tests can help us diagnose VS and assess the change in auditory-vestibular nerve function during the post-GKS follow-up period. The results of these three tests were independent for smaller tumors, but all tests may show abnormal findings with larger tumors. Although the study is still ongoing, the preliminary data showed that GKS treatment would not affect the auditory-vestibular nerve function within a 1-year follow-up period.
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Affiliation(s)
- Yi-Fang Lee
- Department of Otolaryngology, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mao-Che Wang
- Department of Otolaryngology, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kang-Du Liu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - An-Suey Shiao
- Department of Otolaryngology, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - David Hung-Chi Pan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Yuh Chung
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sanford P C Hsu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Venhovens J, Meulstee J, Verhagen WIM. Vestibular evoked myogenic potentials (VEMPs) in central neurological disorders. Clin Neurophysiol 2015; 127:40-49. [PMID: 25649969 DOI: 10.1016/j.clinph.2014.12.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/28/2014] [Accepted: 12/31/2014] [Indexed: 11/28/2022]
Abstract
Several types of acoustic stimulation (i.e. tone bursts or clicks), bone-conducted vibration, forehead taps, and galvanic stimulation elicit myogenic potentials. These can be recorded in cervical and ocular muscles, the so called vestibular evoked myogenic potentials (VEMPs). The cervical VEMP (cVEMP) resembles the vestibulo-collic reflex and the responses can be recorded from the ipsilateral sternocleidomastoid muscle. The ocular VEMP resembles the vestibulo-ocular reflex and can be recorded from extra-ocular muscles by a surface electrode beneath the contralateral infraorbital margin. Initially, the literature concerning VEMPs was limited to peripheral vestibular disorders, however, the field of VEMP testing is rapidly expanding, with an increasing focus on central neurological disorders. The current literature concerning VEMP abnormalities in central neurological disorders is critically reviewed, especially regarding the methodological aspects in relation to quality as well as the clinical interpretation of the VEMP results. Suggestions for further research are proposed as well as some clinically useful indications.
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Affiliation(s)
- J Venhovens
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, The Netherlands.
| | - J Meulstee
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, The Netherlands
| | - W I M Verhagen
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, The Netherlands
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Differentiating cerebellopontine angle meningioma from schwannoma using caloric testing and vestibular-evoked myogenic potentials. J Neurol Sci 2013; 335:155-9. [DOI: 10.1016/j.jns.2013.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/11/2013] [Accepted: 09/13/2013] [Indexed: 11/20/2022]
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Rosengren SM, Welgampola MS, Colebatch JG. Vestibular evoked myogenic potentials: past, present and future. Clin Neurophysiol 2010; 121:636-51. [PMID: 20080441 DOI: 10.1016/j.clinph.2009.10.016] [Citation(s) in RCA: 382] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 09/30/2009] [Accepted: 10/26/2009] [Indexed: 01/31/2023]
Abstract
Since the first description of sound-evoked short-latency myogenic reflexes recorded from neck muscles, vestibular evoked myogenic potentials (VEMPs) have become an important part of the neuro-otological test battery. VEMPs provide a means of assessing otolith function: stimulation of the vestibular system with air-conducted sound activates predominantly saccular afferents, while bone-conducted vibration activates a combination of saccular and utricular afferents. The conventional method for recording the VEMP involves measuring electromyographic (EMG) activity from surface electrodes placed over the tonically-activated sternocleidomastoid (SCM) muscles. The "cervical VEMP" (cVEMP) is thus a manifestation of the vestibulo-collic reflex. However, recent research has shown that VEMPs can also be recorded from the extraocular muscles using surface electrodes placed near the eyes. These "ocular VEMPs" (oVEMPs) are a manifestation of the vestibulo-ocular reflex. Here we describe the historical development and neurophysiological properties of the cVEMP and oVEMP and provide recommendations for recording both reflexes. While the cVEMP has documented diagnostic utility in many disorders affecting vestibular function, relatively little is known as yet about the clinical value of the oVEMP. We therefore outline the known cVEMP and oVEMP characteristics in common central and peripheral disorders encountered in neuro-otology clinics.
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Affiliation(s)
- S M Rosengren
- Prince of Wales Clinical School and Medical Research Institute, University of New South Wales, Randwick, Sydney, NSW 2031, Australia.
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