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Silva VAR, Lavinsky J, Pauna HF, Vianna MF, Santos VM, Ikino CMY, Sampaio ALL, Tardim Lopes P, Lamounier P, Maranhão ASDA, Soares VYR, Polanski JF, Denaro MMDC, Chone CT, Bento RF, Castilho AM. Brazilian Society of Otology task force - Vestibular Schwannoma ‒ evaluation and treatment. Braz J Otorhinolaryngol 2023; 89:101313. [PMID: 37813009 PMCID: PMC10563065 DOI: 10.1016/j.bjorl.2023.101313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE To review the literature on the diagnosis and treatment of vestibular schwannoma. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. CONCLUSIONS Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO
| | - Joel Lavinsky
- Sociedade Brasileira de Otologia - SBO; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Ciências Morfológicas, Porto Alegre, RS, Brazil
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Melissa Ferreira Vianna
- Sociedade Brasileira de Otologia - SBO; Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Vanessa Mazanek Santos
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Cláudio Márcio Yudi Ikino
- Universidade Federal de Santa Catarina, Hospital Universitário, Departamento de Cirurgia, Florianópolis, SC, Brazil
| | - André Luiz Lopes Sampaio
- Sociedade Brasileira de Otologia - SBO; Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Paula Tardim Lopes
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Pauliana Lamounier
- Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), Departamento de Otorrinolaringologia, Goiânia, GO, Brazil
| | - André Souza de Albuquerque Maranhão
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Vitor Yamashiro Rocha Soares
- Hospital Flavio Santos e Hospital Getúlio Vargas, Grupo de Otologia e Base Lateral do Crânio, Teresina, PI, Brazil
| | - José Fernando Polanski
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil; Faculdade Evangélica Mackenzie do Paraná, Faculdade de Medicina, Curitiba, PR, Brazil
| | | | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Ricardo Ferreira Bento
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO.
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Higuchi Y, Nakano S, Aoyagi K, Origuchi S, Horiguchi K, Serizawa T, Yamakami I, Iwadate Y. Growth potential of small residual tumors after vestibular schwannoma surgery: comparison between remnants and the natural history of small tumors. J Neurosurg 2023; 139:423-431. [PMID: 36461821 DOI: 10.3171/2022.10.jns22680] [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: 03/24/2022] [Accepted: 10/11/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Due to the heterogeneous definitions of tumor regrowth and various tumor volume distributions, the nature of small remnants after vestibular schwannoma (VS) surgery and the appropriate timing of adjuvant stereotactic radiosurgery for these remnants remain unclear. In this study, the growth potential of small remnants (< 1 cm3) after VS surgery was compared with that of treatment-naïve (TN) small VSs. METHODS This retrospective single-center study included 44 patients with VS remnants following subtotal resection (STR) of a large VS (remnant group) and 75 patients with TN VS (< 1 cm3; TN group). A 20% change in tumor volume over the imaging interval indicated radiographic progression or regression. Tumor progression-free survival (TPFS) rates were estimated using the Kaplan-Meier method. RESULTS In the remnant group, the mean preoperative tumor volume was 13.8 ± 9.0 cm3 and the mean tumor resection rate was 95% ± 5%. The mean tumor volume at the start of the observation period did not differ significantly between the two groups (remnant vs TN: 0.41 ± 0.29 vs 0.34 ± 0.28 cm3, p = 0.171). The median periods until tumor progression was detected were 15.1 (range 4.9-76.2) months and 44.7 (range 12.6-93.2) months in the TN and remnant groups, respectively. In the remnant group, the TPFS rates were 74% and 70% at 3 and 5 years after the surgery, respectively, compared with 59% and 47% in the TN group. The log-rank test demonstrated a significant difference (p = 0.008) in the TPFS rates between the two groups. Furthermore, 42 patients each from the remnant and TN groups were matched based on tumor volume. TPFS was significantly longer in the remnant group than in the TN group (3-year rates, 77% vs 62%; 5-year rates, 73% vs 51%; p = 0.02). In the remnant group, 18% of the tumor remnants demonstrated regression during follow-up, compared with 9% in the TN group, but this intergroup difference was not significant (p = 0.25). CONCLUSIONS This study demonstrated that the growth potential of small VS remnants was lower than that of TN tumors. Observing for small remnants may be appropriate after STR of a large VS. Given the risk of tumor regrowth, careful observation using MRI should be mandatory during follow-up.
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Affiliation(s)
- Yoshinori Higuchi
- 1Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba
| | - Shigeki Nakano
- 1Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba
| | - Kyoko Aoyagi
- 1Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba
- 2Department of Neurosurgery, Chiba Cerebral and Cardiovascular Center, Ichihara
| | - Shinichi Origuchi
- 1Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba
| | - Kentaro Horiguchi
- 1Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba
| | - Toru Serizawa
- 3Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo; and
| | - Iwao Yamakami
- 4Department of Neurosurgery, Seikeikai Chiba Medical Center, Chiba, Japan
| | - Yasuo Iwadate
- 1Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba
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Truong LUF, Kleiber JC, Durot C, Brenet E, Barbe C, Hoeffel C, Bazin A, Labrousse M, Dubernard X. The study of predictive factors for the evolution of vestibular schwannomas. Eur Arch Otorhinolaryngol 2023; 280:1661-1670. [PMID: 36114332 DOI: 10.1007/s00405-022-07651-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The primary objective was to determine whether the analysis of textural heterogeneity of vestibular schwannomas on MRI at diagnosis was predictive of their radiological evolutivity. The secondary objective was to determine whether some clinical or radiological factors could also be predictive of growth. METHODS We conducted a pilot, observational and retrospective study of patients with a vestibular schwannoma, initially monitored, between April 2001 and November 2019 within the Oto-Neurosurgical Institute of Champagne Ardenne, Texture analysis was performed on gadolinium injected T1 and CISS T2 MRI sequences and six parameters were extracted: mean greyscale intensity, standard deviation of the greyscale histogram distribution, entropy, mean positive pixels, skewness and kurtosis, which were analysed by the Lasso method, using statistically penalised Cox models. Extrameatal location, tumour necrosis, perceived hearing loss < 2 years with objectified tone audiometry asymmetry, tinnitus at diagnosis, were investigated by the Log-Rank test to obtain univariate survival analyses. RESULTS 78 patients were included and divided into 2 groups: group A comprising 39 "stable patients", and B comprising the remaining 39 "progressive patients". Independent analysis of the texture factors did not predict the growth potential of vestibular schwannomas. Among the clinical or radiological signs of interest, hearing loss < 2 years was identified as a prognostic factor for tumour progression with a significant trend (p = 0.05). CONCLUSIONS This study did not identify an association between texture analysis and vestibular schwannomas growth. Decreased hearing in the 2 years prior to diagnosis appears to predict potential radiological progression.
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Affiliation(s)
- Le-Uyen France Truong
- Department of Oto-Rhino-Laryngology and Head and neck surgery of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France
| | - Jean Charles Kleiber
- Department of Neurosurgery of the CHU of Reims, Hôpital Maison Blanche, 45 rue Cognacq-Jay, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Carole Durot
- Department of Radiology of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Esteban Brenet
- Department of Oto-Rhino-Laryngology and Head and neck surgery of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Coralie Barbe
- Research and Public Health Unit of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Christine Hoeffel
- Department of Radiology of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Arnaud Bazin
- Department of Neurosurgery of the CHU of Reims, Hôpital Maison Blanche, 45 rue Cognacq-Jay, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Marc Labrousse
- Department of Oto-Rhino-Laryngology and Head and neck surgery of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France
| | - Xavier Dubernard
- Department of Oto-Rhino-Laryngology and Head and neck surgery of the CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France.
- Faculty of Medicine, Reims Champagne Ardenne University, 51100, Reims, France.
- Service d'ORL et Chirurgie cervico-faciale, CHU of Reims, Hôpital Robert Debré, Rue du Général Koenig, 51100, Reims, France.
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Colombo F, Maye H, Rutherford S, King A, Hammerbeck-Ward C, Whitfield GA, McBain C, Colaco R, Entwistle H, Wadeson A, Lloyd S, Freeman S, Pathmanaban ON. Surgery versus radiosurgery for vestibular schwannoma: Shared decision making in a multidisciplinary clinic. Neurooncol Adv 2023; 5:vdad089. [PMID: 37547267 PMCID: PMC10403749 DOI: 10.1093/noajnl/vdad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Background Our neurosurgical unit adopted a model of shared decision-making (SDM) based on multidisciplinary clinics for vestibular schwannoma (VS). A unique feature of this clinic is the interdisciplinary counseling process with a surgeon presenting the option of surgery, an oncologist radiosurgery or radiotherapy, and a specialist nurse advocating for the patient. Methods This is a retrospective cohort study. All new patients seen in the combined VS clinic and referred from the skull base multidisciplinary team (MDT) from beginning of June 2013 to end of January 2019 were included. Descriptive statistics and frequency analysis were carried out for the full cohort. Results Three hundred and fifty-four patients presenting with new or previously untreated VS were included in the analysis. In our cohort, roughly one-third of patients fall into each of the treatment strategies with slightly smaller numbers of patients undergoing surgery than watch, wait and rescan (WWR) ,and SRS (26.6% vs. 32.8% and 37.9%, respectively). Conclusion In our experience, the combined surgery/oncology/specialist nurse clinic streamlines the patient experience for those with a VS suitable for either microsurgical or SRS/radiotherapy treatment. Decision-making in this population of patients is complex and when presented with all treatment options patients do not necessarily choose the least invasive option as a treatment. The unique feature of our clinic is the multidisciplinary counseling process with a specialist nurse advocating and guiding the patient. Treatment options are likely to become more rather than less complex in future years making combined clinics more valuable than ever in the SDM process.
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Affiliation(s)
- Francesca Colombo
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Helen Maye
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Scott Rutherford
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrew King
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Charlotte Hammerbeck-Ward
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Gillian A Whitfield
- Department of Neuro-Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Catherine McBain
- Department of Neuro-Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Rovel Colaco
- Department of Neuro-Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Helen Entwistle
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrea Wadeson
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Simon Lloyd
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Simon Freeman
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Omar N Pathmanaban
- Geoffrey Jefferson Brain Research Centre, Manchester Centre for Clinical Neurosciences, Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine, and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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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.
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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
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Growing Versus Non-Growing Vestibular Schwannomas: Assessment of Natural History. The Journal of Laryngology & Otology 2021; 136:934-938. [PMID: 34593068 DOI: 10.1017/s0022215121002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Profant O, Bureš Z, Balogová Z, Betka J, Fík Z, Chovanec M, Voráček J. Decision making on vestibular schwannoma treatment: predictions based on machine-learning analysis. Sci Rep 2021; 11:18376. [PMID: 34526580 PMCID: PMC8443556 DOI: 10.1038/s41598-021-97819-x] [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: 06/01/2021] [Accepted: 08/25/2021] [Indexed: 02/08/2023] Open
Abstract
Decision making on the treatment of vestibular schwannoma (VS) is mainly based on the symptoms, tumor size, patient's preference, and experience of the medical team. Here we provide objective tools to support the decision process by answering two questions: can a single checkup predict the need of active treatment?, and which attributes of VS development are important in decision making on active treatment? Using a machine-learning analysis of medical records of 93 patients, the objectives were addressed using two classification tasks: a time-independent case-based reasoning (CBR), where each medical record was treated as independent, and a personalized dynamic analysis (PDA), during which we analyzed the individual development of each patient's state in time. Using the CBR method we found that Koos classification of tumor size, speech reception threshold, and pure tone audiometry, collectively predict the need for active treatment with approximately 90% accuracy; in the PDA task, only the increase of Koos classification and VS size were sufficient. Our results indicate that VS treatment may be reliably predicted using only a small set of basic parameters, even without the knowledge of individual development, which may help to simplify VS treatment strategies, reduce the number of examinations, and increase cause effectiveness.
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Affiliation(s)
- Oliver Profant
- grid.424967.a0000 0004 0404 6946Department of Auditory Neuroscience, Institute of Experimental Medicine, Czech Academy of Sciences, Prague, Czech Republic
| | - Zbyněk Bureš
- grid.6652.70000000121738213Department of Cognitive Systems and Neurosciences, Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University, Jugoslávských partyzánů 1580/3, 160 00 Prague 6, Czech Republic
| | - Zuzana Balogová
- grid.4491.80000 0004 1937 116XDepartment of Otorhinolaryngology, 3rd Faculty of Medicine, University Hospital Královské Vinohrady, Charles University in Prague, Prague, Czech Republic
| | - Jan Betka
- grid.4491.80000 0004 1937 116XDepartment of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, University Hospital Motol, Charles University in Prague, Prague, Czech Republic
| | - Zdeněk Fík
- grid.4491.80000 0004 1937 116XDepartment of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, University Hospital Motol, Charles University in Prague, Prague, Czech Republic
| | - Martin Chovanec
- grid.4491.80000 0004 1937 116XDepartment of Otorhinolaryngology, 3rd Faculty of Medicine, University Hospital Královské Vinohrady, Charles University in Prague, Prague, Czech Republic
| | - Jan Voráček
- Faculty of Management, Prague University of Economics and Business, Jindrichuv Hradec, Czech Republic
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Whitley H, Benedict NT, Tringali S, Gurusinghe NT, Roberts G, Fieux M, Alalade AF. Identifying Factors Associated with the Growth of Vestibular Schwannomas: A Systematic Review. World Neurosurg 2021; 149:e766-e779. [PMID: 33540091 DOI: 10.1016/j.wneu.2021.01.101] [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: 01/03/2021] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Surveillance imaging is a valid management option for selected vestibular schwannomas (VS). An ideal protocol for radiologic monitoring would highlight growth-related risk factors and tailor management accordingly. This study aims to identify variables associated with the growth of sporadic VS to enhance surveillance imaging, enable early intervention, and optimize outcomes. METHODS The review was conducted according to the PRISMA guidelines. A systematic review of 5 databases (PubMed, Ovid, Cochrane Library, Web of Science, and Google Scholar) was performed to identify negative and positive growth predictors of sporadic vestibular schwannomas. The search was limited to studies reported between January 2015 and January 2020. We conducted an individual patient data meta-analysis using a 1-stage multivariate mixed-effect logistic regression model. RESULTS A total of 437 studies were identified, of which 25 met our criteria for full-text analysis. Articles that measured VS with comparable methods were determined eligible for meta-analysis inclusion. The selected articles were highly heterogeneous in their use of grading scales and assessment of tumor size. Our review showed that size at diagnosis (odds ratio, 1.15; 95% confidence interval, 1.11-1.18; P < 0.0001) and intracanalicular localization (odds ratio, 0.49; 95% confidence interval, 0.26-0.90; P = 0.023) were associated with VS growth. CONCLUSIONS The factors most frequently reported as being associated with growth within the literature were size of VS at diagnosis and localization of an intracanalicular component. Greater attention should be placed on these criteria within the surveillance imaging algorithm for VS.
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Affiliation(s)
- Helen Whitley
- First Faculty of Medicine, Charles University in Prague, Nove Mesto, Czech Republic
| | - Narmatha T Benedict
- First Faculty of Medicine, Charles University in Prague, Nove Mesto, Czech Republic
| | - Stephane Tringali
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université de Lyon, Université Lyon 1, Lyon, France
| | - Nihal T Gurusinghe
- Department of Neurosurgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Gareth Roberts
- Department of Neurosurgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Maxime Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université de Lyon, Université Lyon 1, Lyon, France
| | - Andrew F Alalade
- Department of Neurosurgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom.
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