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Wang SSY, Horstmann G, van Eck A, Tatagiba M, Naros G. Likelihood-of-harm/help of microsurgery compared to radiosurgery in large vestibular schwannoma. J Neurooncol 2024; 169:299-308. [PMID: 38951458 PMCID: PMC11341602 DOI: 10.1007/s11060-024-04732-0] [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] [Received: 04/30/2024] [Accepted: 05/31/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE It has been shown that in large vestibular schwannomas (VS), radiosurgery (SRS) is inferior with respect to tumor control compared to microsurgical resection (SURGERY). However, SURGERY poses a significantly higher risk of facial-function deterioration (FFD). The aim of this study was to illustrate the effectiveness in terms of number-needed-to-treat/operate (NNO), number-needed-to-harm (NNH), and likelihood-of-harm/help (LHH) by comparing both treatment modalities in large VS. METHODS This was a retrospective, dual-center cohort study. Tumor size was classified by Hannover Classification. Absolute risk reduction and risk increase were used to derive additional estimates of treatment effectiveness, namely NNO and NNH. LHH was then calculated by a quotient of NNH/NNO to illustrate the risk-benefit-ratio of SURGERY. RESULTS Four hundred and forty-nine patients treated met the inclusion criteria. The incidence of tumor recurrence was significantly higher in SRS (14%), compared to SURGERY (3%) resulting in ARR of 11% and NNO of 10. At the same time, SURGERY was related to a significant risk of FFD resulting in an NNH of 12. Overall, the LHH calculated at 1.20 was favored SURGERY, especially in patients under the age of 40 years (LHH = 2.40), cystic VS (LHH = 4.33), and Hannover T3a (LHH = 1.83) and T3b (LHH = 1.80). CONCLUSIONS Due to a poorer response of large VS to SRS, SURGERY is superior with respect to tumor control. One tumor recurrence can be prevented, when 10 patients are treated by SURGERY instead of SRS. Thus, LHH portrays the benefit of SURGERY in large VS even when taking raised FFD into account.
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Affiliation(s)
- Sophie Shih-Yüng Wang
- Department of Neurosurgery, Eberhard Karls University, Hoppe-Seyler-Strasse 3, Tubingen, Germany.
| | | | | | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University, Hoppe-Seyler-Strasse 3, Tubingen, Germany
| | - Georgios Naros
- Department of Neurosurgery, Eberhard Karls University, Hoppe-Seyler-Strasse 3, Tubingen, Germany
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Kadri H, Agha MS, Abouharb R, Mackieh R, Kadri T. The outcome of the retrosigmoid approach in the decompression of vestibular schwannomas - a retrospective cohort study of 60 consecutive cases. J Med Life 2024; 17:426-431. [PMID: 39071514 PMCID: PMC11282897 DOI: 10.25122/jml-2024-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/10/2024] [Indexed: 07/30/2024] Open
Abstract
This multicenter retrospective cohort study aimed to evaluate the effectiveness of the retrosigmoid surgical approach in decompressing vestibular schwannomas, focusing on tumor decompression, neurological function preservation, and postoperative complications. A cohort of 60 patients, operated between 2016 and 2019, was analyzed for age, sex, symptoms, tumor size, surgery duration, complications, mortality, and facial/auditory functions using established criteria. Hearing loss was observed in 80% of patients, mainly progressive, with tumor size emerging as a critical prognostic factor. Facial weakness affected 10% of patients preoperatively; postoperatively, 35% of patients had affected facial nerve function, with 10% exhibiting poor or no facial nerve function, linked to resection extent rather than tumor size. Tinnitus was more prevalent with larger tumors, whereas headaches were common irrespective of size. Balance disorders improved after surgery, especially in case of larger tumors. Functional recovery varied, with 41.67% of patients returning to their previous activity within 4 months, 25% within 4-12 months, and 33.33% remaining inactive. The mortality rate was low at 3.3 %, with two deaths out of 60 patients after surgery. This analysis highlights surgery risks for vestibular schwannomas (e.g., facial nerve decline, tinnitus, headaches), but also emphasizes benefits like improved balance and low mortality. Many patients regain professional activity, stressing the importance of informed treatment decisions for this condition.
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Affiliation(s)
- Hassan Kadri
- Department of Neurosurgery, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mohamad Shehadeh Agha
- Department of Internal Medicine, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Raed Abouharb
- Department of Internal Medicine, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Rostom Mackieh
- Department of Neurosurgery, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Thea Kadri
- Department of Biology, George Washington University, Washington, USA
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Quimby AE, Salmon MK, Zhao CH, Y K Lee J, Bigelow DC, Ruckenstein MJ, Brant JA. Socioeconomic determinants impact quality of life at vestibular schwannoma diagnosis. J Clin Neurosci 2024; 119:122-128. [PMID: 38007900 DOI: 10.1016/j.jocn.2023.11.028] [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: 08/28/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Socioeconomic variables including race, education, and income have been shown to affect vestibular schwannoma incidence, treatment, and outcomes. We sought to determine the impact of socioeconomic factors on quality of life at the time of vestibular schwannoma diagnosis. METHODS Retrospective cohort study conducted at a tertiary academic center. All patients evaluated for vestibular schwannoma from March 1, 2010 to December 31, 2021 who completed at least one Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire at presentation or prior to any intervention were included. PANQOL scores were compared across income quintiles, racial groups, and health insurance categories. RESULTS Two-hundred and ninety-six patients who had non-missing information on variables of interest were included. Compared to White/Caucasian patients (84.5 %), Black/African American patients (4.7 %) had significantly lower PANQOL total scores (b = -12.8[-21.7, -4.0], p = 0.005). Compared to patients with Commercial insurance (53 %), patients who were Uninsured/ Self-pay (1.7 %) had significantly lower PANQOL total scores (b = -16.7[-31.4, -1.9], p = 0.027). Patients in higher income quintiles had significantly higher PANQOL total scores (b = 11.7[3.9, 19.5], p = 0.004 comparing highest income quintile to lowest). After controlling for potential confounders, income quintile (b = 9.6[1.3, 17.9], p = 0.023 comparing highest quintile to lowest) and insurance (b = -17.0[-31.9, -21], p = 0.025 comparing Uninsured/Self-pay to Commercial insurance) remained predictors of total PANQOL score. CONCLUSIONS Socioeconomic factors including race, health insurance, and income appear to contribute to quality of life at the time of vestibular schwannoma diagnosis. These variables are interrelated and the effects of race may be mediated in part by differences in income and health insurance coverage.
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Affiliation(s)
- Alexandra E Quimby
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA; Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Mandy K Salmon
- Department of Otolaryngology, Oregon Health & Science University, Portland, OR, USA
| | | | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas C Bigelow
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael J Ruckenstein
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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Wang SSY, Machetanz K, Ebner F, Naros G, Tatagiba M. Association of extent of resection on recurrence-free survival and functional outcome in vestibular schwannoma of the elderly. Front Oncol 2023; 13:1153698. [PMID: 37342182 PMCID: PMC10277928 DOI: 10.3389/fonc.2023.1153698] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/02/2023] [Indexed: 06/22/2023] Open
Abstract
Background Despite the ongoing debate on the risk-benefit ratio of vestibular schwannoma (VS) treatment options, watchful observation and radiation are usually favored in the elderly (>65 years). If surgery is inevitable, a multimodal approach after deliberate subtotal resection has been described as a valid option. The relationship between the extent of resection (EOR) of surgical and functional outcomes and recurrence-free survival (RFS) remains unclear. This present study aims to evaluate the functional outcome and RFS of the elderly in relation to the EOR. Methods This matched cohort study analyzed all consecutive elderly VS patients treated at a tertiary referral center since 2005. A separate cohort (<65 years) served as a matched control group (young). Clinical status was assessed by the Charlson Comorbidity Index (CCI), the Karnofsky Performance (KPS), and the Gardner and Robertson (GR) and House & Brackmann (H&B) scales. RFS was evaluated by Kaplan-Meier analysis using contrast-enhanced magnetic resonance imaging to identify tumor recurrence. Results Among 2,191 patients, 296 (14%) patients were classified as elderly, of whom 133 (41%) were treated surgically. The elderly were characterized by a higher preoperative morbidity and worse gait uncertainty. Postoperative mortality (0.8% and 1%), morbidity (13% and 14%), and the functional outcome (G&R, H&B, and KPS) did not differ between the elderly and the young. There was a significant benefit in regard to the preoperative imbalance. Gross total resection (GTR) was accomplished in 74% of all cases. Lower grades of the EOR (subtotal and decompressive surgery) raised the incidence of recurrence significantly. Mean time to recurrence in the surgELDERLY was 67.33 ± 42.02 months and 63.2 ± 70.98 months in the surgCONTROL. Conclusions Surgical VS treatment aiming for complete tumor resection is feasible and safe, even in advanced age. A higher EOR is not associated with cranial nerve deterioration in the elderly compared to the young. In contrast, the EOR determines RFS and the incidence of recurrence/progression in both study cohorts. If surgery is indicated in the elderly, GTR can be intended safely, and if only subtotal resection is achieved, further adjuvant therapy, e.g., radiotherapy, should be discussed in the elderly, as the incidence of recurrence is not significantly lower compared to the young.
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Affiliation(s)
- Sophie Shih-Yüng Wang
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Kathrin Machetanz
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Florian Ebner
- Department of Neurosurgery, Alfried Krupp Hospital, Essen, Germany
| | - Georgios Naros
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University Tübingen, Tübingen, Germany
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Zhang Z, Zhang X, Yang Y, Liu J, Zheng C, Bai H, Ma Q. Accurate segmentation algorithm of acoustic neuroma in the cerebellopontine angle based on ACP-TransUNet. Front Neurosci 2023; 17:1207149. [PMID: 37292160 PMCID: PMC10244508 DOI: 10.3389/fnins.2023.1207149] [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] [Received: 04/17/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Acoustic neuroma is one of the most common tumors in the cerebellopontine angle area. Patients with acoustic neuroma have clinical manifestations of the cerebellopontine angle occupying syndrome, such as tinnitus, hearing impairment and even hearing loss. Acoustic neuromas often grow in the internal auditory canal. Neurosurgeons need to observe the lesion contour with the help of MRI images, which not only takes a lot of time, but also is easily affected by subjective factors. Therefore, the automatic and accurate segmentation of acoustic neuroma in cerebellopontine angle on MRI is of great significance for surgical treatment and expected rehabilitation. In this paper, an automatic segmentation method based on Transformer is proposed, using TransUNet as the core model. As some acoustic neuromas are irregular in shape and grow into the internal auditory canal, larger receptive fields are thus needed to synthesize the features. Therefore, we added Atrous Spatial Pyramid Pooling to CNN, which can obtain a larger receptive field without losing too much resolution. Since acoustic neuromas often occur in the cerebellopontine angle area with relatively fixed position, we combined channel attention with pixel attention in the up-sampling stage so as to make our model automatically learn different weights by adding the attention mechanism. In addition, we collected 300 MRI sequence nuclear resonance images of patients with acoustic neuromas in Tianjin Huanhu hospital for training and verification. The ablation experimental results show that the proposed method is reasonable and effective. The comparative experimental results show that the Dice and Hausdorff 95 metrics of the proposed method reach 95.74% and 1.9476 mm respectively, indicating that it is not only superior to the classical models such as UNet, PANet, PSPNet, UNet++, and DeepLabv3, but also show better performance than the newly-proposed SOTA (state-of-the-art) models such as CCNet, MANet, BiseNetv2, Swin-Unet, MedT, TransUNet, and UCTransNet.
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Affiliation(s)
- Zhuo Zhang
- Tianjin Key Laboratory of Optoelectronic Detection Technology and Systems, School of Electronic and Information Engineering, Tiangong University, Tianjin, China
| | - Xiaochen Zhang
- Tianjin Cerebral Vascular and Neural Degenerative Disease Key Laboratory, Tianjin Huanhu Hospital, Tianjin, China
| | - Yong Yang
- School of Computer Science and Technology, Tiangong University, Tianjin, China
| | - Jieyu Liu
- Tianjin Key Laboratory of Optoelectronic Detection Technology and Systems, School of Electronic and Information Engineering, Tiangong University, Tianjin, China
| | - Chenzi Zheng
- College of Foreign Languages, Nankai University, Tianjin, China
| | - Hua Bai
- Tianjin Key Laboratory of Optoelectronic Detection Technology and Systems, School of Electronic and Information Engineering, Tiangong University, Tianjin, China
| | - Quanfeng Ma
- Tianjin Cerebral Vascular and Neural Degenerative Disease Key Laboratory, Tianjin Huanhu Hospital, Tianjin, China
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Brandel MG, Plonsker JH, Khan UA, Rennert RC, Friedman RA, Schwartz MS. Going the distance in acoustic neuroma resection: microsurgical outcomes at high-volume centers of excellence. J Neurooncol 2023; 163:105-114. [PMID: 37084124 DOI: 10.1007/s11060-023-04313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE High-volume hospitals are associated with improved surgical outcomes for acoustic neuromas (ANs). Due to the benign and slow-growing nature of ANs, many patients travel to geographically distant cities, states, or countries for their treatment. However, the impact of travel burden to high-volume centers, as well as its relative benefit are poorly understood. We compared post-operative outcomes between AN patients that underwent treatment at local, low-volume hospitals with those that traveled long distances to high-volume hospitals. METHODS The National Cancer Database was used to analyze AN patients that underwent surgery (2004-2015). Patients in the lowest quartile of travel distance and volume (Short-travel/Low-Volume: STLV) were compared to patients in the highest quartile of travel distance and volume (Long-travel/High-Volume: LTHV). Only STLV and LTHV cases were included for analysis. RESULTS Of 13,370 cases, 2,408 met inclusion criteria. STLV patients (n = 1,305) traveled a median of 6 miles (Interquartile range [IQR] 3-9) to low-volume centers (median 2, IQR 1-3 annual cases) and LTHV patients (n = 1,103) traveled a median of 143 miles [IQR 103-230, maximum 4,797] to high-volume centers (median 34, IQR 28-42 annual cases). LTHV patients had lower Charlson/Deyo scores (p = 0.001), mostly received care at academic centers (81.7% vs. 39.4%, p < 0.001), and were less likely to be minorities (7.0% vs. 24.2%, p < 0.001) or underinsured (4.2% vs. 13.8%, p < 0.001). There was no difference in average tumor size. On multivariable analysis, LTHV predicted increased likelihood of gross total resection (odds ratio [OR] 5.6, 95% confidence interval [CI] 3.8-8.4, p < 0.001), longer duration between diagnosis and surgery (OR 1.3, 95% CI 1.0-1.6, p = 0.040), decreased length of hospital stay (OR 0.5, 95% CI 0.4-0.7, p < 0.001), and greater overall survival (Hazard Ratio [HR] 0.6, 95% CI 0.4-0.95, p = 0.029). There was no significant difference in 30-day readmission on adjusted analysis. CONCLUSION Although traveling farther to high-volume centers was associated with greater time between diagnosis and treatment for AN patients, they experienced superior postoperative outcomes compared to patients who received treatment locally at low-volume centers. Enabling access and travel to high-volume centers may improve AN patient outcomes.
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Affiliation(s)
- Michael G Brandel
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Jillian H Plonsker
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Usman A Khan
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Robert C Rennert
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Rick A Friedman
- Department of Otolaryngology, University of California San Diego, San Diego, CA, USA
| | - Marc S Schwartz
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA.
- Acoustic Neuroma Center, 9300 Campus Point Drive Mail Code 7893, La Jolla, CA, 92037, USA.
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Tatagiba M, Wang SS, Rizk A, Ebner F, van Eck ATCJ, Naros G, Horstmann G. A comparative study of microsurgery and gamma knife radiosurgery in vestibular schwannoma evaluating tumor control and functional outcome. Neurooncol Adv 2023; 5:vdad146. [PMID: 38024239 PMCID: PMC10681278 DOI: 10.1093/noajnl/vdad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Background Both stereotactic radiosurgery (SRS) and microsurgical resection (SURGERY) are available as treatment options for sporadic vestibular schwannoma (VS). There are very few direct comparative studies comparing both treatment modalities in large cohorts allowing detailed subgroup analysis. This present study aimed to compare the nuances in the treatment of VS by SURGERY and SRS in 2 highly specialized neurosurgical centers. Methods This is a retrospective bicentric cohort study. Data from patients treated between 2005 and 2011 were collected retrospectively. Recurrence-free survival (RFS) was assessed radiographically by contrast-enhanced magnetic resonance imaging. Results The study population included N = 901 patients with a mean follow-up of 7 years. Overall, the incidence of recurrence was 7% after SURGERY, and 11% after SRS with superior tumor control in SURGERY in the Kaplan-Meier-analysis (P = 0.031). In small tumors (Koos I and II), tumor control was equivalent in both treatment arms. In large VS (Koos III and IV), however, RFS was superior in SURGERY. The extent of resection correlated with RFS (P < .001). Facial and hearing deterioration was similar in both treatment arms in small VS, but more pronounced in SURGERY of large VS. Tinnitus, vertigo, imbalance, and trigeminal symptoms were more often improved by SURGERY than SRS. Conclusions SRS can achieve similar tumor control compared to SURGERY in smaller VS (Koos I and II)-with similar postinterventional morbidities. In large VS (Koos III and IV), long-term tumor control of SRS is inferior to SURGERY. Based on these results, we suggest that if combination therapy is chosen, the residual tumor should not exceed the size of Koos II.
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Affiliation(s)
- Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University, Tubingen, Germany
| | - Sophie S Wang
- Department of Neurosurgery, Eberhard Karls University, Tubingen, Germany
| | - Ahmed Rizk
- Department of Neurosurgery, Eberhard Karls University, Tubingen, Germany
| | - Florian Ebner
- Department of Neurosurgery, Eberhard Karls University, Tubingen, Germany
| | | | - Georgios Naros
- Department of Neurosurgery, Eberhard Karls University, Tubingen, Germany
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North M, Weishaar J, Nuru M, Anderson D, Leonetti JP. Assessing Surgical Approaches for Acoustic Neuroma Resection: Do Patients Perceive a Difference in Quality-of-Life Outcomes? Otol Neurotol 2022; 43:1245-1251. [DOI: 10.1097/mao.0000000000003720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Schipmann S, Lohmann S, Al Barim B, Suero Molina E, Schwake M, Toksöz ÖA, Stummer W. Applicability of contemporary quality indicators in vestibular surgery-do they accurately measure tumor inherent postoperative complications of vestibular schwannomas? Acta Neurochir (Wien) 2022; 164:359-372. [PMID: 34859305 PMCID: PMC8854327 DOI: 10.1007/s00701-021-05044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/28/2021] [Indexed: 12/01/2022]
Abstract
Background Due to rising costs in health care delivery, reimbursement decisions have progressively been based on quality measures. Such quality indicators have been developed for neurosurgical procedures, collectively. We aimed to evaluate their applicability in patients that underwent surgery for vestibular schwannoma and to identify potential new disease-specific quality indicators. Methods One hundred and three patients operated due to vestibular schwannoma were subject to analysis. The primary outcomes of interest were 30-day and 90-day reoperation, readmission, mortality, nosocomial infection and surgical site infection (SSI) rates, postoperative cerebral spinal fluid (CSF) leak, facial, and hearing function. The secondary aim was the identification of prognostic factors for the mentioned primary outcomes. Results Thirty-day (90-days) outcomes in terms of reoperation were 10.7% (14.6%), readmission 9.7% (13.6%), mortality 1% (1%), nosocomial infection 5.8%, and SSI 1% (1%). A 30- versus 90-day outcome in terms of CSF leak were 6.8% vs. 10.7%, new facial nerve palsy 16.5% vs. 6.1%. Hearing impairment from serviceable to non-serviceable hearing was 6.8% at both 30- and 90-day outcome. The degree of tumor extension has a significant impact on reoperation (p < 0.001), infection (p = 0.015), postoperative hemorrhage (p < 0.001), and postoperative hearing loss (p = 0.026). Conclusions Our data demonstrate the importance of entity-specific quality measurements being applied even after 30 days. We identified the occurrence of a CSF leak within 90 days postoperatively, new persistent facial nerve palsy still present 90 days postoperatively, and persisting postoperative hearing impairment to non-serviceable hearing as potential new quality measurement variables for patients undergoing surgery for vestibular schwannoma.
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Affiliation(s)
- Stephanie Schipmann
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Sebastian Lohmann
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Bilal Al Barim
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Eric Suero Molina
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Özer Altan Toksöz
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Desai AD, Shah VP, Tseng CC, Povolotskiy R, Wackym PA, Ying YLM. Impact of Social Determinants of Health on Stereotactic Radiotherapy for Vestibular Schwannoma. Laryngoscope 2022; 132:2232-2240. [PMID: 35076095 DOI: 10.1002/lary.30016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/02/2021] [Accepted: 01/04/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Linear accelerator (LINAC) and Gamma Knife (GK) are common stereotactic radiation therapies for treating vestibular schwannoma (VS). There is currently limited literature examining specific demographic and socioeconomic factors, which influence the type of stereotactic radiation therapy a patient with VS receives. STUDY DESIGN Retrospective database review. METHODS The National Cancer Database was queried for cases of VS between 2004 and 2016. Patient demographic characteristics were compared using chi-squared and t-tests between GK and LINAC treated groups. Multivariate regression analysis was performed to assess predictors of stereotactic radiation therapy received. RESULTS Of the 6,208 included patients, 5,306 (85.5%) received GK and 902 (14.5%) received LINAC. The mean age of GK patients was significantly lower than that of LINAC patients (58.0 vs. 59.7, P < .001). Individuals treated with GK had greater proportions of private insurance (P < .001) and incomes greater than $63,332 (P = .003). A greater proportion of GK patients were treated in academic centers (P < .001), in high-volume facilities (P < .001), in metropolitan areas (P < .001), and in the Northeastern United States (P < .001). On multivariate logistic regression analysis, region, metropolitan area, facility type, tumor size, and distance traveled by patients independently predict receipt of GK versus LINAC. CONCLUSION Differences in patient demographics and other social determinants of health influence choice of GK versus LINAC therapy for VS patients. Future studies focused on addressing barriers to care, which may influence postprocedural quality of life and clinical outcomes associated with these two treatments are necessary to better understand the impact of these social differences. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Amar D Desai
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Vraj P Shah
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Roman Povolotskiy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - P Ashley Wackym
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Yu-Lan Mary Ying
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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Kieu HD, Vuong DN, Mai KT, Pham PC, Le TD. Long-term outcomes of rotating gamma knife for vestibular schwannoma: A 4-year prospective longitudinal study of 89 consecutive patients in Vietnam. Surg Neurol Int 2021; 12:585. [PMID: 34992902 PMCID: PMC8720424 DOI: 10.25259/sni_687_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Microsurgical total removal of vestibular schwannoma (VS) is the definitive treatment but has a high incidence of postoperative neurological deficits. Rotating Gamma Knife (RGK) is a preferred option for a small tumor. This study aims to evaluate long-term neurological outcomes of RGK for VS. Methods: This prospective longitudinal study was conducted at the Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam. Eighty-nine consecutive patients were enrolled from October 2011 to October 2015 and followed up to June 2017. RGK was indicated for VS measuring <2.2 cm, while RGK for tumors measuring 2.2–3 cm was considered in patients with severe comorbidities, high-risk surgery, and who denied surgery. Concurrently, VS consisted of newly diagnosed, postoperative residual, and recurrent tumors. Patients with neurofibromatosis type 2 were excluded from the study. Primary outcomes were radiological tumor control rate, vestibulocochlear functions, facial and trigeminal nerve preservation. Stereotactic radiosurgery was performed by the Rotating Gamma System Gamma ART 6000. Results: The tumors were measured 20.7 ± 5.6 mm at pre treatment and 17.6 ± 4.1 mm at 3-year post treatment. The mean radiation dose was 13.5 ± 0.9 Gy. Mean follow-up was 40.6 ± 13.3 months. The radiological tumor control rate was achieved 95.5% at 5-year post treatment. The hearing and vestibular functions were preserved in 70.3% and 68.9%, respectively. The facial and trigeminal nerve preservation rates were 94.4% and 73.3%, respectively. Conclusion: RGK is an effective and safe treatment for VS measuring ≤3 cm with no significant complications during long-term follow-up.
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Affiliation(s)
- Hung Dinh Kieu
- Department of Neurosurgery and Spine Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Duong Ngoc Vuong
- The Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Khoa Trong Mai
- The Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Phuong Cam Pham
- The Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Tam Duc Le
- Department of Neurosurgery and Spine Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
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12
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Systematic Review of Racial, Socioeconomic, and Insurance Status Disparities in Neurosurgical Care for Intracranial Tumors. World Neurosurg 2021; 158:38-64. [PMID: 34710578 DOI: 10.1016/j.wneu.2021.10.126] [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: 08/31/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The impact of race, socioeconomic status (SES), insurance status, and other social metrics on the outcomes of patients with intracranial tumors has been reported in several studies. However, these findings have not been comprehensively summarized. METHODS We conducted a PRISMA systematic review of all published articles between 1990 and 2020 that analyzed intracranial tumor disparities, including race, SES, insurance status, and safety-net hospital status. Outcomes measured include access, standards of care, receipt of surgery, extent of resection, mortality, complications, length of stay (LOS), discharge disposition, readmission rate, and hospital charges. RESULTS Fifty-five studies were included. Disparities in mortality were reported in 27 studies (47%), showing minority status and lower SES associated with poorer survival outcomes in 14 studies (52%). Twenty-seven studies showed that African American patients had worse outcomes across all included metrics including mortality, rates of surgical intervention, extent of resection, LOS, discharge disposition, and complication rates. Thirty studies showed that privately insured patients and patients with higher SES had better outcomes, including lower mortality, complication, and readmission rates. Six studies showed that worse outcomes were associated with treatment at safety-net and/or low-volume hospitals. The influence of Medicare or Medicaid status, or inequities affecting other minorities, was less clearly delineated. Ten studies (18%) were negative for evidence of disparities. CONCLUSIONS Significant disparities exist among patients with intracranial tumors, particularly affecting patients of African American race and lower SES. Efforts at the hospital, state, and national level must be undertaken to identify root causes of these issues.
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13
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Chiu SJ, Hickman SJ, Pepper IM, Tan JHY, Yianni J, Jefferis JM. Neuro-Ophthalmic Complications of Vestibular Schwannoma Resection: Current Perspectives. Eye Brain 2021; 13:241-253. [PMID: 34621136 PMCID: PMC8491867 DOI: 10.2147/eb.s272326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
Vestibular schwannomas (VSs), also called acoustic neuromas, are benign intracranial neoplasms of the vestibulocochlear (VIII) cranial nerve. Management options include “wait-and-scan,” stereotactic radiosurgery and surgical resection. Due to the proximity of the VIII nerve to the facial (VII) nerve in the cerebello-pontine angle, the VII nerve is particularly vulnerable to the effects of surgical resection. This can result in poor eye closure, lagophthalmos and resultant corneal exposure post VS resection. Additionally, compression from the tumor or resection can cause trigeminal (V) nerve damage and a desensate cornea. The combination of an exposed and desensate cornea puts the eye at risk of serious ocular complications including persistent epithelial defects, corneal ulceration, corneal vascularization, corneal melting and potential perforation. The abducens (VI) nerve can be affected by a large intracranial VS causing raised intracranial pressure (a false localizing sign) or as a result of damage to the VI nerve at the time of resection. Other types of neurogenic strabismus are rare and typically transient. Contralaterally beating nystagmus as a consequence of vestibular dysfunction is common post-operatively. This generally settles to pre-operative levels as central compensation occurs. Ipsilaterally beating nystagmus post-operatively should prompt investigation for post-operative cerebrovascular complications. Papilledema (and subsequent optic atrophy) can occur as a result of a large VS causing raised intracranial pressure. Where papilledema follows surgical resection of a VS, it can indicate that cerebral venous sinus thrombosis has occurred. Poor visual function following VS resection can result as a combination of all these potential complications and is more likely with larger tumors.
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Affiliation(s)
- Stephanie J Chiu
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK.,Department of Medical Education, University of Sheffield, Sheffield, UK
| | - Simon J Hickman
- Department of Medical Education, University of Sheffield, Sheffield, UK.,Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
| | - Irene M Pepper
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK.,Department of Medical Education, University of Sheffield, Sheffield, UK
| | - Jennifer H Y Tan
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK.,Department of Medical Education, University of Sheffield, Sheffield, UK
| | - John Yianni
- Department of Medical Education, University of Sheffield, Sheffield, UK.,Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Joanna M Jefferis
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK.,Department of Medical Education, University of Sheffield, Sheffield, UK.,Department of Neuro-Ophthalmology, Manchester Royal Eye Hospital, Manchester, UK
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14
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Hospitalization outcomes among brain metastasis patients receiving radiation therapy with or without stereotactic radiosurgery from the 2005-2014 Nationwide Inpatient Sample. Sci Rep 2021; 11:19209. [PMID: 34584139 PMCID: PMC8478906 DOI: 10.1038/s41598-021-98563-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/08/2021] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to compare hospitalization outcomes among US inpatients with brain metastases who received stereotactic radiosurgery (SRS) and/or non-SRS radiation therapies without neurosurgical intervention. A cross-sectional study was conducted whereby existing data on 35,199 hospitalization records (non-SRS alone: 32,981; SRS alone: 1035; SRS + non-SRS: 1183) from 2005 to 2014 Nationwide Inpatient Sample were analyzed. Targeted maximum likelihood estimation and Super Learner algorithms were applied to estimate average treatment effects (ATE), marginal odds ratios (MOR) and causal risk ratio (CRR) for three distinct types of radiation therapy in relation to hospitalization outcomes, including length of stay (' ≥ 7 days' vs. ' < 7 days') and discharge destination ('non-routine' vs. 'routine'), controlling for patient and hospital characteristics. Recipients of SRS alone (ATE = - 0.071, CRR = 0.88, MOR = 0.75) or SRS + non-SRS (ATE = - 0.17, CRR = 0.70, MOR = 0.50) had shorter hospitalizations as compared to recipients of non-SRS alone. Recipients of SRS alone (ATE = - 0.13, CRR = 0.78, MOR = 0.59) or SRS + non-SRS (ATE = - 0.17, CRR = 0.72, MOR = 0.51) had reduced risks of non-routine discharge as compared to recipients of non-SRS alone. Similar analyses suggested recipients of SRS alone had shorter hospitalizations and similar risk of non-routine discharge when compared to recipients of SRS + non-SRS radiation therapies. SRS alone or in combination with non-SRS therapies may reduce the risks of prolonged hospitalization and non-routine discharge among hospitalized US patients with brain metastases who underwent radiation therapy without neurosurgical intervention.
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15
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Impact of hospital volume on mortality for brain metastases treated with radiation. REPORTS OF PRACTICAL ONCOLOGY AND RADIOTHERAPY : JOURNAL OF GREATPOLAND CANCER CENTER IN POZNAN AND POLISH SOCIETY OF RADIATION ONCOLOGY 2021; 26:626-634. [PMID: 34434579 DOI: 10.5603/rpor.a2021.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/27/2021] [Indexed: 11/25/2022]
Abstract
Background The impact of hospital volume on cancer patient survival has been demonstrated in the surgical literature, but sparsely for patients receiving radiation therapy (RT). This analysis addresses the impact of hospital volume on patients receiving RT for the most common central nervous system tumor: brain metastases. Materials and methods Analysis was conducted using the National Cancer Database (NCDB) from 2010-2015 for patients with metastatic brain disease from lung cancer, breast cancer, and colorectal cancer requiring RT. Hospital volume was stratified as high-volume (≥ 12 brain RT/year), moderate (5-11 RT/year), and low (< 5 RT/year). The effect of hospital volume on overall survival was assessed using a multivariable Cox regression model. Results A total of 18,841 patients [9479 (50.3%) men, 9362 (49.7%) women; median age 64 years] met the inclusion criteria. 16.7% were treated at high-volume hospitals, 36.5% at moderate-volume, and the remaining 46.8% at low-volume centers. Multivariable analysis revealed that mortality was significantly improved in high-volume centers (HR: 0.95, p = 0.039) compared with low-volume centers after accounting for multiple demographics including age, sex, race, insurance status, income, facility type, Charlson-Deyo score and receipt of palliative care. Conclusion Hospitals performing 12 or more brain RT procedures per year have significantly improved survival in brain metastases patients receiving radiation as compared to lower volume hospitals. This finding, independent of additional demographics, indicates that the increased experience associated with increased volume may improve survival in this patient population.
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16
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Almosnino G, Sikora MJ, Farrokhi FR, Schwartz SR, Zeitler DM. Tumor-Related and Patient-Related Variables Affecting Length of Hospital Stay Following Vestibular Schwannoma Microsurgery. Ann Otol Rhinol Laryngol 2021; 131:535-543. [PMID: 34210194 DOI: 10.1177/00034894211029103] [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: 11/15/2022]
Abstract
OBJECTIVE Review a single institution's vestibular schwannoma (VS) microsurgery experience to determine (1) correlations between demographics, comorbidities, and/or surgical approach on hospital length of stay (LOS) and discharge disposition and (2) trends in surgical approach over time. METHODS Retrospective case series from a multidisciplinary skull base program at a tertiary care, academic hospital. All adult (>18 years) patients undergoing primary microsurgery for VS between 2008 and 2018 were included. RESULTS A total of 147 subjects were identified. Surgical approach was split between middle fossa (MF) (16%), retrosigmoid (RS) (35%), and translabyrinthine (TL) (49%) craniotomies. For the 8% of patients had other than routine (OTR) discharge. Mean LOS was significantly longer for patients undergoing RS than either MF or TL. Brainstem compression by the tumor was associated with longer LOS as were diagnoses of chronic obstructive pulmonary disease (COPD) and peripheral vascular disease (PVD). For all discharges, the 40 to 50- and 50 to 60-year-old subgroups had significantly shorter LOS than the 70-years-and-older patients. For the 92% of patients routinely discharged, there was a significantly shorter LOS in the 40 to 50-year-olds compared to the 70-years-and-older patients. There was a significant shift in surgical approach from RS to TL over the study period. CONCLUSION Over 90% of VS microsurgery patients were routinely discharged with a median hospital LOS of 3.2 days, both of which are consistent with published data. There is an inverse relationship between age and LOS with patients older than 70 years having significantly longer LOS. Brainstem compression, COPD, PVD, and the RS approach negatively affect LOS. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Galit Almosnino
- Department of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Matt J Sikora
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Farrokh R Farrokhi
- Department of Neurosurgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Seth R Schwartz
- Listen for Life Center, Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, WA 98101, USA
| | - Daniel M Zeitler
- Listen for Life Center, Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, WA 98101, USA
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17
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Dicpinigaitis AJ, Kalakoti P, Schmidt M, Gurgel R, Cole C, Carlson A, Pickett B, Sun H, Mukherjee D, Al-Mufti F, Bowers CA. Associations of Baseline Frailty Status and Age With Outcomes in Patients Undergoing Vestibular Schwannoma Resection. JAMA Otolaryngol Head Neck Surg 2021; 147:608-614. [PMID: 33914061 DOI: 10.1001/jamaoto.2021.0670] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Although numerous studies have evaluated the influence of advanced age on surgical outcomes following vestibular schwannoma (VS) resection, few if any large-scale investigations have assessed the comparative prognostic effects of age and frailty. As the population continues to age, it is imperative to further evaluate treatment and management strategies for older patients. Objective To conduct a population-based evaluation of the independent associations of chronological age and frailty (physiological age) with outcomes following VS resection. Design, Setting, and Participants In this large-scale, multicenter, cross-sectional analysis, weighted discharge data from the National Inpatient Sample were searched to identify adult patients (≥18 years old) who underwent VS resection from 2002 through 2017 using International Classification of Diseases, Ninth Revision, Clinical Modification and Tenth Revision, Clinical Modification codes. Data collection and analysis took place September to December 2020. Main Outcomes and Measures Complex samples regression models and receiver operating characteristic curve analysis were used to evaluate the independent associations of frailty and age (along with demographic confounders) with complications and discharge disposition. Frailty was evaluated using the previously validated 11-point modified frailty index (mFI). Results Among the 27 313 patients identified for VS resection, the mean (SEM) age was 50.4 (0.2) years, 15 031 (55.0%) were women, and 4720 (21.0%) were of non-White race/ethnicity, as determined by the National Inpatient Sample data source. Of the included patients, 15 090 (55.2%) were considered robust (mFI score = 0), 8204 (30.0%) were prefrail (mFI score = 1), 3022 (11.1%) were frail (mFI score = 2), and 996 (3.6%) were severely frail (mFI score ≥3). On univariable analysis, increasing frailty was associated with development of postoperative hemorrhagic or ischemic stroke (odds ratio [OR], 2.44 [95% CI, 2.07-2.87]; area under the curve, 0.73), while increasing age was not. Following multivariable analysis, increasing frailty and non-White race/ethnicity were independently associated with both mortality (adjusted OR [aOR], 2.32 [95% CI, 1.70-3.17], and aOR, 3.05 [95% CI, 1.02-9.12], respectively) and extended hospital stays (aOR, 1.54 [95% CI, 1.41-1.67], and aOR, 1.71 [95% CI, 1.42-2.05], respectively), while increasing age was not. Increasing frailty (aOR, 0.61 [95% CI, 0.56-0.67]), age (aOR, 0.98 [95% CI, 0.97-0.99]), and non-White race/ethnicity (aOR, 0.62 [95% CI 0.51-0.75]) were all independently associated with routine discharge. Conclusions and Relevance In this cross-sectional study, findings suggest that frailty may be more accurate for predicting outcomes and guiding treatment decisions than advanced patient age alone following VS resection.
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Affiliation(s)
| | - Piyush Kalakoti
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Meic Schmidt
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque
| | - Richard Gurgel
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | - Chad Cole
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque
| | - Andrew Carlson
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque
| | - Brad Pickett
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico School of Medicine, Albuquerque
| | - Hai Sun
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.,Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque
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18
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Li Y, Ran G, Chen K, Shen X. Preoperative Psychological Burdens in Patients with Vestibular Schwannoma. Ann Otol Rhinol Laryngol 2021; 131:239-243. [PMID: 34032139 DOI: 10.1177/00034894211018915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess preoperative psychological burden in patients with vestibular schwannoma (VS). METHODS A total of 100 patients undergoing VS resection between September 2019 and June 2020 completed preoperative psychological screening. The Hospital Anxiety and Depression Scale (HADS) was applied the day before surgery, and a score >14 was considered clinically important. Univariate and multivariate logistic regression analyzes were used to identify risk factors associated with increased preoperative psychological stress. RESULTS Of the 100 patients who underwent VS resection, 44% were male, with a mean age of 45.9 years. Twenty-two (22%) had HADS scores >14. For the univariate analysis, risk factors associated with elevated psychological burden included time since diagnosis, number of symptoms, headache, vertigo, and nausea and/or vomiting. In the regression analysis, the number of symptoms and greater time from diagnosis to treatment correlated with higher preoperative psychological stress. CONCLUSION Nearly 1 in 4 patients with VS experienced clinically significant emotional burden preoperatively. Number of symptoms and greater time from diagnosis to treatment contributed to this psychological burden.
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Affiliation(s)
- Yufeng Li
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Guo Ran
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Kaizheng Chen
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xia Shen
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
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19
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Abstract
OBJECTIVE To determine the current epidemiology and management trends for patients with vestibular schwannomas (VS). STUDY DESIGN Retrospective cohort study. SETTING The Surveillance, Epidemiology, and End Results (SEER) tumor registry. PATIENTS The SEER database was queried to identify patients diagnosed with VS from 1973 to 2015. Demographics, patient and tumor characteristics, and treatment methods were analyzed. RESULTS A total of 14,507 patients with VS were identified. The mean age at diagnosis was 55 ± 14.9 years. Age-adjusted incidence from 2006 to 2015 was 1.4 per 100,000 per year and remained relatively stable. Incidence across age varied with sex, as younger women and older men had increased incidences comparatively. A higher percentage of patients underwent surgery alone (43%), followed by observation (32%), radiation alone (23%), and combined radiation and surgery (2%). Age 65 and older was associated with observation (odds ratio [OR] 1.417; p = 0.029) whereas age 20 to 39 and 40 to 49 were associated with surgery (OR 2.013 and 1.935; p < 0.001). Older age was associated with radiation. Larger tumor size was associated with surgery and combined treatment. African American patients and American Indian or Alaskan Native patients were more likely to undergo observation than surgery. CONCLUSIONS The overall incidence of VS is 1.4 per 100,000 per year and has remained relatively stable. There is a trend toward more conservative management with observation, which may be secondary to earlier diagnosis given widespread use of magnetic resonance imaging. Further studies are necessary to investigate differences in disease patterns and disparities in management.
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20
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Bunevicius A, Sheehan D, Lee Vance M, Schlesinger D, Sheehan JP. Outcomes of Cushing's disease following Gamma Knife radiosurgery: effect of a center's growing experience and era of treatment. J Neurosurg 2021; 134:547-554. [PMID: 32005023 DOI: 10.3171/2019.12.jns192743] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/02/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) is used for the management of residual or recurrent Cushing's disease (CD). Increasing experience and technological advancements of Gamma Knife radiosurgery (GKRS) systems can impact the outcomes of CD patients. The authors evaluated the association of their center's growing experience and the era in which GKRS was performed with treatment success and adverse events in patients with CD. METHODS The authors studied consecutive patients with CD treated with GKRS at the University of Virginia since installation of the first Gamma Knife system in March 1989 through August 2019. They compared endocrine remission and complication rates between patients treated before 2000 (early cohort) and those who were treated in 2000 and later (contemporary cohort). RESULTS One hundred thirty-four patients with CD underwent GKRS during the study period: 55 patients (41%) comprised the early cohort, and 79 patients (59%) comprised the contemporary cohort. The contemporary cohort, compared with the early cohort, had a significantly greater treatment volume, radiation prescription dose, maximal dose to the optic chiasm, and number of isocenters, and they more often had cavernous sinus involvement. Endocrine remission rates were higher in the contemporary cohort when compared with the early cohort (82% vs 66%, respectively; p = 0.01). In a Cox regression analysis adjusted for demographic, clinical, and SRS characteristics, the contemporary GKRS cohort had a higher probability of endocrine remission than the early cohort (HR 1.987, 95% CI 1.234-3.199; p = 0.005). The tumor control rate, incidence of cranial nerve neuropathy, and new anterior pituitary deficiency were similar between the two groups. CONCLUSIONS Technological advancements over the years and growing center experience were important factors for improved endocrine remission rates in patients with CD. Technological aspects and results of contemporary Gamma Knife systems should be considered when counseling patients, planning treatment, and reporting treatment results. Studies exploring the learning curve for GKRS are warranted.
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Affiliation(s)
| | | | - Mary Lee Vance
- Departments of1Neurological Surgery and
- 2Medicine, University of Virginia Health System, Charlottesville, Virginia
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21
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Tang OY, Rivera Perla KM, Lim RK, Weil RJ, Toms SA. The impact of hospital safety-net status on inpatient outcomes for brain tumor craniotomy: a 10-year nationwide analysis. Neurooncol Adv 2021; 3:vdaa167. [PMID: 33506205 PMCID: PMC7813162 DOI: 10.1093/noajnl/vdaa167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Outcome disparities have been documented at safety-net hospitals (SNHs), which disproportionately serve vulnerable patient populations. Using a nationwide retrospective cohort, we assessed inpatient outcomes following brain tumor craniotomy at SNHs in the United States. Methods We identified all craniotomy procedures in the National Inpatient Sample from 2002–2011 for brain tumors: glioma, metastasis, meningioma, and vestibular schwannoma. Safety-net burden was calculated as the number of Medicaid plus uninsured admissions divided by total admissions. Hospitals in the top quartile of burden were defined as SNHs. The association between SNH status and in-hospital mortality, discharge disposition, complications, hospital-acquired conditions (HACs), length of stay (LOS), and costs were assessed. Multivariate regression adjusted for patient, hospital, and severity characteristics. Results 304,719 admissions were analyzed. The most common subtype was glioma (43.8%). Of 1,206 unique hospitals, 242 were SNHs. SNH admissions were more likely to be non-white (P < .001), low income (P < .001), and have higher severity scores (P = .034). Mortality rates were higher at SNHs for metastasis admissions (odds ratio [OR] = 1.48, P = .025), and SNHs had higher complication rates for meningioma (OR = 1.34, P = .003) and all tumor types combined (OR = 1.17, P = .034). However, there were no differences at SNHs for discharge disposition or HACs. LOS and hospital costs were elevated at SNHs for all subtypes, culminating in a 10% and 9% increase in LOS and costs for the overall population, respectively (all P < .001). Conclusions SNHs demonstrated poorer inpatient outcomes for brain tumor craniotomy. Further analyses of the differences observed and potential interventions to ameliorate interhospital disparities are warranted.
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Affiliation(s)
- Oliver Y Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Krissia M Rivera Perla
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rachel K Lim
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Robert J Weil
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Steven A Toms
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
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22
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Koo AB, Yeung JT, Freedman IG, Lee JH, Ahmed OM, Ma AK, Miyagishima DF, DiLuna M, Kahle K. Clinical and economic burden of neurofibromatosis type 2 in the United States. Clin Neurol Neurosurg 2020; 197:106053. [PMID: 32683193 DOI: 10.1016/j.clineuro.2020.106053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/19/2020] [Accepted: 06/27/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We aimed to investigate the prevalence and cost-associated risk factors for hospital stays for Neurofibromatosis Type 2 (NF2) patients in the past decade. PATIENTS AND METHODS A multi-year cross-sectional study was performed using the National Inpatient Sample. Patients with a diagnosis code of NF2 according to the International Classification of Diseases, 9th Revision, Clinical Modification coding system were queried from 2006-2014. Sampling discharge weights were used to calculate trend estimates for national demographics, hospital characteristics, comorbidities, and surgical interventions. Regression analysis was performed to determine significant independent associations between comorbidities and admission cost. RESULTS From 2006-2014, there were 5,078 discharges for patients diagnosed with NF2. Patient demographics, comorbidities, and procedures performed were overall consistent over time. The most common admission diagnoses were hearing loss (28.2 %), acoustic schwannoma (14.3 %), cranial meningioma (11.8 %) and epilepsy (10.8 %). The most common procedures performed were craniotomy and meningioma resection (10.2 %) and acoustic neuroma open resection (7.9 %). The median inflation-adjusted cost of admission did not change over time, with an admission cost value of $12,387 [6,042 - 26,051]. On regression analysis, obstructive hydrocephalus, craniotomy and meningioma resection, acoustic neuroma open resection, and spine tumor resection were all independent predictors of increased cost. CONCLUSION The care for NF2 patients continues to evolve over time. We report the prevalence of patient demographics, comorbidities, and treatments in the NF2 inpatient population. Further studies are warranted to better understand the risk factors for higher costs, so that patients with NF2 may continue to receive life-long quality care in a cost-effective manner.
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Affiliation(s)
- Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Jacky T Yeung
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.
| | - Isaac G Freedman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Jun Hui Lee
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Osama M Ahmed
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Anthony K Ma
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | | | - Michael DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Kristopher Kahle
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
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Hasegawa T, Kato T, Naito T, Tanei T, Ishii K, Tsukamoto E, Okada K. Long-Term Outcomes of Sporadic Vestibular Schwannomas Treated with Recent Stereotactic Radiosurgery Techniques. Int J Radiat Oncol Biol Phys 2020; 108:725-733. [PMID: 32473897 DOI: 10.1016/j.ijrobp.2020.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Vestibular schwannomas (VSs) are benign; thus, understanding long-term tumor control and late adverse radiation effects of stereotactic radiosurgery (SRS) through current radiosurgical techniques is important to inform treatment decisions. Our aim was to clarify long-term tumor control rates and incidence of late adverse radiation effects in patients with VSs followed for 5 years or longer after SRS. METHODS AND MATERIALS Altogether, 615 patients with VSs (excluding neurofibromatosis type 2 and partially treated tumors) followed for 5 years or longer after SRS using recent radiosurgical techniques were evaluated. All patients were treated at a margin dose of less than 14 Gy. All tumors were classified into 4 categories: type A (intracanalicular tumor, 87 patients [14%]), type B (cerebellopontine angle [CPA] tumor, 325 patients [53%]), type C (CPA tumor compressing the brain stem, 138 patients [22%]), and type D (CPA tumor compressing the brain stem with a deviation of the fourth ventricle, 65 patients [11%]). Median tumor volume was 2.0 cm3 and median marginal dose was 12 Gy. RESULTS Median follow-up period was 158 months. Actuarial 5-, 10-, and 15-year or longer local control (LC) rates were 93%, 91%, and 89%, respectively. Tumor type (P < .001, hazard ratio 2.389) and number of prior surgeries (P = .007, hazard ratio 1.698) were significant for LC. Depending on the tumor type, the actuarial 10-year LC rates were 100%, 93%, 88%, and 70% in type A, B, C, and D tumors, respectively. No patient developed persistent facial palsy. Twenty patients (3.3%) developed delayed cysts. One patient developed malignant transformation (0.2%). CONCLUSIONS SRS is a safe and effective treatment for VSs in the long term, excluding VSs compressing the brain stem with a deviation of the fourth ventricle. Delayed cysts such as cyst formation, enlarged preexisting cysts or extratumoral cysts, and malignant transformation should be considered possible causes of long-term treatment failures.
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Affiliation(s)
- Toshinori Hasegawa
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan.
| | - Takenori Kato
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
| | - Takehiro Naito
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
| | - Takafumi Tanei
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
| | - Kazuki Ishii
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
| | - Eisuke Tsukamoto
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
| | - Kou Okada
- Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Japan
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Morselli C, Boari N, Artico M, Bailo M, Piccioni LO, Giallini I, de Vincentiis M, Mortini P, Mancini P. The emerging role of hearing loss rehabilitation in patients with vestibular schwannoma treated with Gamma Knife radiosurgery: literature review. Neurosurg Rev 2020; 44:223-238. [PMID: 32030543 DOI: 10.1007/s10143-020-01257-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/20/2020] [Accepted: 01/30/2020] [Indexed: 12/19/2022]
Abstract
Stereotactic radiosurgery (SRS) is currently the most common treatment for small- to medium-size vestibular schwannoma (VS). Despite favorable outcome, hearing deterioration still remains an underestimated problem, and the role of hearing rehabilitation is an underinvestigated topic. Among available technologies, cochlear implant (CI) should represent a valid alternative in sporadic VS with single-sided deafness and in neurofibromatosis (NF2) with bilateral profound hearing loss. A literature review of the current clinical data was performed searching scientific literature databases. From all of the articles found, 16 papers were selected. Forty-four subjects treated with radiosurgery (18 male, 19 female, and in 7 cases, sex were not specified; 43 NF2 and 1 sporadic VS) were included in the analysis. Epidemiological, clinical, tumor, treatment, and audiological data were collected. Clinical outcome at last follow-up showed an audiological improvement in 25 of the 44 patients. The audiological outcome was unchanged in 16 cases. Audiological deterioration was recorded in 3 cases. Severity of NF2 phenotype, long history of ipsilateral profound deafness before implantation, progressive tumor growth, and high radiation dose (20 and 40 Gy) were found in patients with a worst audiological outcome. Hearing rehabilitation can improve audiological results for VS patients following SRS in selected cases. Hearing rehabilitation with cochlear implant (CI) in SSD leads to partial restoration of binaural hearing with an improvement in speech comprehension in noise and in sound localization, and partial suppression of subjective incapacitating tinnitus. SRS followed by CI may represent in selected cases a potential emerging option in the management of these patients, aimed at improving their quality of life. Possible implications for the follow-up of these patients are still present, although partially resolved.
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Affiliation(s)
- Carlotta Morselli
- Department of Human Neurosciences, Spienza University of Rome, Rome, Italy.
| | - N Boari
- Department of Neurosurgery and Radiosurgery Units, San Raffaele University Health Institute, Milan, Italy
| | - M Artico
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - M Bailo
- Department of Neurosurgery and Radiosurgery Units, San Raffaele University Health Institute, Milan, Italy
| | - L O Piccioni
- Department of Neurosurgery and Radiosurgery Units, San Raffaele University Health Institute, Milan, Italy
| | - I Giallini
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - M de Vincentiis
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - P Mortini
- Department of Neurosurgery and Radiosurgery Units, San Raffaele University Health Institute, Milan, Italy
| | - P Mancini
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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Does Hospital Volume Affect Outcomes in Patients Undergoing Vestibular Schwannoma Surgery? Otol Neurotol 2019; 39:481-487. [PMID: 29342051 DOI: 10.1097/mao.0000000000001718] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the effect of hospital surgical case volume on the outcomes of vestibular schwannoma surgery. STUDY DESIGN Retrospective case review. SETTING University HealthSystem Consortium member hospitals (includes nearly every US academic medical center). PATIENTS Three thousand six hundred ninety-seven patients who underwent vestibular schwannoma resection over a 3-year timespan (2012-2015) grouped by race, age, comorbidities, payer, and sex. INTERVENTION Surgical resection of vestibular schwannoma. MAIN OUTCOME MEASURES Morbidity and mortality following vestibular schwannoma excision are compared by hospital volume (low, medium, and high) including deciles. RESULTS There was significantly longer length of stay (p ≤ 0.005) among groups with low-volume hospitals followed by medium-volume hospitals and high-volume hospitals. Low-volume hospitals had a significantly higher rate of complications including stroke, aspiration, and respiratory failure (p ≤ 0.0175). Patient characteristics of age, sex, sex, and baseline comorbidities were similar between hospital groups. However, patients at high-volume hospitals were more likely to be Caucasian (83.1%, p = 0.0001) and have private insurance (76.7%, p < 0.0001). There was a strong negative correlation between complication rates and hospital volume (r = -0.8164, p = 0.0040). CONCLUSION The volume of vestibular schwannoma surgeries performed at a hospital impacts length of stay and rates of postoperative complications. Demographics among hospital groups were similar though high-volume hospitals had significantly more patients who were privately insured and Caucasian.
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McClelland S, Hatfield J, Degnin C, Chen Y, Mitin T. Extent of resection and role of adjuvant treatment in resected localized breast angiosarcoma. Breast Cancer Res Treat 2019; 175:409-418. [PMID: 30820717 DOI: 10.1007/s10549-019-05172-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/18/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Localized breast angiosarcoma (LBA) is a rare condition with no prospective clinical trials guiding the management of afflicted patients. Management of LBA and the resulting outcomes on a nationwide scale has not been previously examined. METHODS The National Cancer Data Base (NCDB) from 2004 to 2014 identified resected LBA patients. Treatment patterns were compared between three time periods (2004-2007, 2008-2011, and 2012-2014). Demographic and tumor characteristics, as well as treatments received-extent of surgery and adjuvant therapies-were analyzed for association with overall survival after adjustment for covariates. RESULTS 826 resected localized breast angiosarcoma patients were identified. Mastectomy was the most common surgical approach (86%); over 60% of patients did not receive adjuvant therapies after surgery. On multivariate analysis, tumor grade, tumor size, and surgical margins were associated with worse survival. Extent of surgery (mastectomy versus lumpectomy) and radiation therapy use were not associated with improved survival. Adjuvant chemotherapy was associated with improved survival in patients with primary tumors 5 cm and greater. CONCLUSIONS The extent of surgery is not associated with improved survival in women with LBA, and patients may consider breast-conservation surgery. Adjuvant therapies are not associated with improved survival, with the exception of possible role of adjuvant chemotherapy in large primary tumors (5 cm or greater). Further clinical studies are needed to determine the impact of these treatments on local control, progression-free survival, and patients' quality of life. Until then, the findings of our analysis will form basis for the multi-disciplinary discussion of management of women with LBA.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Oncology, Indiana University School of Medicine, 535 Barnhill Drive, RT 041, Indianapolis, IN, 46202, USA.
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA.
| | - Jess Hatfield
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Catherine Degnin
- Biostatistics Shared Resource, Oregon Health and Science University, Portland, OR, USA
| | - Yiyi Chen
- Biostatistics Shared Resource, Oregon Health and Science University, Portland, OR, USA
| | - Timur Mitin
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA
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Frischer JM, Gruber E, Schöffmann V, Ertl A, Höftberger R, Mallouhi A, Wolfsberger S, Arnoldner C, Eisner W, Knosp E, Kitz K, Gatterbauer B. Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study. J Neurosurg 2019; 130:388-397. [PMID: 29498575 DOI: 10.3171/2017.8.jns171281] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/21/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors present long-term follow-up data on patients treated with Gamma Knife radiosurgery (GKRS) for acoustic neuroma. METHODS Six hundred eighteen patients were radiosurgically treated for acoustic neuroma between 1992 and 2016 at the Department of Neurosurgery, Medical University Vienna. Patients with neurofibromatosis and patients treated too recently to attain 1 year of follow-up were excluded from this retrospective study. Thus, data on 557 patients with spontaneous acoustic neuroma of any Koos grade are presented, as are long-term follow-up data on 426 patients with a minimum follow-up of 2 years. Patients were assessed according to the Gardner-Robertson (GR) hearing scale and the House-Brackmann facial nerve function scale, both prior to GKRS and at the times of follow-up. RESULTS Four hundred fifty-two patients (81%) were treated with radiosurgery alone and 105 patients (19%) with combined microsurgery-radiosurgery. While the combined treatment was especially favored before 2002, the percentage of cases treated with radiosurgery alone has significantly increased since then. The overall complication rate after GKRS was low and has declined significantly in the last decade. The risk of developing hydrocephalus after GKRS increased with tumor size. One case (0.2%) of malignant transformation after GKRS was diagnosed. Radiological tumor control rates of 92%, 91%, and 91% at 5, 10, and 15 years after GKRS, regardless of the Koos grade or pretreatment, were observed. The overall tumor control rate without the need for additional treatment was even higher at 98%. At the last follow-up, functional hearing was preserved in 55% of patients who had been classified with GR hearing class I or II prior to GKRS. Hearing preservation rates of 53%, 34%, and 34% at 5, 10, and 15 years after GKRS were observed. The multivariate regression model revealed that the GR hearing class prior to GKRS and the median dose to the cochlea were independent predictors of the GR class at follow-up. CONCLUSIONS In small to medium-sized spontaneous acoustic neuromas, radiosurgery should be recognized as the primary treatment at an early stage. Although minimizing the cochlear dose seems beneficial for hearing preservation, the authors, like others before, do not recommend undertreating intracanalicular tumors in favor of low cochlear doses. For larger acoustic neuromas, radiosurgery remains a reliable management option with tumor control rates similar to those for smaller acoustic neuromas; however, careful patient selection and counseling are recommended given the higher risk of side effects. Microsurgery must be considered in acoustic neuromas with significant brainstem compression or hydrocephalus.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Wilhelm Eisner
- 5Department of Neurosurgery, Medical University Innsbruck, Austria
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Anzalone CL, Glasgow AE, Van Gompel JJ, Carlson ML. Racial Differences in Disease Presentation and Management of Intracranial Meningioma. J Neurol Surg B Skull Base 2018; 80:555-561. [PMID: 31750040 DOI: 10.1055/s-0038-1676788] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022] Open
Abstract
Objective/Hypothesis The aim of the study was to determine the impact of race on disease presentation and treatment of intracranial meningioma in the United States. Study Design This study comprised of the analysis of a national population-based tumor registry. Methods Analysis of the surveillance, epidemiology, and end results (SEER) database was performed, including all patients identified with a diagnosis of intracranial meningioma. Associations between race, disease presentation, treatment strategy, and overall survival were analyzed in a univariate and multivariable model. Results A total of 65,973 patients with intracranial meningiomas were identified. Of these, 45,251 (68.6%) claimed white, 7,796 (12%) black, 7,154 (11%) Hispanic, 4,902 (7%) Asian, and 870 (1%) patients reported "other-unspecified" or "other-unknown." The median annual incidence of disease was lowest among black (3.43 per 100,000 persons) and highest among white (9.52 per 100,000 persons) populations ( p < 0.001). Overall, Hispanic patients were diagnosed at the youngest age and white patients were diagnosed at the oldest age (mean of 59 vs. 66 years, respectively; p < 0.001). Compared with white populations, black, Hispanic, and Asian populations were more likely to present with larger tumors ( p < 0.001). After controlling for tumor size, age, and treatment center in a multivariable model, Hispanic patients were more likely to undergo surgery than white, black, and Asian populations. Black populations had the poorest disease specific and overall survival rates at 5 years following surgery compared with other groups. Conclusion Racial differences among patients with intracranial meningioma exist within the United States. Understanding these differences are of vital importance toward identifying potential differences in the biological basis of disease or alternatively inequalities in healthcare delivery or access Further studies are required to determine which factors drive differences in tumor size, age, annual disease incidence, and overall survival between races.
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Affiliation(s)
- C Lane Anzalone
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Amy E Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program, Minnesota, United States
| | - Jamie J Van Gompel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
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30
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Bashjawish B, Kılıç S, Baredes S, Eloy JA, Liu JK, Ying YLM. Changing trends in management of vestibular schwannoma: A National Cancer Database study. Laryngoscope 2018; 129:1197-1205. [PMID: 30450631 DOI: 10.1002/lary.27568] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe changes in management trends of vestibular schwannoma (VS) and the effects of median income, education level, insurance status, and tumor size on receipt of treatment. METHODS Cross-sectional analysis using the National Cancer Database from 2004 to 2014. All patients with a diagnosis of VS were identified between 2004 and 2014. Trends in treatment modality over time were analyzed. Correlation between demographics, institution type, median income, education level, and insurance status were assessed using univariate and multivariate logistic regressions. RESULTS Of the 22,290 VS patients identified, 16,011 (71.8%) received treatment, whereas 6,279 (28.2%) received observation. Management trend analysis over the 11-year period revealed patients with tumor size < 1 cm are more frequently observed (34.6% of cases in 2004 vs. 60.8% of cases in 2014) and less frequently received surgery (34.6% vs. 16.8%). Multivariate analysis showed observation was more frequently used in patients ≥ 65 years; black patients; and those on Medicaid, Medicare, and noninsured (P < 0.0001). All tumors > 2 cm were more likely to be treated with surgery, specifically subtotal resections (P < 0.0001). Patients treated at nonacademic centers were more likely to receive linear accelerator, or LINAC (Accuray Incorporated, Sunnyvale, CA) therapy than Gamma Knife (Elekta, Stockholm, Sweden) (P < 0.0001). CONCLUSION Management of VS is shifting toward increased observation, most significantly in tumors size < 1 cm. Insurance provider plays a significant role on receipt of treatment and modality, whereas income and education do not. LEVEL OF EVIDENCE NA Laryngoscope, 129:1197-1205, 2019.
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Affiliation(s)
- Bassel Bashjawish
- Department of Otolaryngology-Head and Neck Surgery, Newark, New Jersey
| | - Suat Kılıç
- Department of Otolaryngology-Head and Neck Surgery, Newark, New Jersey
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Newark, New Jersey.,Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Newark, New Jersey.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey.,Department of Neurological Surgery, Newark, New Jersey.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - James K Liu
- Department of Neurological Surgery, Newark, New Jersey
| | - Yu-Lan Mary Ying
- Department of Otolaryngology-Head and Neck Surgery, Newark, New Jersey
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McClelland S, Jaboin JJ. Optimal treatment for African-Americans with intractable mesial temporal lobe epilepsy remains anterior temporal lobectomy. Clin Neurol Neurosurg 2018; 174:247. [PMID: 30197091 DOI: 10.1016/j.clineuro.2018.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/29/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Shearwood McClelland
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, United States.
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, United States
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Babadjouni R, Wen T, Donoho DA, Buchanan IA, Cen SY, Friedman RA, Amar A, Russin JJ, Giannotta SL, Mack WJ, Attenello FJ. Increased Hospital Surgical Volume Reduces Rate of 30- and 90-Day Readmission After Acoustic Neuroma Surgery. Neurosurgery 2018; 84:726-732. [DOI: 10.1093/neuros/nyy187] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/17/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Robin Babadjouni
- Department of Neurological Surgery, University of Southern California, Los Angeles, California
| | - Timothy Wen
- Department of Neurological Surgery, University of Southern California, Los Angeles, California
| | - Daniel A Donoho
- Department of Neurological Surgery, University of Southern California, Los Angeles, California
| | - Ian A Buchanan
- Department of Neurological Surgery, University of Southern California, Los Angeles, California
| | - Steven Y Cen
- Department of Neurological Surgery, University of Southern California, Los Angeles, California
| | - Rick A Friedman
- Department of Neurological Surgery, University of Southern California, Los Angeles, California
| | - Arun Amar
- Department of Neurological Surgery, University of Southern California, Los Angeles, California
| | - Jonathan J Russin
- Department of Neurological Surgery, University of Southern California, Los Angeles, California
| | - Steven L Giannotta
- Department of Neurological Surgery, University of Southern California, Los Angeles, California
| | - William J Mack
- Department of Neurological Surgery, University of Southern California, Los Angeles, California
| | - Frank J Attenello
- Department of Neurological Surgery, University of Southern California, Los Angeles, California
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Hatch JL, Bauschard MJ, Nguyen SA, Lambert PR, Meyer TA, McRackan TR. National Trends in Vestibular Schwannoma Surgery: Influence of Patient Characteristics on Outcomes. Otolaryngol Head Neck Surg 2018; 159:102-109. [PMID: 29584554 DOI: 10.1177/0194599818765717] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective To characterize current vestibular schwannoma (VS) surgery outcomes with a nationwide database and identify factors associated with increased complications and prolonged hospital course. Study Design Retrospective review utilizing the University HealthSystem Consortium national inpatient database. Setting US academic health centers. Subjects and Methods Data from patients undergoing VS surgery were analyzed over a 3-year time span (October 2012 to September 2015). Surgical outcomes, such as length of stay (LOS), complications, and mortality, were analyzed on the basis of race, sex, age, and comorbidities during the 30-day postoperative period. Results A total of 3697 VS surgical cases were identified. The overall mortality rate was 0.38%, and the overall complication rate was 5.3%. Advanced age significantly affected intensive care unit LOS, mortality, and complications ( P = .04). Comorbidities, including hypertension, obesity, and depression, also significantly increased complication rates ( P = .02). Sixty-eight patients (1.8%) had a history of irradiation, and they had a significantly increased LOS ( P = .03). Conclusion Modern VS surgery has a low mortality rate and a relatively low rate of complications. Several factors contribute to high complication rates, including age and comorbidities. These data will help providers in counseling patients on which treatment course might be best suited for them.
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Affiliation(s)
- Jonathan L Hatch
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael J Bauschard
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul R Lambert
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore R McRackan
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Carlson ML, Van Gompel JJ, Wiet RM, Tombers NM, Devaiah AK, Lal D, Morcos JJ, Link MJ. A Cross-sectional Survey of the North American Skull Base Society: Current Practice Patterns of Vestibular Schwannoma Evaluation and Management in North America. J Neurol Surg B Skull Base 2017; 79:289-296. [PMID: 29765827 DOI: 10.1055/s-0037-1607319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022] Open
Abstract
Background Very few studies have examined vestibular schwannoma (VS) management trends across centers and between providers. The objective of this study is to examine current practice trends, variance in treatment philosophies, and nuanced or controversial aspects of VS care across North America. Methods This is a cross-sectional survey of North American Skull Base Society (NASBS) members who report regular involvement in VS care. Results A total of 57 completed surveys were returned. Most respondents claimed to have over 20 years of experience and the majority reported working in an academic practice with an affiliated otolaryngology and/or neurosurgery residency program. Sixty-three percent of respondents claimed to evaluate VS patients in clinic with both an otolaryngologist and neurosurgeon involved. Eighty-six percent of respondents claimed to operate on VS with both an otolaryngologist and neurosurgeon involved, while only 18% of neurosurgeons and 9% of otolaryngologists performed surgery alone. There was a wide range in the number of cases evaluated at each center annually. Similarly, there was wide variation in the number of patients treated with microsurgery and radiation at each center. Additional details regarding management preferences for microsurgery, stereotactic radiosurgery, stereotactic radiotherapy, and conservative observation are presented. Conclusion VS management practices vary between providers and centers. Overall, most centers employ a multidisciplinary approach to management with collaboration between otolaryngology and neurosurgery. Overall, survey responses concur with previous studies suggesting a shift toward conservatism in management.
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Affiliation(s)
- Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States.,Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
| | - Jamie J Van Gompel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States.,Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
| | - R Mark Wiet
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Nicole M Tombers
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
| | - Anand K Devaiah
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, United States
| | - Devyani Lal
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic College of Medicine, Phoenix, Arizona, United States
| | - Jacques J Morcos
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, United States
| | - Michael J Link
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States.,Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
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Copeland WR, Carlson ML, Neff BA, Driscoll CL, Link MJ. Management of Residual Tumor After Limited Subtotal Resection of Large Vestibular Schwannomas: Lessons Learned and Rationale for Specialized Care. World Neurosurg 2017. [DOI: 10.1016/j.wneu.2017.06.108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ohaegbulam S, Okwunodulu O, Ndubuisi C, Mezue W, Chikani M, Nkwerem S, Ekuma M. Vestibular schwannoma appears to be very rare in a region of Sub-Saharan Africa. Surg Neurol Int 2017; 8:171. [PMID: 28840075 PMCID: PMC5551295 DOI: 10.4103/sni.sni_100_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/12/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Vestibular schwannoma (VS) is a significant neurosurgical problem hence it enjoys a special attention at conferences and workshops. It accounts for about 8-10% of all intracranial tumors with an annual incidence of about 11-14 per million per year. Most VS are sporadic with 5-10% attributed to neurofibromatosis type 2 (NF2). However, VS is alleged to be rare in Africans and uncommon in African Americans, connoting a racial bias. To our knowledge, no study from sub-Saharan Africa has addressed this subject. The aim of this study is to determine the frequency of VS in a tertiary neurosurgical hospital in sub-Saharan Africa. METHODS This is a retrospective study of all intracranial neoplasms and VS managed in a major tertiary hospital in sub-Saharan Africa from January 2003 to December 2015. Patients' records and neuroimaging studies were reviewed retrospectively. Additionally, database of all cranial computed tomography (CT) and magnetic resonance imaging (MRI) done for various indications within the same period was searched retrospectively for "incidental" VS cases. RESULTS Over the study period of 13 years, out of 612 cases of intracranial neoplasms, only three (0.49%) were VSs (two sporadic, one bilateral VS in NF2). A search for "incidental" cases of VS from a pool of 7475 cranial scans (CT: 5290; MRI: 2185), yielded none. CONCLUSIONS The findings strongly suggest that VS is very rare in the study population. It is hoped that other centers in Africa and beyond would perform similar studies.
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Affiliation(s)
- S. Ohaegbulam
- Neurosurgery Department, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - O. Okwunodulu
- Neurosurgery Department, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - C. Ndubuisi
- Neurosurgery Department, Memfys Hospital for Neurosurgery, Enugu, Nigeria
- Enugu State University Teaching Hospital, Enugu, Nigeria
| | - W. Mezue
- Neurosurgery Department, Memfys Hospital for Neurosurgery, Enugu, Nigeria
- Neurosurgery Department, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - M. Chikani
- Neurosurgery Department, Memfys Hospital for Neurosurgery, Enugu, Nigeria
- Neurosurgery Department, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - S. Nkwerem
- Neurosurgery Department, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - M. Ekuma
- Neurosurgery Department, Memfys Hospital for Neurosurgery, Enugu, Nigeria
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McClelland S, Kim E, Murphy JD, Jaboin JJ. Impact of insurance status and race on receipt of treatment for acoustic neuroma: A national cancer database analysis. J Clin Neurosci 2017; 42:143-147. [DOI: 10.1016/j.jocn.2017.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/06/2017] [Indexed: 11/30/2022]
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Operative Mortality Rates of Acoustic Neuroma Surgery: A National Cancer Database Analysis. Otol Neurotol 2017; 38:751-753. [DOI: 10.1097/mao.0000000000001362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sylvester MJ, Shastri DN, Patel VM, Raikundalia MD, Eloy JA, Baredes S, Ying YLM. Outcomes of Vestibular Schwannoma Surgery among the Elderly: Analysis of the National Inpatient Sample. Otolaryngol Head Neck Surg 2016; 156:166-172. [DOI: 10.1177/0194599816677522] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To compare comorbidities and in-hospital complications between elderly and nonelderly patients undergoing vestibular schwannoma (VS) surgery. To examine average length of stay (LOS) and hospital charges among elderly patients. Study Design Population-based inpatient registry analysis. Setting Academic medical center. Subjects and Methods Retrospective analysis of the National Inpatient Sample for patients undergoing VS surgery from 2002 to 2010: 4137 patients met inclusion criteria, with 519 (12.5%) in the elderly cohort (≥65 years). Outcomes of elderly and nonelderly (<65 years) patient cohorts were compared. Results Compared with the nonelderly cohort, the elderly cohort had more comorbidities, including diabetes mellitus, hypertension, and pulmonary disease (all P < .001). Elderly patients had longer LOS (6.5 vs 5.4 days; P = .001) but did not incur significantly greater hospital charges. Rates of cerebrospinal fluid leak, meningitis, and facial nerve injury did not vary significantly between groups. The elderly cohort experienced higher rates of in-hospital complications, including acute cardiac events, iatrogenic cerebrovascular infarction/hemorrhage, postoperative bleeding (hemorrhage/hematoma), and in-hospital mortality (all P < .05). In binary logistic regression, correcting for patient demographics and presence of comorbidities, elderly status was associated with 1.848 (95% confidence interval, 1.167-2.927; P = .009) greater odds of medical complications and 13.188 (95% confidence interval, 1.829-95.113; P = .011) greater odds of in-hospital mortality. Conclusion Elderly patients undergoing VS surgery have more comorbidities, in-hospital complications, and longer LOS than nonelderly patients. The elderly cohort had a greater rate of in-hospital mortality, though rare. Interestingly, elderly patients did not have a higher rate of many known complications associated with VS surgery and did not incur more hospital charges.
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Affiliation(s)
- Michael J. Sylvester
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Darshan N. Shastri
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Viral M. Patel
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Milap D. Raikundalia
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Yu-Lan Mary Ying
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Is Patient Age Associated with Perioperative Outcomes After Surgical Resection of Benign Cranial Nerve Neoplasms? World Neurosurg 2016; 89:101-7. [DOI: 10.1016/j.wneu.2016.01.089] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/27/2016] [Indexed: 11/21/2022]
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Kunert P, Dziedzic T, Nowak A, Czernicki T, Marchel A. Surgery for sporadic vestibular schwannoma. Part I: General outcome and risk of tumor recurrence. Neurol Neurochir Pol 2016; 50:83-9. [PMID: 26969563 DOI: 10.1016/j.pjnns.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/28/2015] [Accepted: 01/06/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vestibular schwannomas are slow growing, benign tumors. There are three possible management options: surgery, radiation treatment or active surveillance. The aim of this study was to assess the general outcome and risk of tumor recurrence. MATERIALS AND METHODS The study included 220 consecutive patients (134 women, 86 men; the age ranged from 18 to 74) operated with the retrosigmoid transmeatal approach. The largest extrameatal diameter of the tumor ranged from 8 to 72mm (mean 30mm). According to the Samii grading scale, the tumors were classified as follows: T2-12 (6%), T3-51 (23%) and T4-157 (71%). Gross total resection was performed in 217 patients and neartotal in 3. RESULTS Two hundred and eighteen (99.1%) patients were discharged home in a satisfactory neurological condition (GR or MD in GOS). One (0.5%) patient died due to brainstem infarction. One (0.5%) patient had unchanged severe cerebellar syndrome in comparison to the preoperative period (SD in GOS). In long-term follow-up, one patient went blind within a few months after surgery. Including the results of further neurosurgical procedures for CSF leak, shunt implantation, tumor regrowth and facial nerve reanimation, 98.6% of the patients were fully independent but with different neurological deficits. Tumor recurrence was observed in 5 (2.3%) patients during the follow-up period (mean term: 6.4 years). The average time to recurrence diagnosis was 8.8 years. All those patients were operated on again without any adjuvant therapy and there was no further re-growth at mean follow-up of 5.2 years. CONCLUSIONS Complete removal of VS is usually curative and poses very low risks of severe disability (if audio-facial sequels are not included), mortality and long-term recurrence. For recurrent tumors, carefully tailored revision surgery without irradiation offers a high efficacy with low risk of complications.
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Affiliation(s)
- Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
| | - Arkadiusz Nowak
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Czernicki
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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Carlson ML, Marston AP, Glasgow AE, Habermann EB, Sweeney AD, Link MJ, Wanna GB. Racial differences in vestibular schwannoma. Laryngoscope 2016; 126:2128-33. [DOI: 10.1002/lary.25892] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 12/28/2015] [Accepted: 12/31/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Matthew L. Carlson
- Department of Otorhinolaryngology; Mayo Clinic School of Medicine; Rochester Minnesota
- Department of Neurologic Surgery; Mayo Clinic School of Medicine; Rochester Minnesota
| | - Alexander P. Marston
- Department of Otorhinolaryngology; Mayo Clinic School of Medicine; Rochester Minnesota
| | - Amy E. Glasgow
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Mayo Clinic School of Medicine; Rochester Minnesota
| | - Elizabeth B. Habermann
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Mayo Clinic School of Medicine; Rochester Minnesota
| | - Alex D. Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery; Baylor College of Medicine; Houston Texas
| | - Michael J. Link
- Department of Otorhinolaryngology; Mayo Clinic School of Medicine; Rochester Minnesota
- Department of Neurologic Surgery; Mayo Clinic School of Medicine; Rochester Minnesota
| | - George B. Wanna
- Department of Otolaryngology-Head and Neck Surgery; Vanderbilt University; Nashville Tennessee U.S.A
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Predictive value of intraoperative neurophysiologic monitoring in assessing long-term facial function in grade IV vestibular schwannoma removal. Acta Neurochir (Wien) 2015; 157:1991-7; discussion 1998. [PMID: 26347044 DOI: 10.1007/s00701-015-2571-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite routine use of intraoperative neuromonitoring in acoustic neuroma removal, its application in predicting long-term facial function is limited. METHODS Prospective recording of facial nerve function and subsequent review of intraoperative neurophysiologic data. Stimulation of the facial nerve was performed proximal and distal to the tumor locus after tumor removal with measurement of amplitude and latency responses in the orbicularis oculi and oris muscles. Prospective review of current facial nerve function was performed using the House-Brackmann (HB) scoring system. Good facial function was determined as HB I/II and HB III-VI was considered poor facial function. Minimum follow-up time was 15 months, and averaged 40 months. RESULTS Twenty-four grade IV acoustic neuromas (54 % larger than 4 cm) were completely removed from October 2008 to November 2013. Nine patients (37.5 %) had HB I/II and 15 (62.5 %) had HB III-VI. The poor prognosis group had a higher latency than the good prognosis group (p = 0.045). Lower proximal amplitude was detected in the poor prognosis group (p = 0.046). Lower proximal-to-distal amplitude ratio was also detected in the poor prognosis group (p = 0.052). Amplitude ratio cut-offs of 0.44 and 0.25 were able to predict poor prognosis with sensitivity of 0.73 and 0.4 and specificity of 0.78 and 1, respectively (p = 0.046). CONCLUSIONS Lower proximal amplitude and proximal-distal amplitude ratio were previously reported as predictors of poor facial function in different sizes of vestibular schwannomas. We observed that the same applies specifically for large-sized, completely removed, grade IV tumors. Additionally, we describe a difference in proximal latency time between the good and poor prognosis groups, which was not previously reported.
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Psychological status and quality of life in acoustic neuroma patients with facial palsy after microsurgery: a 1-year postoperative follow-up study. Acta Neurol Belg 2015; 115:311-6. [PMID: 25344828 DOI: 10.1007/s13760-014-0382-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 10/15/2014] [Indexed: 12/20/2022]
Abstract
Psychological status and quality of life in postoperative acoustic neuroma patients were well documented. However, few studies have been proceed in China and investigated in a relative homogenous group. To assess the psychological status and quality of life in patients with facial palsy operated by an identical surgeon in Shanghai, China. We retrospectively reviewed 24 patients who had undergone microsurgery via a retrosigmoid approach in 2009-2010. Each patient was followed up with MRI/CT image and facial palsy evaluation. A mailed comprehensive questionnaire was used to assess the psychological status and quality of life for these patients. Meanwhile, a telephone interview was previously carried out for the consents. Statistical analysis was performed using Stata software. We found that a proportion of anxiety and depression existed among the postoperative acoustic neuroma patients, although a relative physical health was reserved. Facial palsy caused by microsurgery treatment may be a key factor triggered and involved in the psychiatric symptoms and clinicians must be aware that early involvement of a clinical psychologist may be very helpful.
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McRackan TR, Brackmann DE. Historical Perspective on Evolution in Management of Lateral Skull Base Tumors. Otolaryngol Clin North Am 2015; 48:397-405. [DOI: 10.1016/j.otc.2015.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liu SW, Jiang W, Zhang HQ, Li XP, Wan XY, Emmanuel B, Shu K, Chen JC, Chen J, Lei T. Intraoperative neuromonitoring for removal of large vestibular schwannoma: Facial nerve outcome and predictive factors. Clin Neurol Neurosurg 2015; 133:83-9. [DOI: 10.1016/j.clineuro.2015.03.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 02/27/2015] [Accepted: 03/21/2015] [Indexed: 11/27/2022]
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Mahboubi H, Maducdoc MM, Yau AY, Ziai K, Ghavami Y, Badran KW, Al-Thobaiti M, Brandon B, Djalilian HR. Vestibular Schwannoma Excision in Sporadic versus Neurofibromatosis Type 2 Populations. Otolaryngol Head Neck Surg 2015; 153:822-31. [PMID: 25791708 DOI: 10.1177/0194599815573223] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 01/27/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To understand the differences in characteristics of neurofibromatosis type 2 (NF2) and sporadic patients with surgically excised vestibular schwannomas in the state of California. STUDY DESIGN Cross-sectional. SETTING, SUBJECTS, AND METHODS The records of all patients who underwent vestibular schwannoma excision between 1997 and 2011 were extracted from the California Hospital Inpatient Discharge Databases (CHIDD). NF2 cases were identified using ICD-9-CM diagnosis code 237.72, neurofibromatosis, type 2. All other cases were recoded as sporadic. Trends in total number and population-adjusted rates (per 1 million California residents) of surgery, demographics, hospital case volume, state of residency, complications, length of stay, total charges, expected source of payment, and disposition were examined. RESULTS Vestibular schwannoma (VS) excision was performed on 7017 patients, of which 464 patients (6.6%) had NF2. The population-adjusted surgery rate declined from 11.8 to 6.2 (P < .001) for sporadic cases and from 0.3 to 0.2 (P = .01) for NF2 cases over the study period. NF2 was associated with younger age (mean, 32.9 vs 51.3), higher rate of other complications (8.8% vs 4.4%) and facial nerve complications (32.3% vs 16.8%), higher total charges (median $70,106 vs $46,395), longer stay (median 5 vs 4), and high volume hospitals (80.4% vs 48.8%) (all P < .001). CONCLUSION The surgery rates for vestibular schwannoma excision for both sporadic and NF2 patients have declined, but the decline is more prominent for sporadic cases. NF2 patients tend to be younger and have a longer hospitalization and possibly higher corresponding hospital charges compared to patients with sporadic VS.
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Affiliation(s)
- Hossein Mahboubi
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Marlon M Maducdoc
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Amy Y Yau
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Kasra Ziai
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Yaser Ghavami
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Karam W Badran
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Majid Al-Thobaiti
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Bryan Brandon
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Hamid R Djalilian
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA Department of Biomedical Engineering, University of California, Irvine, Orange, California, USA
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Combs SE, Engelhard C, Kopp C, Wiedenmann N, Schramm O, Prokic V, Debus J, Molls M, Grosu AL. Long-term outcome after highly advanced single-dose or fractionated radiotherapy in patients with vestibular schwannomas – Pooled results from 3 large German centers. Radiother Oncol 2015; 114:378-83. [DOI: 10.1016/j.radonc.2015.01.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/18/2015] [Accepted: 01/20/2015] [Indexed: 10/24/2022]
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Yamasaki A, Sedaghat AR, Lin GC, Curry WT, Shih HA, Gray ST. A Rare Finding of Schwannoma of the Vidian Canal: A Case Report. J Neurol Surg Rep 2015; 76:e48-51. [PMID: 26251809 PMCID: PMC4520991 DOI: 10.1055/s-0034-1544112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/01/2014] [Indexed: 11/13/2022] Open
Abstract
Background Schwannomas of the vidian canal are an extremely rare type of intracranial tumor that can have variable clinical presentations including headache, facial pain, facial muscle paralysis, decreased lacrimation, or nasal dryness. We present an atypical case of an incidentally identified asymptomatic vidian canal schwannoma. Case Description A 49-year-old woman with a history of multiple sclerosis presented for routine surveillance magnetic resonance imaging that detected an ovoid mass originating in the vidian canal. Given the unusual location of the lesion, an endoscopic endonasal biopsy was performed and confirmed the diagnosis of a vidian canal schwannoma, for which the patient chose to receive fractionated radiation therapy. Conclusion When a vidian canal tumor is identified, endoscopic endonasal biopsy can be used to confirm the diagnosis before pursuing either surgical or radiotherapy treatment. In particular, fractionated radiation therapy offers a radiobiologically safe means of delivering radiation when there is concern for late radiation-related side effects following treatment completion.
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Affiliation(s)
- Alisa Yamasaki
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Giant C Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - William T Curry
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
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Boari N, Bailo M, Gagliardi F, Franzin A, Gemma M, Vecchio AD, Bolognesi A, Picozzi P, Mortini P. Gamma Knife radiosurgery for vestibular schwannoma: clinical results at long-term follow-up in a series of 379 patients. J Neurosurg 2014; 121 Suppl:123-42. [DOI: 10.3171/2014.8.gks141506] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ObjectSince the 1990s, Gamma Knife radiosurgery (GKRS) has become the first-line treatment option for small- to medium-size vestibular schwannomas (VSs), especially in patients without mass effect–related symptoms and with functional hearing. The aim of this study was to assess the safety and efficacy of GKRS, in terms of tumor control, hearing preservation, and complications, in a series of 379 consecutive patients treated for VS.MethodsOf 523 patients treated at the authors' institution for VS between 2001 and 2010, the authors included 379 who underwent GKRS as the primary treatment. These patients were not affected by Type 2 neurofibromatosis and had clinical follow-up of at least 36 months. Clinical follow-up (mean and median 75.7 and 69.5 months, respectively) was performed for all patients, whereas audiometric and quantitative radiological follow-up examinations were obtained for only 153 and 219 patients, respectively. The patients' ages ranged from 23 to 85 years (mean 59 years). The mean tumor volume was 1.94 ± 2.2 cm3 (median 1.2 cm3, range 0.013–14.3 cm3), and the median margin dose was 13 Gy (range 11–15 Gy). Parameters considered as determinants of the clinical outcome were long-term tumor control, hearing preservation, and complications. A statistical analysis was performed to correlate clinical outcomes with the radiological features of the tumor, dose-planning parameters, and patient characteristics.ResultsControl of the tumor with GKRS was achieved in 97.1% of the patients. In 82.7% of the patients, the tumor volume had decreased at the last follow-up, with a mean relative reduction of 34.1%. The rate of complications was very low, with most consisting of a transient worsening of preexisting symptoms. Patients who had vertigo, balance disorders, or facial or trigeminal impairment usually experienced a complete or at least significant symptom relief after treatment. However, no significant improvement was observed in patients previously reporting tinnitus. The overall rate of preservation of functional hearing at the long-term follow-up was 49%; in patients with hearing classified as Gardner-Robertson (GR) Class I, this value was 71% and reached 93% among cases of GR Class I hearing in patients younger than 55 years.ConclusionsGamma Knife radiosurgery is a safe and effective treatment for VS, achieving tumor control in 97.1% of cases and resulting in a very low morbidity rate. Younger GR Class I patients had a significantly higher probability of retaining functional hearing even at the 10-year follow-up; for this reason, the time between symptom onset, diagnosis, and treatment should be shortened to achieve better outcomes in functional hearing preservation.
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Affiliation(s)
| | | | | | | | | | | | - Angelo Bolognesi
- 4Service of Radiation Oncology, I.R.C.C.S. San Raffaele Hospital; and
| | | | - Pietro Mortini
- 1Department of Neurosurgery,
- 5Department of Neurosurgery, Vita-Salute San Raffaele University, Milan, Italy
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