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Tsai CC, Fang CL, Liao M, Yang Y, Hsieh KLC, Wong TT. Sporadic pediatric vestibular schwannoma: a case report in a 4-year-old boy. Childs Nerv Syst 2024; 40:2251-2255. [PMID: 38709258 DOI: 10.1007/s00381-024-06398-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/06/2024] [Indexed: 05/07/2024]
Abstract
Sporadic vestibular schwannomas (VSs) are rare in children. When occurred in the pediatric population, they usually appear bilaterally and are related to neurofibromatosis type 2 (NF2). The current study reports a 4-year-old boy without family history of VS or NF2 who presented with a large (5.7-cm) VS involving the right cerebellopontine angle and internal auditory canal. Through seven-staged surgical interventions and two stereotactic γ‑knife radiosurgery, the disease was stabilized. At 2-year follow-up, the child had right ear hearing loss, grade IV facial palsy, and normal motor function and gait. No definite evidence of gene mutation regarding NF2 can be identified after sequence analysis and deletion/duplication testing. This case highlights the significance of considering the possibility of sporadic VSs, even in very young children. It emphasizes the importance of not overlooking initial symptoms, as they may indicate the presence of a large tumor and could potentially result in delayed diagnosis.
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Affiliation(s)
- Cheng-Chieh Tsai
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Chia-Lang Fang
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Department of Pathology, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Minhua Liao
- Pediatric Brain Tumor Program, Taipei Cancer Center and Taipei Neurological Institute, Taipei Medical University, Taipei City, Taiwan
| | - YiShan Yang
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Kevin Li-Chun Hsieh
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei City, Taiwan.
- Pediatric Brain Tumor Program, Taipei Cancer Center and Taipei Neurological Institute, Taipei Medical University, Taipei City, Taiwan.
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 110301, Taiwan.
| | - Tai-Tong Wong
- Pediatric Brain Tumor Program, Taipei Cancer Center and Taipei Neurological Institute, Taipei Medical University, Taipei City, Taiwan
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
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Matsushima K, Kohno M, Ichimasu N, Nakajima N, Yoshino M. Pediatric vestibular schwannoma without evidence of neurofibromatosis: consecutive 18 microsurgical experiences. Childs Nerv Syst 2022; 38:1505-1512. [PMID: 35585306 DOI: 10.1007/s00381-022-05477-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/26/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Sporadic vestibular schwannoma (VS) is rare in children in contrast to adults, and detailed investigations of case series of these patients using a single fixed protocol are scarce. This study presents our surgical experience of pediatric VSs without clinical evidence of neurofibromatosis type 2 (NF2) at the initial diagnosis. METHODS Among 1385 consecutive sporadic VS surgeries, 18 pediatric patients (1.3%; 11-18 years old) were retrospectively investigated. RESULTS The most common initial symptom was hearing disturbance (72.2%), and 6 patients (33.3%) experienced a delayed diagnosis (over 2 years after initial symptom onset). Preoperative image characteristics of these tumors included a solid tumor, hypervascularity, and significant extension into the internal acoustic meatus, when compared with adults. Preoperative embolization was successfully accomplished for 2 recent hypervascular tumors. The tumor resection rate was 95-100% under sufficient intraoperative neuromonitoring, and no additional surgery was required during the follow-up period (average: 57.9 months). No patients experienced permanent facial nerve palsy, and serviceable hearing function was preserved in 6 of 11 patients. Signs of NF2, such as bilateral VSs, were not identified in any patients during the follow-up. CONCLUSION Safe and sufficient tumor resection was achieved under detailed neuromonitoring in pediatric patients with sporadic VS, although this tends to be difficult owing to hypervascularity, a small cranium, and significant meatal extension. Preoperative embolization may help safe resection of hypervascular tumors. Subsequent development of NF2 has not been observed up to the most recent follow-up, but careful observation is essential for these younger patients.
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Affiliation(s)
- Ken Matsushima
- Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. .,Department of Neurosurgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
| | - Norio Ichimasu
- Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Nobuyuki Nakajima
- Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Masanori Yoshino
- Department of Neurosurgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
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Management of Sporadic Vestibular Schwannomas in Children—Volumetric Analysis and Clinical Outcome Assessment. CHILDREN 2022; 9:children9040490. [PMID: 35455534 PMCID: PMC9032576 DOI: 10.3390/children9040490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
Vestibular schwannomas (VS) usually manifest between the 5th and 8th decade of life. Most pediatric cases are associated with Neurofibromatosis type 2 and sporadic VS are rare in this age group. Few case series have been published. We report on our institutional series of sporadic VS in children. We included all cases between 2003 and 2021; 28 of 1635 patients harbored a sporadic VS and were younger than 21 years old. A retrospective review of clinical parameters and surgical data as well as outcomes was performed. All procedures were performed via a retrosigmoid approach. Preoperative imaging was assessed, and tumor volumetry was performed. Mean follow-up was 28 months, symptomatology was diverse. Most children and adolescents presented with hearing loss and tinnitus. All cases with multiple preoperative magnetic resonance imaging scans showed volumetric tumor growth between 1 and 18%/month (mean 8.9 ± 5.6%). Cystic tumor morphology and bone erosion was seen in larger tumors. Gross total resection was possible in 78% of patients and no recurrence was observed. All patients with subtotal resection showed tumor regrowth. Sporadic VS in children are rare and present with a high clinical variability. Surgical resection is the primary therapy and is feasible with favorable results comparable to the adult age group.
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Kawashima M, Hasegawa H, Shin M, Shinya Y, Katano A, Saito N. Outcomes of stereotactic radiosurgery in young adults with vestibular schwannomas. J Neurooncol 2021; 154:93-100. [PMID: 34241770 DOI: 10.1007/s11060-021-03803-w] [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] [Received: 05/15/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Vestibular schwannomas (VSs) are comparatively rare in younger patients, and stereotactic radiosurgery (SRS) outcome data are limited. We aimed to evaluate long-term SRS outcomes concerning sporadic VSs in patients aged ≤ 40 years. METHODS Of 383 patients with VS who had undergone SRS at our institution between 1990 and 2017, we retrospectively compared younger and older patients' tumor control and radiation-induced complication rates using case-control propensity score (PS) matching. RESULTS The mean follow-up was 83 and 92 months in older and younger patients, respectively. Compared with older patients, younger patients were more likely to have a history of resection (20% vs. 39%, p = 0.006) and be treated with higher marginal doses (median, 12 Gy vs. 14 Gy; p = 0.014). Cumulative 5- and 10-year tumor control rates were higher in older patients (97.7% and 93.9%, respectively) than in younger patients (90.2% and 85.4%, respectively, p = 0.024). After PS matching, younger patients' cumulative tumor control rates (93.6%, 85.4%, and 85.4% at 5, 10, and 15 years, respectively) were similar to those of older patients (p = 0.411). No significant between-cohort differences in hearing preservation rates or other cranial nerve complications were observed. Two younger patients had malignant tumors several years post-SRS, with one patient having confirmed histological transformation. CONCLUSIONS SRS is equally effective for younger and older patients. Complications other than hearing deterioration are uncommon. However, malignant transformation is possible, and long-term post-SRS surveillance MRI is important. These data are useful for decision-making involving young adults with VSs.
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Affiliation(s)
- Mariko Kawashima
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Krukov AI, Garov EV, Ivoilov AY, Zelikovich EI, Kaloshina AS, Zelenkova VN, Gorchakov SA, Zelenkov AV. [Acoustic neurinomes of childhood]. Vestn Otorinolaringol 2021; 86:62-65. [PMID: 33929154 DOI: 10.17116/otorino20218602162] [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: 11/17/2022]
Abstract
The article presents a review of the literature on the vestibular schwannoma of childhood, the features of its clinical manifestations, diagnostic methods, methods of treating education and indications for their use.
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Affiliation(s)
- A I Krukov
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology of the Moscow Department of Healthcare, Russian Federation, Moscow, Russia.,N.I. Pirogov Russian National Research Medical University of the Ministry of Health, Moscow, Russia
| | - E V Garov
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology of the Moscow Department of Healthcare, Russian Federation, Moscow, Russia.,N.I. Pirogov Russian National Research Medical University of the Ministry of Health, Moscow, Russia
| | - A Yu Ivoilov
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology of the Moscow Department of Healthcare, Russian Federation, Moscow, Russia.,N.I. Pirogov Russian National Research Medical University of the Ministry of Health, Moscow, Russia.,«Children's City Clinical Hospital H. N. Speransky» Moscow Department of Healthcare, Moscow, Russia
| | - E I Zelikovich
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology of the Moscow Department of Healthcare, Russian Federation, Moscow, Russia
| | - A S Kaloshina
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology of the Moscow Department of Healthcare, Russian Federation, Moscow, Russia
| | - V N Zelenkova
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology of the Moscow Department of Healthcare, Russian Federation, Moscow, Russia
| | - S A Gorchakov
- «Children's City Clinical Hospital H. N. Speransky» Moscow Department of Healthcare, Moscow, Russia
| | - A V Zelenkov
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology of the Moscow Department of Healthcare, Russian Federation, Moscow, Russia
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Malina GEK, Heiferman DM, Riedy LN, Szujewski CC, Rezaii EG, Leonetti JP, Anderson DE. Pediatric vestibular schwannomas: case series and a systematic review with meta-analysis. J Neurosurg Pediatr 2020; 26:302-310. [PMID: 32470932 DOI: 10.3171/2020.3.peds19514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sporadic unilateral vestibular schwannomas are rare in the pediatric population. Little has been reported in the literature on the presentation, tumor size, response to surgical treatment, and recurrence rates in these younger patients. The authors' goal was to describe their institutional experience with pediatric sporadic vestibular schwannomas and to conduct a meta-analysis of the existing literature to provide further insight into the presentation, tumor characteristics, and surgical outcomes for these rare tumors to help direct future treatment strategies. METHODS The authors performed a retrospective review of all patients 21 years of age or younger with unilateral vestibular schwannomas and without neurofibromatosis type 2 who underwent resection by the senior authors between 1997 and 2019. A systematic review of the literature and meta-analysis was also performed by entering the search terms "pediatric" and "vestibular schwannoma" or "acoustic neuroma," as well as "sporadic" into PubMed. Presentation, treatment, clinical outcomes, and follow-up were analyzed. RESULTS Fifteen patients were identified at the authors' institution, ranging in age from 12 to 21 years (mean 16.5 years). Common presenting symptoms included hearing loss (87%), headache (40%), vertigo (33%), ataxia (33%), and tinnitus (33%). At the time of surgery, the mean tumor size was 3.4 cm, with four 1-cm tumors. Four patients had residual tumor following their first surgery, 3 (75%) of whom had significant radiographic regrowth that required further treatment. The literature review identified an additional 81 patients from 26 studies with patient-specific clinical data available for analysis. This resulted in a total of 96 reported patients with an overall average age at diagnosis of 12.1 years (range 6-21 years) and an average tumor size of 4.1 cm. CONCLUSIONS Pediatric vestibular schwannomas present similarly to those in adults, although symptoms of mass effect are more common, as these tumors tend to be larger at diagnosis. Some children are found to have small tumors and can be successfully treated surgically. Residual tumors in pediatric patients were found to have a higher rate of regrowth than those in their adult counterparts.
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Affiliation(s)
| | | | - Loren N Riedy
- Departments of1Neurological Surgery and.,3Department of Neurobiology, University of Chicago, Illinois
| | - Caroline C Szujewski
- Departments of1Neurological Surgery and.,3Department of Neurobiology, University of Chicago, Illinois
| | | | - John P Leonetti
- 2Otolaryngology, Loyola University Medical Center, Maywood; and
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Rafiq R, Sharma R, Borkar SA. Giant Sporadic Unilateral Vestibular Schwannoma in Child: Can It Get Bigger Than This? World Neurosurg 2019; 130:378-379. [PMID: 31306840 DOI: 10.1016/j.wneu.2019.07.064] [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: 06/05/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/25/2022]
Abstract
Vestibular schwannomas (VSs) are rare in children and, when present, are usually part of neurofibromatosis 2 and bilateral. Sporadic unilateral VSs in the pediatric age group itself are rare in medical literature and giant sporadic unilateral pediatric VSs (>4 cm) are extremely rare. Herein, we describe the largest reported case of giant sporadic left-sided VS in a 10-year-old boy.
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Affiliation(s)
- Rahil Rafiq
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin A Borkar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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8
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Lateral Skull Base Approaches in Pediatric Skull Base Surgery. J Neurol Surg B Skull Base 2018; 79:47-57. [PMID: 29404241 DOI: 10.1055/s-0038-1624572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Lateral skull base pathology is rare in children. Awareness of the potential for lateral skull base lesions in children is imperative for timely identification and appropriate management. Some of the common presentations and pathologies shall be presented, as well as a variety of approaches that may be utilized to access the lateral skull base in the pediatric patient. Although the lateral skull base approaches utilized in adults may also be considered for management of pediatric lesions, some special considerations given the small developing anatomy need to be kept in mind.
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Grinblat G, Prasad SC, Fulcheri A, Laus M, Russo A, Sanna M. Lateral skull base surgery in a pediatric population: A 25-year experience in a referral skull base center. Int J Pediatr Otorhinolaryngol 2017; 94:70-75. [PMID: 28167016 DOI: 10.1016/j.ijporl.2017.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the pathology and surgical outcomes of lateral skull base (LSB) procedures in a pediatric population. STUDY DESIGN Retrospective case review in a referral skull base center. METHODS Charts of pediatric patients who underwent defined LSB procedures from 1983 to 2015 for various pathologies were evaluated at our center. A systematic review of literature was performed and our results were compared with the literature. RESULTS 63 patients presented with 65 diseased ears. The mean age was 13 years. 29 (44.6%) presented with hearing loss and 28 (44.4%) and chronic otorrhea. The most common pathology was petrous bone cholesteatoma (27, 42.5%) followed by vestibular schwannoma (10, 15.8%). Subtotal petrosectomy (24, 35.8%) was the most common surgical procedure followed by, transotic (18, 26.8%). The facial nerve function was preserved in 45 (67.1%) and the hearing in 28 (41.7%) cases respectively. No major complications, including mortality was encountered in our series. CONCLUSION In rare and extensive pathologies involving the skull base in a pediatric population, the surgeon is posed with the dilemma of trying to achieve facial and hearing preservation while dealing with total tumor clearance. Mastery over LSB procedures can ensure complete disease clearance with optimal functional outcomes. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Golda Grinblat
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy.
| | | | - Andrea Fulcheri
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Melissa Laus
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Alessandra Russo
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Mario Sanna
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
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11
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Levi E, Bekhit EK, Berkowitz RG. Magnetic Resonance Imaging Findings in Children With Tinnitus. Ann Otol Rhinol Laryngol 2014; 124:126-31. [DOI: 10.1177/0003489414546605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Tinnitus in adults is generally investigated by contrast-enhanced magnetic resonance imaging (MRI) to rule out the diagnosis of acoustic neuroma. Acoustic neuroma is rare in children and, therefore, the role of MRI in children with tinnitus is unclear. This study was undertaken to determine the value of MRI in the investigation of tinnitus in children. Methods: Retrospective study of children younger than 18 years who underwent MRI for the investigation of tinnitus over a 10-year period. Results: Sixty-five patients were identified, but there were only 34 who had also undergone audiologic assessment. Among the 25 patients with normal audiology, MRI abnormalities were present in 9, but these were all thought to be nonspecific. Nine patients had abnormal audiograms and the MRI was abnormal in 4 of these cases, which included 3 children who were found to have multiple sclerosis. Conclusion: Magnetic resonance imaging would appear to be mandatory in the investigation of tinnitus in children who are found to have sensorineural hearing loss, particularly to rule out the diagnosis of multiple sclerosis. Although our study does not support the routine use of MRI in children with normal audiology, the numbers in our series are too small for a conclusive recommendation.
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Affiliation(s)
- Eric Levi
- Department of Otolaryngology, Royal Children’s Hospital Melbourne, Victoria, Australia
| | - Elhamy K. Bekhit
- Department of Medical Imaging, Royal Children’s Hospital Melbourne, Victoria, Australia
- Department of Radiology, The University of Melbourne, Melbourne, Australia
| | - Robert G. Berkowitz
- Department of Otolaryngology, Royal Children’s Hospital Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, The University of Melbourne, Melbourne, Australia
- Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
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González del Pino B, Femia P, Pérez-Fernández N. Vestibular Examination of Children With Alterations in Balance (II): Results by Pathologies. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.otoeng.2011.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Sriskandan N, Connor S. The role of radiology in the diagnosis and management of vestibular schwannoma. Clin Radiol 2011; 66:357-65. [DOI: 10.1016/j.crad.2010.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 10/25/2010] [Accepted: 10/28/2010] [Indexed: 10/18/2022]
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González del Pino B, Femia P, Pérez-Fernández N. [Vestibular examination of children with alterations in balance (II): results by pathologies]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011; 62:385-91. [PMID: 21353187 DOI: 10.1016/j.otorri.2011.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 12/29/2010] [Accepted: 01/03/2011] [Indexed: 11/29/2022]
Abstract
We review the findings of vestibular examinations in children according to disease. Just as in adults, the dizziness can be classified following a physiopathological scheme.
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Abstract
The authors discuss the current management for cerebellopontine angle (CPA) tumors in children. CPA tumors accounted for 1% to 3% of intracranial tumors in children. There had been much controversy with the management of these tumors. A total of 29 eligible patients were enrolled to the study and 5 patients had multiple lesions at diagnosis. Eight patients with tumors exclusively confined in the CPA. Sixteen patients with tumors occurred predominantly within CPA and 5 arising from the vicinity and growing mainly into the CPA. Twelve tumors were located in the right CPA (41%) and 5 (17%) on the left. Thirteen of the 29 patients developed hydrocephalus and 3 required placement of a shunt. Lesions of the CPAs were divided into those native to the angle and those extending to the angle from adjacent structures. Gross total removal was achieved in 9 cases, subtotal in 14, and 2 had biopsies only. Four patients were diagnosed with pontine glioma solely by magnetic resonance imaging without histologic confirmation. Two died soon after the operation. Ten patients died with a mortality rate of 34.5%. The median follow-up in this study was 38 months (range: 4 to 225 mo). The CPA is a rare location for lesions in children, with clear predominance on the right side. Although low-grade lesions are more frequent, the histology varies widely and is limited by the lack of radiologic-pathologic correlation.
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Mazzoni A, Dubey SP, Poletti AM, Colombo G. Sporadic acoustic neuroma in pediatric patients. Int J Pediatr Otorhinolaryngol 2007; 71:1569-72. [PMID: 17643497 DOI: 10.1016/j.ijporl.2007.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 06/08/2007] [Accepted: 06/10/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Sporadic acoustic neuroma, usually occur between the ages of 40 and 70 years, are very rare in children. We review the experiences of 10 cases of sporadic (non-NF2) acoustic neuromas in pediatric patients. METHOD During last 26 years 2000 skull base procedures were performed in the Otorhinolaryngology Unit of the Ospedali Riuniti di Bergamo. Among these almost 900 cases were acoustic neuromas. Only 10 were at or under the age of 18 years. RESULTS The age of the youngest patient in our series was 12 years. Deafness were the commonest presentation and were seen in eight patients. It varied between 10 and 65 dB sensorineural hearing loss. Among these eight cases, two patients have sudden onset of hearing loss. Two patients presented with dizziness. The duration of complaints were between 2 months and 5 years in these patients. The diameter of the tumors varied widely with minimum of 10 mm to maximum up to 60 mm. Five patients each underwent resection of the tumor by translabyrinthine and retrosigmoid approach, respectively. The minimum postoperative follow-up was 3 years and maximum was 22 years in our series. Postoperatively seven cases the facial nerve recovered to grade I, and one each to grade II and grade VI of House-Brackmann classification. All five cases who underwent retrosigmoid approach had moderate (40 dB) to total sensorineural hearing loss postoperatively. The youngest patient with largest tumor diameter of 60 mm developed transient hemiparesis in the immediate postoperative period and he recovered fully in due course. CONCLUSION We found preservation of facial nerve function is more easier than hearing in this group of patients.
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Affiliation(s)
- Antonio Mazzoni
- Department of Otorhinolaryngology, Istituto Clinico Humanitas, IRCCS, Rozzano, Milano, Italy
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Mirzayan MJ, Gerganov VM, Lüdemann W, Oi S, Samii M, Samii A. Management of vestibular schwannomas in young patients-comparison of clinical features and outcome with adult patients. Childs Nerv Syst 2007; 23:891-5. [PMID: 17384953 DOI: 10.1007/s00381-007-0308-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Indexed: 10/23/2022]
Abstract
OBJECTS Vestibular schwannomas (VS) in young patients are rare. They are regarded to have different biological characteristics. Our objective is to analyze a series of such patients, with respect to their clinical presentation, treatment, and outcome and to compare the results to a matched series of adult patients. MATERIALS AND METHODS Retrospective analysis of 20 patients under 21 years of age. All patients underwent surgery via the retrosigmoid approach. The analysis included: age, gender, tumor size, clinical, and neurological pre- and postoperative status including cochlear and facial nerve function, and complications. Statistical comparison of the young patient's data with a series of 200 adult patients previously published by the authors. CONCLUSIONS The current study demonstrates that the outcome after surgical management in patients harboring VS does not show any significant difference between young and adult patients.
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Affiliation(s)
- M Javad Mirzayan
- Department of Neurosurgery, Medizinische Hchschule Hannover, Hannover, Germany
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Abstract
BACKGROUND Cerebellopontine angle (CPA) lesions are more commonly found in adults in which they account for 5-10% of all intracranial tumors. However, they are uncommon in children, with an incidence of only 1%. MATERIALS AND METHODS This is a review of the management of CPA lesions in children admitted to the Hospital Nacional de Pediatría "Profesor Doctor Juan P. Garrahan" (Argentine National Pediatrics Hospital "Professor Juan P. Garrahan") between January 1988 and December 2003. RESULTS The series included 30 children with 33 CPA lesions, 20 arising from the subarachnoid space of the CPA and 13 from the vicinity and growing mainly into the CPA. Twenty-seven tumors were located in the left CPA (82%) and six (12%), on the right. Ten of the 30 patients developed hydrocephalus, but only three of these required treatment. All patients underwent retrosigmoid suboccipital craniotomy and microsurgical resection. Gross total removal was achieved in 12 cases, subtotal in 18, and fenestration of the cyst wall in the three arachnoid cysts. Ten patients have no sequelae, ten have mild deficit, three have severe deficits, and seven have died. CONCLUSION The CPA is a rare location for lesions in children, with clear predominance on the left side. Benign lesions are more frequent. Even though schwannoma is the most frequently found lesion, the histology varies widely.
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Affiliation(s)
- Graciela Zúccaro
- Department of Neurosurgery, Hospital Nacional de Pediatria Juan P. Garrahan, Buenos Aires, Argentina.
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Cunningham CD, Friedman RA, Brackmann DE, Hitselberger WE, Lin HW. Neurotologic skull base surgery in pediatric patients. Otol Neurotol 2005; 26:231-6. [PMID: 15793410 DOI: 10.1097/00129492-200503000-00017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Innovations in diagnosis, surgical techniques, and perioperative care have dramatically improved outcomes in lateral skull base procedures in recent years. There is a belief, however, that children with skull base tumors have yet to benefit from these technological and procedural advances. The purpose of this study is to provide a clinical review of neurotologic skull base surgery in the pediatric population. STUDY DESIGN Retrospective case review. SETTING Private practice tertiary referral center. PATIENTS Eighty-nine pediatric patients undergoing 115 neurotologic procedures for lateral skull base tumors from July 1992 to September 2003. MAIN OUTCOME MEASURES Initial clinical presentation, tumor type, pre- and postoperative hearing and facial nerve status, treatment course, complications, and functional outcomes. RESULTS The majority of tumors in this series were vestibular schwannomas, and 65 patients were diagnosed with neurofibromatosis Type 2. Surgical approaches included 70 middle fossa, 40 translabyrinthine, 2 transcochlear, 2 infratemporal fossa, and 1 retrosigmoid craniotomy. Complete tumor removal was accomplished in the majority of cases (97%), with good preservation of facial nerve function (House-Brackmann Grade I or II) in 80% of patients. In patients undergoing middle fossa surgery for hearing preservation, measurable hearing was preserved in 61.4% of cases. The incidence of complications was low. CONCLUSION With advances in diagnostic procedures and use of current neurotologic techniques, pediatric patients may undergo successful treatment of lateral skull base tumors, with good functional outcomes and minimal morbidity.
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Rodriguez-Casero MV, Mandelstam S, Kornberg AJ, Berkowitz RG. Acute tinnitus and hearing loss as the initial symptom of multiple sclerosis in a child. Int J Pediatr Otorhinolaryngol 2005; 69:123-6. [PMID: 15627460 DOI: 10.1016/j.ijporl.2004.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Revised: 08/10/2004] [Accepted: 08/13/2004] [Indexed: 11/18/2022]
Abstract
Acute hearing loss with or without tinnitus has been reported in a number of adult series of multiple sclerosis (MS), but is considered a rare phenomenon. It generally occurs during disease exacerbations, rather than as an isolated finding or presenting feature. We present the case of an 11-year-old girl in whom persistent tinnitus and reversible hearing loss were the sole manifestation of MS at initial presentation.
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Abstract
A 13-month-old cochlear implant recipient underwent routine device activation. Three months postoperatively, the patient sustained a fall with contact to the area of the implant without immediate complication. Ten months postoperatively, the position of the external coil appeared to have moved and the patient did not seem to be responding as well to sound. Audiological testing could not elicit normal device impedances. AP and lateral plain radiographs of the skull revealed migration of the internal magnet from its position within the internal coil to a position over the receiver/stimulator. This is the first known published case of cochlear implant magnet migration.
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Affiliation(s)
- Eric P Wilkinson
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
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