1
|
Mahboubi H, Slattery WH, Miller ME, Lekovic GP. Comparison of Surgeons' Assessment of the Extent of Vestibular Schwannoma Resection with Immediate Post Operative and Follow-Up Volumetric MRI Analysis. Brain Sci 2023; 13:1490. [PMID: 37891857 PMCID: PMC10605232 DOI: 10.3390/brainsci13101490] [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: 09/23/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Incomplete excision of vestibular schwannomas (VSs) is sometimes preferable for facial nerve preservation. On the other hand, subtotal resection may be associated with higher tumor recurrence. We evaluated the correlation between intra-operative assessment of residual tumor and early and follow-up imaging. (2) Methods: The charts of all patients undergoing primary surgery for sporadic vestibular schwannoma during the study period were retrospectively reviewed. Data regarding surgeons' assessments of the extent of resection, and the residual size of the tumor on post-operative day (POD) one and follow-up MRI were extracted. (3) Results: Of 109 vestibular schwannomas meeting inclusion criteria, gross-total resection (GTR) was achieved in eighty-four, near-total (NTR) and sub-total resection (STR) in twenty-two and three patients, respectively. On follow up imaging, volumetric analysis revealed that of twenty-two NTRs, eight were radiographic GTR and nine were radiographic STR (mean volume ratio 11.9%), while five remained NTR (mean volume ratio 1.8%). Of the three STRs, two were radiographic GTR while one remained STR. Therefore, of eighteen patients with available later follow up MRIs, radiographic classification of the degree of resection changed in six. (4) Conclusions: An early MRI (POD#1) establishes a baseline for the residual tumor that may be more accurate than the surgeon's intraoperative assessment and may provide a beneficial point of comparison for long-term surveillance.
Collapse
Affiliation(s)
| | | | - Mia E. Miller
- House Institute, Los Angeles, CA 90057, USA
- Cedars-Sinai Hospital, Los Angeles, CA 90048, USA
| | - Gregory P. Lekovic
- House Institute, Los Angeles, CA 90057, USA
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA
| |
Collapse
|
2
|
Evaluating growth trends of residual sporadic vestibular schwannomas: a systematic review and meta-analysis. J Neurooncol 2022; 159:135-150. [PMID: 35761159 DOI: 10.1007/s11060-022-04051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/30/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Gross total resection remains the gold-standard approach for vestibular schwannomas (VS) when surgery is indicated. In select cases, incomplete resection (IR) becomes a desired alternative to preserve the facial nerve function and the patient's quality of life. While a lot of earlier studies described incompletely resected sporadic VSs as dormant, more recent studies reported a higher growth rate following IR, therefore an evaluation of the residual VS growth rates could have important implications for the follow-up treatment protocols and provide relevant information for neurosurgeons, neuro-otologists, neuropathologists, and radiologists. Although prognostic factors predicting preoperative VS growth have been previously investigated, these factors have not been investigated following IR. Our review aims to examine the growth rate of residual sporadic VS following IR and to examine variables associated with the regrowth of residual VS. METHODS The review was conducted in accordance with the PRISMA guidelines. Six databases (MEDLINE (Ovid), Embase (Ovid), CINAHL Plus (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry Platform and UK Clinical Trials Gateway (WHO ICTRP) were searched. Full-text articles analysing growth rates in at least ten patients who had residual VS after IR were assessed. We conducted a meta-analysis using a random-effects model via RevMan. RESULTS 14 studies totalling 849 patients were included in the analysis. The mean planimetric growth rate was 1.57 mm/year (range 0.16-3.81 mm/year). The mean volumetric growth rate was 281.725 mm3/year (range 17.9-530.0 mm3/year). Age, sex, pre-operative tumour size/volume, cystic tumour sub-type, MIB-1 index, and intracanalicular tumour location were not associated with residual growth. Residual tumour size/volume was statistically significant to growth (OR = 0.65, 95% CI 0.47-0.90, p = 0.01). Radiological re-growth occurred in an average of 26.6% of cases (range 0-54.5%). CONCLUSION From our analysis, only the residual tumour volume/size was associated with residual VS growth. Therefore, close postoperative surveillance for the first year, followed by an annual MRI scan for at least 5 years, and subsequently extended interval surveillance remains of utmost importance to monitor disease progression and provide timely surgical and adjuvant interventions. Our study shows that future work should be aimed at molecular and histological characteristics of residual VSs to aid prognostic understanding of growth.
Collapse
|
3
|
de Boer NP, Böhringer S, Koot RW, Malessy MJA, van der Mey AGL, Jansen JC, Hensen EF. A prediction model for recurrence after translabyrinthine surgery for vestibular schwannoma: toward personalized postoperative surveillance. Eur Arch Otorhinolaryngol 2022; 279:2905-2913. [PMID: 35020036 PMCID: PMC9072472 DOI: 10.1007/s00405-021-07244-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022]
Abstract
Purpose The aim of this study is to compute and validate a statistical predictive model for the risk of recurrence, defined as regrowth of tumor necessitating salvage treatment, after translabyrinthine removal of vestibular schwannomas to individualize postoperative surveillance. Methods The multivariable predictive model for risk of recurrence was based on retrospectively collected patient data between 1995 and 2017 at a tertiary referral center. To assess for internal validity of the prediction model tenfold cross-validation was performed. A ‘low’ calculated risk of recurrence in this study was set at < 1%, based on clinical criteria and expert opinion. Results A total of 596 patients with 33 recurrences (5.5%) were included for analysis. The final prediction model consisted of the predictors ‘age at time of surgery’, ‘preoperative tumor growth’ and ‘first postoperative MRI outcome’. The area under the receiver operating curve of the prediction model was 89%, with a C-index of 0.686 (95% CI 0.614–0.796) after cross-validation. The predicted probability for risk of recurrence was low (< 1%) in 373 patients (63%). The earliest recurrence in these low-risk patients was detected at 46 months after surgery. Conclusion This study presents a well-performing prediction model for the risk of recurrence after translabyrinthine surgery for vestibular schwannoma. The prediction model can be used to tailor the postoperative surveillance to the estimated risk of recurrence of individual patients. It seems that especially in patients with an estimated low risk of recurrence, the interval between the first and second postoperative MRI can be safely prolonged.
Collapse
Affiliation(s)
- Nick P de Boer
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Stefan Böhringer
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Radboud W Koot
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn J A Malessy
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Andel G L van der Mey
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Jeroen C Jansen
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| |
Collapse
|
4
|
Yang JX, Aygun N, Nadgir RN. Imaging of the Postoperative Skull Base and Cerebellopontine Angle. Neuroimaging Clin N Am 2021; 32:159-174. [PMID: 34809836 DOI: 10.1016/j.nic.2021.08.005] [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: 10/19/2022]
Abstract
For pathologic conditions affecting the skull base and cerebellopontine angle, imaging techniques have advanced to assess for residual disease, disease progression, and postoperative complications. Knowledge regarding various surgical approaches of skull base tumor resection, expected postoperative appearance, and common postsurgical complications guides radiologic interpretation. Complexity of skull base anatomy, small size of the relevant structures, lack of familiarity with surgical techniques, and postsurgical changes confound radiologic evaluation. This article discusses the imaging techniques, surgical approaches, expected postoperative changes, and complications after surgery of the skull base, with emphasis on the cerebellopontine angle, anterior cranial fossa, and central skull base regions.
Collapse
Affiliation(s)
- Jeffrey Xi Yang
- Division of Neuroradiology, Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Nafi Aygun
- Division of Neuroradiology, Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Rohini Narahari Nadgir
- Division of Neuroradiology, Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA.
| |
Collapse
|
5
|
Postoperative MRI Surveillance of Vestibular Schwannomas: Is There a Standard of Care? Otol Neurotol 2020; 41:265-270. [DOI: 10.1097/mao.0000000000002501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
6
|
Ultra Long-Term Audiometric Outcomes in the Treatment of Vestibular Schwannoma With the Middle Cranial Fossa Approach. Otol Neurotol 2019; 39:e151-e157. [PMID: 29315191 DOI: 10.1097/mao.0000000000001678] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Define the long-term audiometric outcomes of vestibular schwannomas treated using the middle cranial fossa (MCF) approach. STUDY DESIGN Retrospective records review. SETTING University-based tertiary referral center. PATIENTS Patients undergoing treatment of small vestibular schwannomas using the MCF approach. INTERVENTION(S) MCF exposure and treatment of small vestibular schwannomas. MAIN OUTCOME MEASURE(S) Demographic and audiometric variables were assessed. RESULTS Thirteen subjects demonstrated audiometric data for review. The average time between surgery and the most recent audiometric testing was 14 years (range 10-18 yr). The mean baseline pure-tone average (PTA) was 36 dB HL and the most recent PTA was 59 dB HL in the operated ear. The mean baseline PTA was 16 dB HL and the most recent PTA was 37 dB HL in the nonoperated ear. The mean change from baseline to most recent follow-up was a threshold elevation of 22 and 19 dB HL in the operated and nonoperated ears, respectively. The mean baseline speech discrimination score (SDS) was 83% and the most recent SDS was 73% in the operated ear. The mean baseline SDS was 98% and the most recent SDS was 94% in the nonoperated ear. The mean changes from baseline to most recent follow-up were 10 and 0% SDS depression in the operated and nonoperated ears, respectively. The rates of changes in PTA and SDS were not statistically different between the operated and nonoperated ears. CONCLUSIONS Surgically preserved hearing is maintained in the majority of patients more than 10 years following surgery. PTA and SDS changes were similar between the ipsilateral and contralateral ears.
Collapse
|
7
|
Hulsbergen AFC, Muskens IS, Gormley WB, Broekman MLD. Unnecessary Diagnostics in Neurosurgery: Finding the Ethical Balance. World Neurosurg 2019; 125:527-528. [PMID: 31500070 DOI: 10.1016/j.wneu.2019.02.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Alexander F C Hulsbergen
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ivo S Muskens
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, Los Angeles, California, USA
| | - William B Gormley
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marike L D Broekman
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Haaglanden Medical Center, The Hague, Zuid-Holland, The Netherlands; Department of Neurosurgery, Haga Teaching Hospital, The Hague, Zuid-Holland, The Netherlands; Department of Neurosurgery, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| |
Collapse
|
8
|
Kamal N, Reddy RK, Kohli G, Lee HJ, Ying YLM, Jyung RW, Liu JK. The Role of Fast Imaging Employing Steady-State Acquisition (FIESTA) Magnetic Resonance Imaging for Assessment of Delayed Enhancement of Fat Graft Packing on Postoperative Imaging After Vestibular Schwannoma Surgery. World Neurosurg 2018; 114:e1066-e1072. [PMID: 29605696 DOI: 10.1016/j.wneu.2018.03.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the role and efficacy of fast imaging employing steady-state acquisition (FIESTA) imaging in distinguishing fat graft enhancement from residual or recurrent tumor after vestibular schwannoma (VS) surgery. METHODS A retrospective study of 33 patients who underwent VS resection via the retrosigmoid or translabyrinthine approach with fat graft reconstruction was performed. Magnetic resonance imaging (MRI) was collected at different time points: preoperative, immediate postoperative (24-48 hours), delayed postoperative (3-6 months after surgery), and yearly postoperative. The image sets contained T1, T2, fat-suppressed T1-weighted with gadolinium, and FIESTA. The radiographs were analyzed for tumor recurrence by the primary neurosurgeon and an independent blinded neuroradiologist. If fat-suppressed T1-weighted images demonstrated postoperative enhancement in the resection bed, a comparison was made with FIESTA imaging. RESULTS At 3-6 months postoperatively and at 1 year and beyond, 28 (84.8%) and 33 (100%) of patients, respectively, displayed delayed enhancement of the fat graft on postgadolinium fat-suppressed T1-weighted MRI. The enhancement seen on postgadolinium, fat-suppressed, T1-weighted MRI consistently correlated with the characteristic fat graft signal on FIESTA imaging and not tumor recurrence. FIESTA imaging was able to distinguish residual tumor from enhancing fat graft compared with postgadolinium, fat-suppressed, T1-weighted MRI (P < 0.0001) due to distinctive signaling patterns. CONCLUSIONS FIESTA is an effective tool in discerning fat graft enhancement from residual or recurrent tumor on delayed postoperative imaging after VS resection. Fat graft used in reconstruction consistently enhances on delayed postoperative postgadolinium, fat-suppressed, T1-weighted imaging, which correlates with the fat graft signal seen on FIESTA images.
Collapse
Affiliation(s)
- Naveed Kamal
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Renuka K Reddy
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Gurkirat Kohli
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Huey-Jen Lee
- Department of Radiology, 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; Center for Skull Base and Pituitary Surgery, Rutgers Neurological Institute of New Jersey, Newark, New Jersey, USA
| | - Robert W Jyung
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Center for Skull Base and Pituitary Surgery, Rutgers Neurological Institute of New Jersey, Newark, New Jersey, USA
| | - James K Liu
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Center for Skull Base and Pituitary Surgery, Rutgers Neurological Institute of New Jersey, Newark, New Jersey, USA.
| |
Collapse
|
9
|
Optimal outcomes for hearing preservation in the management of small vestibular schwannomas. The Journal of Laryngology & Otology 2016; 130:606-10. [DOI: 10.1017/s0022215116007969] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To undertake a systematic review of the role of microsurgery, in relation to observation and stereotactic radiation, in the management of small vestibular schwannomas with serviceable hearing.Methods:The Medline database was searched for publications that included the terms ‘vestibular schwannoma’ and/or ‘acoustic neuroma’, occurring in conjunction with ‘hearing’. Articles were manually screened to identify those concerning vestibular schwannomas under 1.5 cm in greatest dimension. Thereafter, only publications discussing both pre-operative and post-operative hearing were considered.Results:Twenty-six papers were identified. Observation is an acceptable strategy for small tumours with slow growth where hearing preservation is not a consideration. In contrast, microsurgery, including the middle fossa approach, may provide excellent hearing outcomes, particularly when a small tumour has begun to cause hearing loss. Immediate post-operative hearing usually predicts long-term hearing. Recent data on stereotactic radiation suggest long-term deterioration of hearing following definitive therapy.Conclusion:In patients under the age of 65 years with small vestibular schwannomas, microsurgery via the middle fossa approach offers durable preservation of hearing.
Collapse
|
10
|
Carlson ML, Van Abel KM, Driscoll CL, Neff BA, Beatty CW, Lane JI, Castner ML, Lohse CM, Link MJ. Magnetic resonance imaging surveillance following vestibular schwannoma resection. Laryngoscope 2012; 122:378-88. [PMID: 22252688 DOI: 10.1002/lary.22411] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/17/2011] [Accepted: 09/20/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe the incidence, pattern, and course of postoperative enhancement within the operative bed using serial gadolinium-enhanced magnetic resonance imaging (MRI) following vestibular schwannoma (VS) resection and to identify clinical and radiologic variables associated with recurrence. STUDY DESIGN Retrospective cohort study. METHODS All patients who underwent microsurgical resection of VS between January 2000 and January 2010 at a single tertiary referral center were reviewed. Postoperative enhancement patterns were characterized on serial MRI studies. Clinical follow-up and outcomes were recorded. RESULTS During the last 10 years, 350 patients underwent microsurgical VS resection, and of these, 203 patients met study criteria (mean radiologic follow-up, 3.5 years). A total of 144 patients underwent gross total resection (GTR), 32 received near-total resection (NTR), and the remaining 27 underwent subtotal resection (STR); 98.5% of patients demonstrated enhancement within the operative bed following resection (58.5% linear, 41.5% nodular). Stable enhancement patterns were seen in 24.5% of patients, regression in 66.0%, and resolution in only 3.5% of patients on the most recent postoperative MRI. Twelve patients recurred a mean of 3.0 years following surgery. The average maximum linear diameter growth rate among recurrent tumors was 2.3 mm per year. Those receiving STR were more than nine times more likely to experience recurrence compared to those undergoing NTR or GTR (P < .001). Nodular enhancement on the initial postoperative MRI was associated with a 16-fold increased risk for future recurrence compared to those with linear patterns (P = .008). Among those with nodular enhancement on baseline postoperative MRI, a maximum linear diameter of ≥ 15 mm or volume of ≥ 0.4 cm(3) was associated with an approximate five-fold increased risk for future growth (P < .02). CONCLUSIONS Persistent nonspecific radiologic enhancement within the postoperative field is common, making the diagnosis of tumor recurrence challenging. Factors including completeness of resection and baseline postoperative MRI findings provide valuable information regarding risk for recurrence, which may assist the clinician in determining an appropriate postoperative MRI surveillance schedule. Future studies using standardized terminology and consistent study metrics are needed to further refine surveillance recommendations.
Collapse
Affiliation(s)
- Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota 55905, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Carlson ML, Van Abel KM, Schmitt WR, Driscoll CLW, Neff BA, Lane JI, Link MJ. Nodular enhancement within the internal auditory canal following retrosigmoid vestibular schwannoma resection: a unique radiological pattern. J Neurosurg 2011; 115:835-41. [DOI: 10.3171/2011.6.jns11772] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors describe the unique occurrence of nodular enhancement within the fundus of the internal auditory canal (IAC) lateral to the preoperative radiological tumor margin following gross-total vestibular schwannoma (VS) resection.
Methods
The nature of the study was a retrospective chart review of records. The authors reviewed the cases of all patients who underwent microsurgical resection of a VS between January 2000 and January 2010 at a single tertiary referral center. Patients with incomplete resection, neurofibromatosis Type 2, and those with fewer than 2 postoperative MR images available for review were excluded.
Postsurgical patients with IAC enhancement located lateral to the preoperative imaging–delineated tumor margin were identified. Lesion morphology was characterized on serial MR imaging studies. Clinical follow-up and outcomes were recorded.
Results
Over the past decade, 350 patients underwent microsurgical VS resection. Of these, 16 patients met study criteria and were found to have postsurgical enhancement in the distal aspect of the IAC lateral to the imaging limits of the preoperative tumor margin on the first postoperative MR imaging study (37.5% women, median age 45 years). Initial MR imaging was performed at a mean of 3.1 months following surgery, and the mean radiological follow-up duration was 39.8 months (range 16.4–101.9 months). None of the 16 patients developed recurrence during the follow-up course.
Conclusions
In contrast to previous publications that have reported a high rate of recurrence in cases involving nodular enhancement within the original tumor bed, postoperative enhancement in the IAC lateral to the original tumor margin appears to carry much less risk for tumor recurrence. These findings may be helpful when counseling patients on the recommended frequency of postoperative follow-up imaging.
Collapse
Affiliation(s)
| | | | | | - Colin L. W. Driscoll
- 1Departments of Otolaryngology Head and Neck Surgery,
- 3Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Brian A. Neff
- 1Departments of Otolaryngology Head and Neck Surgery,
| | | | - Michael J. Link
- 1Departments of Otolaryngology Head and Neck Surgery,
- 3Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
| |
Collapse
|
12
|
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]
|
13
|
Ozgen B, Oguz B, Dolgun A. Diagnostic accuracy of the constructive interference in steady state sequence alone for follow-up imaging of vestibular schwannomas. AJNR Am J Neuroradiol 2009; 30:985-91. [PMID: 19193761 DOI: 10.3174/ajnr.a1472] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vestibular schwannoma (VS) is a benign, slow-growing tumor, and radiologic monitoring is an acceptable alternative to surgery in small lesions and in elderly patients. MR imaging with contrast is the study of choice in the follow-up of these lesions. However, gadolinium-based contrast agents have side effects and should be used only when definitely indicated. The purpose of this study was to evaluate the diagnostic accuracy of the constructive interference in steady state (CISS) sequence used without postcontrast sequences for the follow-up imaging of VS. MATERIALS AND METHODS MR imaging examinations of 18 patients were retrospectively evaluated by 2 radiologists. VS masses were measured on both CISS and the postcontrast images by each observer. For each patient, the masses were also assessed qualitatively for possible progression between every consecutive study. RESULTS Fifty MR images of 18 patients were evaluated. Patients had 1-5 follow-up studies. The mean time interval between the consecutive studies was 23 months (6-55 months). The sensitivity, specificity, and accuracy of the CISS sequence for the detection of progression were 100%. There was good interobserver and intraobserver (CISS and postcontrast) correlation. The CISS sequence had, however, limited sensitivity for the detection of changes in the internal architecture. CONCLUSIONS Noncontrast CISS-only technique may be a viable alternative to routine contrast-enhanced sequences for the follow-up of overall lesion size in patients with VS; however, treatment-related changes internal to the tumor are less noticeable using the CISS sequence.
Collapse
Affiliation(s)
- B Ozgen
- Department of Radiology, Hacettepe University, Faculty of Medicine, Sihhiye, Ankara, Turkey.
| | | | | |
Collapse
|
14
|
Koh ES, Millar BA, Ménard C, Michaels H, Heydarian M, Ladak S, McKinnon S, Rutka JA, Guha A, Pond GR, Laperriere NJ. Fractionated stereotactic radiotherapy for acoustic neuroma. Cancer 2007; 109:1203-10. [PMID: 17318817 DOI: 10.1002/cncr.22499] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The clinical outcome and toxicity of fractionated stereotactic radiotherapy (FSRT) was assessed for acoustic neuroma in 60 patients treated in a single institution. METHODS Between October 1996 and February 2005, 60 patients received FSRT for acoustic neuroma (AN). The mean total dose applied was 50 Gy in single daily 2-Gy fractions over 5 weeks. The median irradiated tumor volume was 4.9 cm(3) (range, 0.3-49.0 cm(3)). The median follow-up period was 31.9 months. RESULTS FSRT was well tolerated in all patients. The 5-year actuarial local control rate was 96.2% (95% CI: 91.1%-100.0%). Five-year actuarial progression-free survival was 92.8% (95% CI: 84.8%-100.0%). The overall hearing preservation rate was 77.3%. Five of 6 patients with initial cranial nerve V (CNV) numbness remained stable post-FSRT. Two of 3 patients with baseline trigeminal neuralgia improved with the remaining patient stable. All 3 patients with nonsurgically related facial nerve weakness either improved or achieved stability in function. There were no cases of new cranial nerve toxicity post-FSRT. CONCLUSIONS FSRT for the treatment of AN is safe, effective, and well tolerated. FSRT should thus be considered as an effective alternative treatment modality when compared with microsurgical resection or single fraction stereotactic radiosurgery.
Collapse
Affiliation(s)
- Eng-Siew Koh
- Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
|