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Moshtaghi O, Dixon PR, Claussen AD, La Monte O, Tadano A, Gillette D, Tawfik K, Schwartz MS, Friedman RA. The Effect of Immediate Microsurgical Resection of Vestibular Schwannoma on Hearing Preservation. Otol Neurotol 2023; 44:600-604. [PMID: 37205868 DOI: 10.1097/mao.0000000000003893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Evaluate for differences in postoperative hearing in patients who undergo immediate versus delayed hearing preservation microsurgical resection of vestibular schwannomas (VS). STUDY DESIGN Retrospective single-institution cohort study spanning November 2017 to November 2021. SETTING Single-institution tertiary care hospital. PATIENTS Sporadic VS in patients with American Academy of Otolaryngology-Head and Neck Surgery hearing classification A or B, with tumor size less than or equal to 2 cm and undergoing hearing preservation microsurgical resection. INTERVENTIONS Delayed surgical intervention defined by time from first diagnostic MRI to date of surgery being greater than 3 months. MAIN OUTCOME MEASURES Preoperative and postoperative audiometric performance. RESULTS In total, 193 patients met inclusion criteria. Within the cohort, 70 (36%) proceeded with surgery within 3 months of diagnostic MRI with a mean observation time of 62 days, whereas 123 (63%) underwent surgery after 3 months with a mean observation time of 301 days. There was no difference in preoperative hearing between the two groups with word recognition score 99% in early intervention group and 100% in delayed intervention group ( p = 0.6). However, 64% of those who proceeded with immediate surgery had successful hearing preservation, compared to a 42% of those who had delayed intervention ( p < 0.01). In a multivariable logistic regression accounting for preoperative word recognition score, tumor size, and age at diagnosis, the odds of hearing preservation were lower in those who delayed surgery compared to immediate surgery (odds ratio, 0.31; 95% confidence interval, 0.15-0.61). CONCLUSIONS Patients who underwent microsurgical resection within 3 months of diagnosis demonstrated a hearing preservation advantage compared to those who did not. Findings of this study highlight the counseling challenges associated with the timing of surgical treatment of VS in patients presenting with good preoperative hearing and small tumors.
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Affiliation(s)
- Omid Moshtaghi
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Peter R Dixon
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Alexander D Claussen
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Olivia La Monte
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Ashley Tadano
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Dominique Gillette
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Kareem Tawfik
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
| | - Marc S Schwartz
- Department of Neurological Surgery, University of California-San Diego, San Diego, California
| | - Rick A Friedman
- Department of Otolaryngology Head and Neck Surgery, University of California-San Diego, San Diego, California
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A 2 and 5-Year Longitudinal Analysis of 671 Consecutive Patients Diagnosed with Unilateral Vestibular Schwannoma. Otol Neurotol 2022; 43:702-708. [PMID: 35709433 DOI: 10.1097/mao.0000000000003536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse the 2 and 5-year outcomes of a cohort of patients with newly diagnosed vestibular schwannoma patients. STUDY DESIGN Longitudinal cohort study. SETTING Tertiary skull base referral unit. PATIENTS Six hundred and seventy-one consecutive patients referred to the Cambridge Skull Base Unit between 2005 and 2010. MAIN OUTCOME MEASURES 1) Treatment outcomes, 2) hearing preservation, 3) facial nerve function, and 4) gross tumor control. RESULTS At initial diagnosis, 440/671(65.6%) of patients entered a watch, wait and rescan (WWR) pathway, 208/671 (31%) underwent primary microsurgical excision and 23/671 (3.4%) primary radiotherapy. Of patients who entered WWR, 144/440 (32.7%) exhibited tumor growth necessitating secondary intervention at a mean of 22.7 months; 67.4% had radiotherapy and 32.6% surgery. Radiotherapy was successful at achieving tumor control in 95% of cases. Primary surgery via the translabyrinthine route was performed in the majority of cases allowing for a radiologically clear surgical resection in 93% of cases. CONCLUSION The Cambridge philosophy of treating the newly diagnosed vestibular schwannoma aims at preserving functional status where possible. In patients with small tumors it is recommended that they are placed on to a WWR pathway, of which 67.3% will not exhibit any growth by 5 years. If small tumors grow more than 2 mm by serial scanning, radiotherapy offers a high rate of tumor control. In patients with larger tumors more than 20 mm we would advocate microsurgical excision by the translabyrinthine route which offers excellent functional outcomes and gross tumor control.
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Abstract
OBJECTIVE To characterize the natural history of hearing loss for patients presenting with serviceable hearing (SH) who undergo a wait-and-scan approach for sporadic vestibular schwannoma (VS) using aggregate time-to-event survival analysis. STUDY DESIGN Systematic review. SETTING Published international English literature, January 1, 2000 to May 31, 2020. PATIENTS Patients with sporadic VS entering a wait-and-scan approach with SH at diagnosis. INTERVENTIONS Observation with serial MRI and audiometry. RESULTS In total, 3,652 patients from 26 studies were included for analysis. Mean age at diagnosis was 58.8 years (SD, 4.1). Mean follow-up was 49.2 months (SD, 26.5). In total, 755 patients (21%) failed conservative treatment and underwent radiosurgery or microsurgery at the time of last follow-up. The average loss to follow-up was 6.9% (SD, 11.1). A total of 1,674 patients had SH at the time of diagnosis. Survival rates for maintaining SH were 96% at 1 year, 77% at 3 years, 62% at 5 years, and 42% at 10 years following diagnosis. CONCLUSION In this systematic review, aggregate data from 3,652 patients across 26 studies show consistent patterns in progression of hearing loss during observation for patients with sporadic VS as a function of time. As an easy-toremember conservative benchmark for those presenting with SH at diagnosis: approximately 75% retain SH at 3 years, 60% at 5 years, and 40% at 10 years.
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Tosi U, Guadix S, An A, Wright D, Christos PJ, Pannullo S, Brandmaier A, Knisely JPS, Stieg PE, Ramakrishna R. Efficacy and comorbidities of hypofractionated and single-dose radiosurgery for vestibular schwannomas: a systematic review and meta-analysis. Neurooncol Pract 2021; 8:391-404. [PMID: 34277018 DOI: 10.1093/nop/npab009] [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] [Indexed: 11/13/2022] Open
Abstract
Background Vestibular schwannomas (VS) are tumors of the cerebellopontine angle with significant morbidity, causing hearing loss, tinnitus, and trigeminal and facial nerve compromise. An effective alternative to microsurgical resection is stereotactic radiosurgery (SRS), which can be delivered in either single-fraction (SRS) or hypofractionated stereotactic radiotherapy (hSRT) (3-5 treatments) regimens. It remains unclear which fractionation regimen provides superior outcomes. Methods Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Reviews were searched for studies either comparing hSRT with SRS or focusing on hSRT alone in treating VS. Primary endpoints included tumor control, serviceable hearing, tinnitus, and cranial nerve V and VII symptoms. A random-effects analysis was employed to compare pre- and post-treatment effects (hSRT alone) or SRS and hSRT outcomes (two-arm studies). Results This analysis included 21 studies focusing on hSRT alone and 13 studies comparing SRS and hSRT. Significant heterogeneity was observed. Overall, when hSRT was analyzed alone, crude tumor control was achieved in 94% (95% CI: 88%, 99%) of 1571 patients. There was no difference between pre- and post-treatment odds ratios (OR) of tinnitus, facial, or trigeminal impairment. Serviceable hearing was diminished following hSRT (OR = 0.60, 95% CI: 0.44, 0.83). Comparison with SRS showed no difference with respect to tumor control, serviceable hearing, trigeminal or facial nerve impairment. Conclusions hSRT achieved excellent tumor control and, with the exception of serviceable hearing, did not result in worse post-treatment cranial nerve symptomatology. Analysis of comparative studies between hSRT and SRS did not reveal any significant difference in either tumor control or treatment morbidities.
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Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Sergio Guadix
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Anjile An
- Division of Biostatistics and Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Drew Wright
- Samuel J. Woods Library, Weill Cornell Medicine, New York, New York, USA
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Susan Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Andrew Brandmaier
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
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5
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Ichimasu N, Kohno M, Nakajima N, Matsushima K, Tanaka Y, Tsukahara K, Inagaki T, Yoshino M, Nagata O. Long-term prognosis of preserved useful hearing after surgery in patients with vestibular schwannoma: a study of 91 cases. Acta Neurochir (Wien) 2020; 162:2619-2628. [PMID: 32803370 DOI: 10.1007/s00701-020-04523-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In patients with a vestibular schwannoma, some studies have reported that useful hearing preserved initially after surgery deteriorates gradually in the long term. Studies with more patients are needed to clarify the maintenance rate of postoperative hearing function and to identify prognostic of hearing function. METHOD Ninety-one patients (mean age, 39.5 years; mean tumor size, 18.9 mm) with preserved useful hearing immediately after surgery were retrospectively analyzed. The useful hearing was defined as the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classes A and B. Hearing tests, including auditory brainstem responses (ABR) and distortion product otoacoustic emissions (DPOAE), were evaluated preoperatively, immediately after surgery, and at outpatient follow-up. RESULTS At the final follow-up (mean, 63.0 months), the useful hearing was maintained in 79 patients (87%), and the hearing class remained unchanged during the follow-up period in 40 patients (44%). Significant predictors of useful hearing maintenance were AAO-HNS class A immediately after surgery, improvement of ABR, and the absence of postoperative DPOAE deterioration. Postoperative DPOAE deterioration correlated with hearing class deterioration. CONCLUSIONS Despite hearing being preserved in vestibular schwannoma patients immediately after surgery, Thirteen percent lost their useful hearing during the long follow-up period, and hearing class worsened in 55% of the patients. This study, which analyzed one of the largest series of vestibular schwannoma patients, demonstrated that retrocochlear condition is a key factor for useful hearing maintenance. In patients with vestibular schwannoma who have preserved hearing function, regular postoperative monitoring of hearing function is as important as regular MRI.
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6
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Zanoletti E, Mazzoni A, Martini A, Abbritti RV, Albertini R, Alexandre E, Baro V, Bartolini S, Bernardeschi D, Bivona R, Bonali M, Borghesi I, Borsetto D, Bovo R, Breun M, Calbucci F, Carlson ML, Caruso A, Cayé-Thomasen P, Cazzador D, Champagne PO, Colangeli R, Conte G, D'Avella D, Danesi G, Deantonio L, Denaro L, Di Berardino F, Draghi R, Ebner FH, Favaretto N, Ferri G, Fioravanti A, Froelich S, Giannuzzi A, Girasoli L, Grossardt BR, Guidi M, Hagen R, Hanakita S, Hardy DG, Iglesias VC, Jefferies S, Jia H, Kalamarides M, Kanaan IN, Krengli M, Landi A, Lauda L, Lepera D, Lieber S, Lloyd SLK, Lovato A, Maccarrone F, Macfarlane R, Magnan J, Magnoni L, Marchioni D, Marinelli JP, Marioni G, Mastronardi V, Matthies C, Moffat DA, Munari S, Nardone M, Pareschi R, Pavone C, Piccirillo E, Piras G, Presutti L, Restivo G, Reznitsky M, Roca E, Russo A, Sanna M, Sartori L, Scheich M, Shehata-Dieler W, Soloperto D, Sorrentino F, Sterkers O, Taibah A, Tatagiba M, Tealdo G, Vlad D, Wu H, Zanetti D. Surgery of the lateral skull base: a 50-year endeavour. ACTA ACUST UNITED AC 2019; 39:S1-S146. [PMID: 31130732 PMCID: PMC6540636 DOI: 10.14639/0392-100x-suppl.1-39-2019] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Disregarding the widely used division of skull base into anterior and lateral, since the skull base should be conceived as a single anatomic structure, it was to our convenience to group all those approaches that run from the antero-lateral, pure lateral and postero-lateral side of the skull base as “Surgery of the lateral skull base”. “50 years of endeavour” points to the great effort which has been made over the last decades, when more and more difficult surgeries were performed by reducing morbidity. The principle of lateral skull base surgery, “remove skull base bone to approach the base itself and the adjacent sites of the endo-esocranium”, was then combined with function preservation and with tailoring surgery to the pathology. The concept that histology dictates the extent of resection, balancing the intrinsic morbidity of each approach was the object of the first section of the present report. The main surgical approaches were described in the second section and were conceived not as a step-by-step description of technique, but as the highlighthening of the surgical principles. The third section was centered on open issues related to the tumor and its treatment. The topic of vestibular schwannoma was investigated with the current debate on observation, hearing preservation surgery, hearing rehabilitation, radiotherapy and the recent efforts to detect biological markers able to predict tumor growth. Jugular foramen paragangliomas were treated in the frame of radical or partial surgery, radiotherapy, partial “tailored” surgery and observation. Surgery on meningioma was debated from the point of view of the neurosurgeon and of the otologist. Endolymphatic sac tumors and malignant tumors of the external auditory canal were also treated, as well as chordomas, chondrosarcomas and petrous bone cholesteatomas. Finally, the fourth section focused on free-choice topics which were assigned to aknowledged experts. The aim of this work was attempting to report the state of the art of the lateral skull base surgery after 50 years of hard work and, above all, to raise questions on those issues which still need an answer, as to allow progress in knowledge through sharing of various experiences. At the end of the reading, if more doubts remain rather than certainties, the aim of this work will probably be achieved.
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Affiliation(s)
- E Zanoletti
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - A Mazzoni
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - A Martini
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - R V Abbritti
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | | | - E Alexandre
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - V Baro
- Academic Neurosurgery, Department of Neuroscience DNS, University of Padova Medical School, Padova, Italy
| | - S Bartolini
- Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - D Bernardeschi
- AP-HP, Groupe Hôspital-Universitaire Pitié-Salpêtrière, Neuro-Sensory Surgical Department and NF2 Rare Disease Centre, Paris, France.,Sorbonne Université, Paris, France
| | - R Bivona
- ENT and Skull-Base Surgery Department, Department of Neurosciences, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - M Bonali
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
| | - I Borghesi
- Neurosurgery, Maria Cecilia Hospital, Cotignola (RA), Italy
| | - D Borsetto
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - R Bovo
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - M Breun
- Department of Neurosurgery, Julius Maximilians University Hospital Würzburg, Bavaria, Germany
| | - F Calbucci
- Neurosurgery, Maria Cecilia Hospital, Cotignola (RA), Italy
| | - M L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - A Caruso
- Gruppo Otologico, Piacenza-Rome, Italy
| | - P Cayé-Thomasen
- The Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - D Cazzador
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy.,Department of Neuroscience DNS, Section of Human Anatomy, Padova University, Padova, Italy
| | - P-O Champagne
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | - R Colangeli
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - G Conte
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - D D'Avella
- Academic Neurosurgery, Department of Neuroscience DNS, University of Padova Medical School, Padova, Italy
| | - G Danesi
- ENT and Skull-Base Surgery Department, Department of Neurosciences, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - L Deantonio
- Department of Radiation Oncology, University Hospital Maggiore della Carità, Novara, Italy.,Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - L Denaro
- Academic Neurosurgery, Department of Neuroscience DNS, University of Padova Medical School, Padova, Italy
| | - F Di Berardino
- Unit of Audiology, Department of Clinical Sciences and Community Health, University of Milano, Italy.,Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - R Draghi
- Neurosurgery, Maria Cecilia Hospital, Cotignola (RA), Italy
| | - F H Ebner
- Department of Neurosurgery, Eberhard Karls University Tübingen, Germany
| | - N Favaretto
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - G Ferri
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
| | | | - S Froelich
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | | | - L Girasoli
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - B R Grossardt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - M Guidi
- Gruppo Otologico, Piacenza-Rome, Italy
| | - R Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, "Julius-Maximilians" University Hospital of Würzburg, Bavaria, Germany
| | - S Hanakita
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | - D G Hardy
- Department of Neurosurgery, Cambridge University Hospital, Cambridge, UK
| | - V C Iglesias
- ENT and Skull-Base Surgery Department, Department of Neurosciences, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - S Jefferies
- Oncology Department, Cambridge University Hospital, Cambridge, UK
| | - H Jia
- Department of Otolaryngology Head and Neck Surgery, Shanghai Ninh People's Hospital, Shanghai Jiatong University School of Medicine, China
| | - M Kalamarides
- AP-HP, Groupe Hôspital-Universitaire Pitié-Salpêtrière, Neuro-Sensory Surgical Department and NF2 Rare Disease Centre, Paris, France.,Sorbonne Université, Paris, France
| | - I N Kanaan
- Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Alfaisal University, College of Medicine, Riyadh, KSA
| | - M Krengli
- Department of Radiation Oncology, University Hospital Maggiore della Carità, Novara, Italy.,Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - A Landi
- Academic Neurosurgery, Department of Neuroscience DNS, University of Padova Medical School, Padova, Italy
| | - L Lauda
- Gruppo Otologico, Piacenza-Rome, Italy
| | - D Lepera
- ENT & Skull-Base Department, Ospedale Nuovo di Legnano, Legnano (MI), Italy
| | - S Lieber
- Department of Neurosurgery, Eberhard Karls University Tübingen, Germany
| | - S L K Lloyd
- Department of Neuro-Otology and Skull-Base Surgery Manchester Royal Infirmary, Manchester, UK
| | - A Lovato
- Department of Neuroscience DNS, Audiology Unit, Padova University, Treviso, Italy
| | - F Maccarrone
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
| | - R Macfarlane
- Department of Neurosurgery, Cambridge University Hospital, Cambridge, UK
| | - J Magnan
- University Aix-Marseille, France
| | - L Magnoni
- Unit of Audiology, Department of Clinical Sciences and Community Health, University of Milano, Italy.,Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - D Marchioni
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Italy
| | | | - G Marioni
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | | | - C Matthies
- Department of Neurosurgery, Julius Maximilians University Hospital Würzburg, Bavaria, Germany
| | - D A Moffat
- Department of Neuro-otology and Skull Base Surgery, Cambridge University Hospital, Cambridge, UK
| | - S Munari
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - M Nardone
- ENT Department, Treviglio (BG), Italy
| | - R Pareschi
- ENT & Skull-Base Department, Ospedale Nuovo di Legnano, Legnano (MI), Italy
| | - C Pavone
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | | | - G Piras
- Gruppo Otologico, Piacenza-Rome, Italy
| | - L Presutti
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
| | - G Restivo
- ENT and Skull-Base Surgery Department, Department of Neurosciences, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - M Reznitsky
- The Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - E Roca
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | - A Russo
- Gruppo Otologico, Piacenza-Rome, Italy
| | - M Sanna
- Gruppo Otologico, Piacenza-Rome, Italy
| | - L Sartori
- Academic Neurosurgery, Department of Neuroscience DNS, University of Padova Medical School, Padova, Italy
| | - M Scheich
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, "Julius-Maximilians" University Hospital of Würzburg, Bavaria, Germany
| | - W Shehata-Dieler
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, "Julius-Maximilians" University Hospital of Würzburg, Bavaria, Germany
| | - D Soloperto
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Italy
| | - F Sorrentino
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - O Sterkers
- AP-HP, Groupe Hôspital-Universitaire Pitié-Salpêtrière, Neuro-Sensory Surgical Department and NF2 Rare Disease Centre, Paris, France.,Sorbonne Université, Paris, France
| | - A Taibah
- Gruppo Otologico, Piacenza-Rome, Italy
| | - M Tatagiba
- Department of Neurosurgery, Eberhard Karls University Tübingen, Germany
| | - G Tealdo
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - D Vlad
- Gruppo Otologico, Piacenza-Rome, Italy
| | - H Wu
- Department of Otolaryngology Head and Neck Surgery, Shanghai Ninh People's Hospital, Shanghai Jiatong University School of Medicine, China
| | - D Zanetti
- Unit of Audiology, Department of Clinical Sciences and Community Health, University of Milano, Italy.,Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
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Abstract
OBJECTIVE To determine the long-term hearing preservation rate for spontaneous vestibular schwannoma treated by primary radiotherapy. DATA SOURCES The MEDLINE/PubMed, Web of Science, Cochrane Reviews, and EMBASE databases were searched using a comprehensive Boolean keyword search developed in conjunction with a scientific librarian. English language papers published from 2000 to 2016 were evaluated. STUDY SELECTION Inclusion criteria: full articles, pretreatment and posttreatment audiograms or audiogram based scoring system, vestibular schwannoma only tumor type, reported time to follow-up, published after 1999, use of either Gamma Knife or linear accelerator radiotherapy. EXCLUSION CRITERIA case report or series with fewer than five cases, inadequate audiometric data, inadequate time to follow-up, neurofibromatosis type 2 exceeding 10% of study population, previous treatment exceeding 10% of study population, repeat datasets, use of proton beam therapy, and non-English language. DATA EXTRACTION Two reviewers independently analyzed papers for inclusion. Class A/B, 1/2 hearing was defined as either pure tone average less than or equal to 50 db with speech discrimination score more than or equal to 50%, American Academy of Otolaryngology-Head & Neck Surgery (AAO-HNS) Hearing Class A or B, or Gardner-Robertson Grade I or II. Aggregate data were used when individual data were not specified. DATA SYNTHESIS Means were compared with student t test. CONCLUSIONS Forty seven articles containing a total of 2,195 patients with preserved Class A/B, 1/2 hearing were identified for analysis. The aggregate crude hearing preservation rate was 58% at an average reporting time of 46.6 months after radiotherapy treatment. Analysis of time-based reporting shows a clear trend of decreased hearing preservation extending to 10-year follow-up. This data encourages a future long-term controlled trial.
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8
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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.
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Carlson ML, Vivas EX, McCracken DJ, Sweeney AD, Neff BA, Shepard NT, Olson JJ. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Hearing Preservation Outcomes in Patients With Sporadic Vestibular Schwannomas. Neurosurgery 2019; 82:E35-E39. [PMID: 29309683 DOI: 10.1093/neuros/nyx511] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/02/2017] [Indexed: 11/14/2022] Open
Abstract
Question 1 What is the overall probability of maintaining serviceable hearing following stereotactic radiosurgery utilizing modern dose planning, at 2, 5, and 10 yr following treatment? Recommendation Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled that there is moderately high probability (>50%-75%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. Question 2 Among patients with AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery hearing classification) class A or GR (Gardner-Robertson hearing classification) grade I hearing at baseline, what is the overall probability of maintaining serviceable hearing following stereotactic radiosurgery, utilizing modern dose planning, at 2, 5, and 10 yr following treatment? Recommendation Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled that there is a high probability (>75%-100%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. Question 3 What patient- and tumor-related factors influence progression to nonserviceable hearing following stereotactic radiosurgery using ≤13 Gy to the tumor margin? Recommendation Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled regarding the probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, smaller tumor size, marginal tumor dose ≤12 Gy, and cochlear dose ≤4 Gy. Age and sex are not strong predictors of hearing preservation outcome. Question 4 What is the overall probability of maintaining serviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas early after surgery, at 2, 5, and 10 yr following treatment? Recommendation Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled that there is a moderately low probability (>25%-50%) of hearing preservation immediately following surgery, moderately low probability (>25%-50%) of hearing preservation at 2 yr, moderately low probability (>25%-50%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. Question 5 Among patients with AAO-HNS class A or GR grade I hearing at baseline, what is the overall probability of maintaining serviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas early after surgery, at 2, 5, and 10 yr following treatment? Recommendation Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled that there is a moderately high probability (>50%-75%) of hearing preservation immediately following surgery, moderately high probability (>50%-75%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. Question 6 What patient- and tumor-related factors influence progression to nonserviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas? Recommendation Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled regarding the probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, smaller tumor size commonly less than 1 cm, and presence of a distal internal auditory canal cerebrospinal fluid fundal cap. Age and sex are not strong predictors of hearing preservation outcome. Question 7 What is the overall probability of maintaining serviceable hearing with conservative observation of vestibular schwannomas at 2, 5, and 10 yr following diagnosis? Recommendation Level 3: Individuals who meet these criteria and are considering observation should be counseled that there is a high probability (>75%-100%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. Question 8 Among patients with AAO-HNS class A or GR grade I hearing at baseline, what is the overall probability of maintaining serviceable hearing with conservative observation at 2 and 5 yr following diagnosis? Recommendation Level 3: Individuals who meet these criteria and are considering stereotactic radiosurgery should be counseled that there is a high probability (>75%-100%) of hearing preservation at 2 yr, and moderately high probability (>50%-75%) of hearing preservation at 5 yr. Insufficient data were available to determine the probability of hearing preservation at 10 yr for this population subset. Question 9 What patient and tumor-related factors influence progression to nonserviceable hearing during conservative observation? Recommendation Level 3: Individuals who meet these criteria and are considering observation should be counseled regarding probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, as well as nongrowth of the tumor. Tumor size at the time of diagnosis, age, and sex do not predict future development of nonserviceable hearing during observation. The full guideline can be found at: https://www.cns.org/guidelines/guidelines-manage-ment-patients-vestibular-schwannoma/chapter_3.
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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
| | - Esther X Vivas
- Department of Otolaryngology-Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - D Jay McCracken
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Alex D Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Brian A Neff
- Department of Otorhinolaryngology, Mayo Clinic, School of Medicine, Rochester, Minnesota.,Department of Neurologic Surgery, Mayo Clinic, School of Medicine, Rochester, Minnesota
| | - Neil T Shepard
- Department of Otorhinolaryngology, Mayo Clinic, School of Medicine, Rochester, Minnesota
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
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Reznitsky M, Cayé-Thomasen P. Systematic Review of Hearing Preservation in Observed Vestibular Schwannoma. J Neurol Surg B Skull Base 2019; 80:165-168. [PMID: 30931224 DOI: 10.1055/s-0039-1679894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022] Open
Abstract
Objective This is a systematic review of the literature on the spontaneous course of hearing in patients observed with a vestibular schwannoma. Included studies are appraised using the Grading of Recommendations Assessment, Development and Evaluation system. Design PubMed, Embase, Medline, Cochrane library, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched for literature on hearing in patients observed with a vestibular schwannoma. Participants Of 217 evaluated papers, 15 were included, representing a total of 2,142 patients. Main Outcome Measures Hearing according to the AAO-HNS (American Academy of Otorhinolaryngology- Head and Neck Surgery) classification system. Weighted average of the proportion of patients preserving good hearing (>70% discrimination score and pure tone audiometry [PTA] < 30dB) and serviceable hearing (>50% discrimination score and PTA < 50dB) was determined. Results Fifty percent of patients presenting with good hearing at diagnosis had preserved this after a mean of 5 years of observation, whereas serviceable hearing was preserved in 54%. Patients with normal discrimination at diagnosis preserve their hearing very well. Very few studies exist on long-term hearing preservation. Conclusions After 5 years of observation, around half of patients will have preserved good or serviceable hearing. Patients with normal discrimination at diagnosis are more likely to preserve good hearing.
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Affiliation(s)
- Martin Reznitsky
- Department of Oto-rhino-laryngology, Head and Neck Surgery, F2074, Copenhagen University Hospital Rigshospitalet, Copenhagen Ø, Denmark
| | - Per Cayé-Thomasen
- Department of Oto-rhino-laryngology, Head and Neck Surgery, F2074, Copenhagen University Hospital Rigshospitalet, Copenhagen Ø, Denmark
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Hearing Outcomes in Conservatively Managed Vestibular Schwannoma Patients With Serviceable Hearing. Otol Neurotol 2018; 39:e704-e711. [DOI: 10.1097/mao.0000000000001914] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Long-term Hearing Preservation After Resection of Vestibular Schwannoma: A Systematic Review and Meta-analysis. Otol Neurotol 2018; 38:1505-1511. [PMID: 29140965 DOI: 10.1097/mao.0000000000001560] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective is to perform a systematic review and meta-analysis of the literature on the long-term results of hearing preservation after vestibular schwannoma resection. DATA SOURCES Ovid/Medline, PubMed, Embase, and the Cochrane library from January 1980 to January 2015. STUDY SELECTION Inclusion criteria: age ≥18 years, minimum 10 patients in the treatment group, hearing preserving microsurgery, no previous radiation treatment, serviceable hearing at immediate postop follow-up, hearing outcomes reported using Gardner Robinson or the American Academy of Otolaryngology-Head and Neck Surgeons hearing grading scales, and average follow-up of 5 years. Preoperative, immediate postoperative, and last follow-up audiograms were required. Exclusion criteria included neurofibromatosis type 2 patients and surgery for salvage therapy or decompression. DATA EXTRACTION Quality evaluated using Methodological Index for Non-Randomized Studies. DATA SYNTHESIS Meta-analysis was performed using R v3.2.2, Metafor package v 1.9-7. Cohen's D was used to determine effect size. Ten reports had at least 5-year follow-up and used standardized hearing grading scales. The systematic review found that if hearing was preserved at Class A or B at early postop visit, the chance of preserving hearing at 5 years was excellent. Those who maintained speech discrimination score ≥ 89% at the early postoperative follow-up had better long-term hearing preservation. The meta-analysis reveals that only preoperative and postoperative pure-tone average was associated with long-term hearing preservation. CONCLUSION Long-term (>5 yr) hearing durability rates are generally very good. Most studies do not report patient and tumor characteristics, therefore precluding combining studies for meta-analysis. Only preoperative and postoperative postoperative pure-tone average was associated with long-term hearing durability.
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Lo A, Ayre G, Ma R, Hsu F, Akagami R, McKenzie M, Valev B, Gete E, Vallieres I, Nichol A. Population-Based Study of Stereotactic Radiosurgery or Fractionated Stereotactic Radiation Therapy for Vestibular Schwannoma: Long-Term Outcomes and Toxicities. Int J Radiat Oncol Biol Phys 2018; 100:443-451. [DOI: 10.1016/j.ijrobp.2017.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 08/26/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
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Kirchmann M, Karnov K, Hansen S, Dethloff T, Stangerup SE, Caye-Thomasen P. Ten-Year Follow-up on Tumor Growth and Hearing in Patients Observed With an Intracanalicular Vestibular Schwannoma. Neurosurgery 2017; 80:49-56. [PMID: 27571523 DOI: 10.1227/neu.0000000000001414] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 06/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Reports on the natural history of tumor growth and hearing in patients with a vestibular schwannoma (VS) are almost exclusively short-term data. Long-term data are needed for comparison with results of surgery and radiotherapy. OBJECTIVE To report the long-term occurrence of tumor growth and hearing loss in 156 patients diagnosed with an intracanalicular VS and managed conservatively. METHODS In this longitudinal cohort study, diagnostic and follow-up magnetic resonance imaging and audiometry were compared. RESULTS After a follow-up of 9.5 years, tumor growth had occurred in 37% and growth into the cerebellopontine angle had occurred in 23% of patients. Conservative treatment failed in 15%. The pure tone average had increased from 51- to 72-dB hearing level, and the speech discrimination score (SDS) had decreased from 60% to 34%. The number of patients with good hearing (SDS > 70%) was reduced from 52% to 22%, and the number of patients with American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A hearing was reduced from 19% to 3%. Hearing was preserved better in patients with 100% SDS at diagnosis than in patients with even a small loss of SDS. Serviceable hearing was preserved in 34% according to AAO-HNS (class A-B) and in 58% according to the word recognition score (class I-II). Rate of hearing loss was higher in patients with growing tumors. CONCLUSION Tumor growth occurred in only a minority of patients diagnosed with an intracanalicular VS during 10 years of observation. The risk of hearing loss is small in patients with normal discrimination at diagnosis. Serviceable hearing is preserved spontaneously in 34% according to AAO-HNS and in 58% according to the word recognition score.
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Affiliation(s)
- Malene Kirchmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, and Audiology, Copenhagen University Hospital Rigshos-pitalet, Copenhagen, Denmark
| | - Kirstine Karnov
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, and Audiology, Copenhagen University Hospital Rigshos-pitalet, Copenhagen, Denmark
| | - Søren Hansen
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, and Audiology, Copenhagen University Hospital Rigshos-pitalet, Copenhagen, Denmark
| | - Thomas Dethloff
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, and Audiology, Copenhagen University Hospital Rigshos-pitalet, Copenhagen, Denmark
| | - Sven-Eric Stangerup
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, and Audiology, Copenhagen University Hospital Rigshos-pitalet, Copenhagen, Denmark
| | - Per Caye-Thomasen
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, and Audiology, Copenhagen University Hospital Rigshos-pitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kranzinger M, Zehentmayr F, Fastner G, Oberascher G, Merz F, Nairz O, Rahim H, Sedlmayer F. Hypofractionated stereotactic radiotherapy of acoustic neuroma: volume changes and hearing results after 89-month median follow-up. Strahlenther Onkol 2014; 190:798-805. [PMID: 24638268 DOI: 10.1007/s00066-014-0630-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The goal of this work was to evaluate toxicity and local control following hypofractionated stereotactic radiation treatment with special focus on changes in tumor volume and hearing capacity. PATIENTS AND METHODS In all, 29 patients with unilateral acoustic neuroma were treated between 2001 and 2007 within a prospective radiation protocol (7 × 4 Gy ICRU dose). Median tumor volume was 0.9 ml. Follow-up started at 6 months and was repeated annually with MRI volumetry and audiometry. Hearing preservation was defined as preservation of Class A/B hearing according to the guidelines of the American Academy of Otolaryngology (1995). RESULTS No patient had any intervention after a median imaging follow-up of 89.5 months, one patient showed radiological progression. Transient increase of tumor volume developed in 17/29 patients, whereas 22/29 patients (75.9%) presented with a volume reduction at last follow-up. A total of 21 patients were eligible for hearing evaluation. Mean pure tone average (PTA) deteriorated from 39.3 to 65.9 dB and mean speech discrimination score (SDS) dropped from 74.3 to 38.1%. The 5-year actuarial Class A/B hearing preservation rate was 50.0 ± 14.4%. CONCLUSION Radiation increases only minimally, if at all, the hearing deterioration which emerges by observation alone. Presbyacusis is not responsible for this deterioration. Transient tumor enlargement is common. Today radiation of small- and medium-sized acoustic neuroma can be performed with different highly conformal techniques as fractionated treatment or single low-dose radiosurgery with equal results regarding tumor control, hearing preservation, and side effects. Hypofractionation is more comfortable for the patient than conventional regimens and represents a serious alternative to frameless radiosurgery.
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Affiliation(s)
- Manfred Kranzinger
- University Clinic of Radiotherapy and Radio-Oncology, Salzburg County Hospital, Paracelsus Medical University Clinics (PMU), Müllner Hauptstraße 48, 5020, Salzburg, Austria,
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16
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Marchetti M, Franzini A, Nazzi V, De Martin E, Fariselli L. Radiosurgical treatment of ulnar plexiform neurofibroma in a neurofibromatosis type 1 (NF1) patient. Acta Neurochir (Wien) 2013; 155:553-5. [PMID: 23307331 DOI: 10.1007/s00701-012-1597-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 12/13/2012] [Indexed: 01/19/2023]
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Di Lella F, Merkus P, Di Trapani G, Taibah A, Guida M, Sanna M. Vestibular Schwannoma in the Only Hearing Ear: Role of Cochlear Implants. Ann Otol Rhinol Laryngol 2013; 122:91-9. [DOI: 10.1177/000348941312200204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We sought to delineate the role of cochlear implantation in the management of vestibular schwannoma or other cerebellopontine angle tumors in the only hearing ear. Methods: We performed a retrospective analysis in a quaternary referral skull base center of all patients who were affected by vestibular schwannoma (or other lesions of the cerebellopontine angle) in the only hearing ear and received a cochlear implant before or after tumor treatment (surgery or radiotherapy) or during the wait-and-scan follow-up. We also performed a systematic review of the English-language literature. Results: The clinical and audiological results of 10 patients are reported. All patients were managed with contralateral cochlear implantation. In 7 patients, cochlear implantation was performed before tumor removal, while hearing in the ear with the tumor was still present. In 3 patients, the implant was placed after curative surgery. Nine of the 10 patients routinely use their implant with subjective benefit and fairly good auditory performance (median disyllabic word recognition, 90%; median sentence comprehension, 75%). The literature search retrieved no major series with assessment of the long-term efficacy of cochlear implantation in this rare clinical scenario. Conclusions: Patients affected by vestibular schwannoma in their only hearing ear may significantly benefit from a cochlear implant on the contralateral side prior to tumor removal. Recent and significant hearing deterioration and tumor growth represent the main indications for cochlear implantation.
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Fractionated Stereotactic Radiotherapy of Vestibular Schwannomas Accelerates Hearing Loss. Int J Radiat Oncol Biol Phys 2012; 83:e607-11. [DOI: 10.1016/j.ijrobp.2012.01.078] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/24/2012] [Accepted: 01/25/2012] [Indexed: 11/20/2022]
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Kopp C, Fauser C, Müller A, Astner ST, Jacob V, Lumenta C, Meyer B, Tonn JC, Molls M, Grosu AL. Stereotactic Fractionated Radiotherapy and LINAC Radiosurgery in the Treatment of Vestibular Schwannoma—Report About Both Stereotactic Methods From a Single Institution. Int J Radiat Oncol Biol Phys 2011; 80:1485-91. [DOI: 10.1016/j.ijrobp.2010.04.057] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 04/12/2010] [Accepted: 04/16/2010] [Indexed: 11/25/2022]
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Radiotherapy for Vestibular Schwannomas: A Critical Review. Int J Radiat Oncol Biol Phys 2011; 79:985-97. [DOI: 10.1016/j.ijrobp.2010.10.010] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 10/01/2010] [Accepted: 10/08/2010] [Indexed: 11/18/2022]
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Whitmore RG, Urban C, Church E, Ruckenstein M, Stein SC, Lee JYK. Decision analysis of treatment options for vestibular schwannoma. J Neurosurg 2011; 114:400-13. [DOI: 10.3171/2010.3.jns091802] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Widespread use of MR imaging has contributed to the more frequent diagnosis of vestibular schwannomas (VSs). These tumors represent 10% of primary adult intracranial neoplasms, and if they are symptomatic, they usually present with hearing loss and tinnitus. Currently, there are 3 treatment options for quality of life (QOL): wait and scan, microsurgery, and radiosurgery. In this paper, the authors' purpose is to determine which treatment modality yields the highest QOL at 5- and 10-year follow-up, considering the likelihood of recurrence and various complications.
Methods
The MEDLINE, Embase, and Cochrane online databases were searched for English-language articles published between 1990 and June 2008, containing key words relating to VS. Data were pooled to calculate the prevalence of treatment complications, tumor recurrence, and QOL with various complications. For parameters in which incidence varied with time of follow-up, the authors used meta-regression to determine the mean prevalence rates at a specified length of follow-up. A decision-analytical model was constructed to compare 5- and 10-year outcomes for a patient with a unilateral tumor and partially intact hearing. The 3 treatment options, wait and scan, microsurgery, and radiosurgery, were compared.
Results
After screening more than 2500 abstracts, the authors ultimately included 113 articles in this analysis. Recurrence, complication rates, and onset of complication varied with the treatment chosen. The relative QOL at the 5-year follow-up was 0.898 of normal for wait and scan, 0.953 for microsurgery, and 0.97 for radiosurgery. These differences are significant (p < 0.0052). Data were too scarce at the 10-year follow-up to calculate significant differences between the microsurgery and radiosurgery strategies.
Conclusions
At 5 years, patients treated with radiosurgery have an overall better QOL than those treated with either microsurgery or those investigated further with serial imaging. The authors found that the complications associated with wait-and-scan and microsurgery treatment strategies negatively impacted patient lives more than the complications from radiosurgery. One limitation of this study is that the 10-year follow-up data were too limited to analyze, and more studies are needed to determine if the authors' results are still consistent at 10 years.
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Affiliation(s)
| | | | | | - Michael Ruckenstein
- 2Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Müller S, Arnolds J, van Oosterhout A. Decision-making of vestibular schwannoma patients. Acta Neurochir (Wien) 2010; 152:973-84. [PMID: 20169371 DOI: 10.1007/s00701-009-0590-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 12/28/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients suffering from vestibular schwannoma can choose between four modalities of management: (1) wait-and-scan, (2) tumour resection, (3) radiosurgery and (4) fractionated radiotherapy. METHOD This study is based on postal questionnaire survey of 739 vestibular schwannoma patients (survey response rate, 78%). It not only investigates the decision-making of patients, especially the medical consultation, but also further influences on the therapy decision and the patients' evaluation of possible side-effects of the treatment. RESULTS Only a minority of the patients was informed about radiosurgery and radiotherapy at all. CONCLUSION The praxis of patient counselling of acoustic neuroma patients in Germany is far from the ideal condition of medical consultation: The most important shortcoming is that it is unilateral: About 69% of the patients are informed about only one treatment option, generally surgery. Furthermore, information about side effects is usually insufficient. We recommend to advice all patients on all treatment options by an interdisciplinary team. The counselling should firstly be based on evidence-based medicine and secondly respond to the patients' individual life situation and preferences.
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Quality of life after vestibular schwannoma surgery: does hearing preservation make a difference? The Journal of Laryngology & Otology 2009; 124:370-3. [PMID: 19941684 DOI: 10.1017/s0022215109992040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Surgery for vestibular schwannoma may reduce patients' quality of life, but the effect of hearing preservation on this process is not fully understood. Our aim was to determine whether hearing preservation makes a difference to patients' quality of life in this clinical setting. STUDY DESIGN Retrospective questionnaire and cross-sectional survey. METHODS The study included 104 consecutive patients who had undergone surgery for vestibular schwannoma between 1998 and 2004. Surgery was via a middle cranial fossa route in 24 patients and a translabyrinthine route in 79. Quality of life was assessed using the SF-36 questionnaire and the Glasgow Benefit Inventory. RESULTS Quality of life was reduced in both patient groups, with a mean Glasgow Benefit Inventory score of -7.5 (confidence interval (CI) -13 to -2.5) in the translabyrinthine patients and -4 (confidence interval -13.5 to 5.5) in the middle fossa patients. The SF-36 scores did not show any statistically significant difference between the two groups, except for social function (p = 0.01). CONCLUSIONS Surgery for vestibular schwannoma reduces patients' quality of life, and the preservation of hearing, achieved by using a middle fossa surgical approach, does not significantly alter this result.
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Bakkouri WE, Kania RE, Guichard JP, Lot G, Herman P, Huy PTB. Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment. J Neurosurg 2009; 110:662-9. [DOI: 10.3171/2007.5.16836] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ObjectThe object of this study was to evaluate the natural history, pattern, and occurrence of tumor growth and its consequences for treatment of small-sized vestibular schwannomas (VSs).MethodsFrom 1990 to 2005, 386 patients underwent conservative management for VS because of the following: age > 60 years, poor health/medical risks, risk of deterioration of good hearing, small tumor size, minimal or no incapacitating symptoms, and/or patient preference. Tumor size was measured by MR imaging according to the guidelines of the Committee on Hearing and Equilibrium. The first MR imaging study was performed 1 year after diagnosis, and subsequent imaging was performed yearly or every 2 years depending on the appearance of new symptoms, tumor growth, or both.ResultsSixty-one patients were lost to follow-up the first year after presentation. Of the 325 patients for whom 1-year follow-up data were available, 39 showed tumor growth ≥ 3 mm. Conservative management was discontinued for these 39 patients. The patients who returned for follow-up were evaluated at 1- or 2-year intervals depending on tumor growth. The authors extrapolated to obtain data for 2-year intervals, yielding data for 160, 56, 21, and 8 patients at 3, 5, 7, and 9 years after initial presentation, respectively. The overall mean tumor growth rate (±standard deviation) was 1.15 ± 2.4 mm/year. This rate was estimated by pooling all values of tumor growth that had been determined for all patients and dividing by the total number of “events,” with each assessment constituting an event. In 58.6% of patients, the annual tumor growth rate was < 1 mm/year; in 29.2%, 1–3 mm/year; and in 12.2%, ≥ 3 mm/ year. The growth rates of intrameatal (1.02 ± 1.8 mm/year) and extrameatal (1.40 ± 3.1 mm/year) tumors did not differ significantly. No significant association was found between tumor growth rate and sex, age, initial hearing status, or initial tumor grade. Delay in diagnosis was the only significant factor associated with tumor growth rate. During follow-up, conservative management was discontinued for 77 (23.7%) of the 325 patients for whom at least 12-month follow-up data were available; surgery was performed in 60 (77.9%) and radiation therapy in 17 (22.1%).ConclusionsThe results of this study support the role of a conservative “wait-and-scan” policy of management for small-sized VSs because most have a slow growth rate. Long-term neuroimaging follow-up is needed even with non-growing tumors.
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Affiliation(s)
- Wissame El Bakkouri
- 1Departments of Otorhinolaryngology–Head and Neck Surgery, Laboratoire de Neurobiologie et des Réseaux Sensorimoteurs, LNRS CNRS 7060
| | - Romain E. Kania
- 1Departments of Otorhinolaryngology–Head and Neck Surgery, Laboratoire de Neurobiologie et des Réseaux Sensorimoteurs, LNRS CNRS 7060
| | | | - Guillaume Lot
- 3Neurosurgery, Lariboisière Hospital, University of Paris 7–Denis Diderot, Paris, France
| | - Philippe Herman
- 1Departments of Otorhinolaryngology–Head and Neck Surgery, Laboratoire de Neurobiologie et des Réseaux Sensorimoteurs, LNRS CNRS 7060
| | - Patrice Tran Ba Huy
- 1Departments of Otorhinolaryngology–Head and Neck Surgery, Laboratoire de Neurobiologie et des Réseaux Sensorimoteurs, LNRS CNRS 7060
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Meijer OWM, Weijmans EJ, Knol DL, Slotman BJ, Barkhof F, Vandertop WP, Castelijns JA. Tumor-volume changes after radiosurgery for vestibular schwannoma: implications for follow-up MR imaging protocol. AJNR Am J Neuroradiol 2008; 29:906-10. [PMID: 18296549 DOI: 10.3174/ajnr.a0969] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The outcome of radiosurgery for vestibular schwannoma (VS) is assessed by posttreatment measurement of tumor size and could be influenced by the timing and quality of the assessment. This study evaluates the volumetric changes of VS after radiosurgery and proposes a radiologic follow-up program. MATERIALS AND METHODS Of 142 patients with VS treated with radiosurgery, we selected patients who were followed at least 3 times during a minimum of 32 months with a T1-weighted gadolinium-enhanced high-resolution 3D MR imaging examination identical to the pretreatment MR imaging. Forty-five patients were identified with a mean follow-up of 50 months (range, 32-78 months). Pre- and posttreatment tumor volumes were calculated by using BrainSCAN software by manually contouring tumors on each MR imaging study. Volume changes of >13% were defined as events. RESULTS At last follow-up MR imaging, volumes were smaller in 37 (82.2%) of the 45 patients. Eleven (29.7%) of these 37 tumors showed transient swelling preceding regression, with a median time to regression of 34 months (range, 20-55 months). Seven (15.6%) of the 45 tumors had volume progression compared with the tumor on pretreatment MR imaging studies. Of these 7 tumors, 3, however, had volume regression compared with the preceding MR imaging study, and in 4, volume progression was ongoing. One tumor remained the same. CONCLUSIONS Tumor-volume measurements by standardized T1-weighted gadolinium-enhanced high-resolution 3D MR imaging follow-up protocols revealed good local control of VS after radiosurgery. The first-follow-up MR imaging at 2 years and the second at 5 years postradiosurgery differentiated transient progression from ongoing progression and may prevent unnecessary therapeutic interventions.
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Affiliation(s)
- O W M Meijer
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
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Dispenza F, De Stefano A, Flanagan S, Romano G, Sanna M. Decision Making for Solitary Vestibular Schwannoma and Contralateral Meniere’s Disease. Audiol Neurootol 2007; 13:53-7. [PMID: 17848792 DOI: 10.1159/000108109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 06/01/2007] [Indexed: 11/19/2022] Open
Abstract
The existence of dual inner ear pathology such as unilateral Meniere's disease (MD) with a contralateral vestibular schwannoma (VS) is very rare, but provides the otologist with a significant management dilemma. In this study, we present 5 cases of unilateral disabling MD with a contralateral VS in the better hearing ear. Conservative management of the VS is mandated unless there are impending complications, with management directed toward controlling the vertigo attributed to MD. If and when the VS requires intervention, or the hearing in that ear deteriorates to unserviceable levels, cochlear implant of the ear affected by MD prior to addressing the VS provides optimal management.
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Affiliation(s)
- Francesco Dispenza
- Dipartimento di Scienze Otorinolaringoiatriche, Università degli Studi di Palermo, Palermo, Italia.
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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.
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Affiliation(s)
- Eng-Siew Koh
- Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, Toronto, Ontario, Canada
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28
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Caye-Thomasen P, Dethloff T, Hansen S, Stangerup SE, Thomsen J. Hearing in patients with intracanalicular vestibular schwannomas. Audiol Neurootol 2006; 12:1-12. [PMID: 17033159 DOI: 10.1159/000096152] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 07/21/2006] [Indexed: 11/19/2022] Open
Abstract
This paper reports data on the spontaneous course of hearing in 156 patients with purely intracanalicular vestibular schwannomas. The mean pure tone average (PTA) was 51 dB HL and the mean speech discrimination score (SDS) 60% at diagnosis. The risk of a significant subsequent hearing loss (>or=10 dB PTA or >or=10% SDS) was 54% during 4.6 years of observation. Patients with normal speech discrimination at diagnosis had a significantly smaller risk of loosing hearing. The hearing loss at diagnosis and during observation was not related to age, gender, diagnostic tumor size, tumor- induced expansion of the internal auditory canal or tumor sublocalization (fundus, central or porus). However, the loss of PTA was smaller in shrinking tumors and the PTA deterioration rate correlated with the volumetric tumor growth rate. After 4.6 years observation, the PTA had increased by 14 dB to 65 dB HL, and the SDS reduced by 17% to 43%. The proportion of patients eligible for hearing preservation treatment as determined by word recognition score class I (70-100% SDS) was reduced to 28% (a 44% reduction), and by AAO-HNS class A to 9% (a 53% reduction).
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Affiliation(s)
- Per Caye-Thomasen
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Gentofte University Hospital of Copenhagen, Copenhagen, Denmark.
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29
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Doherty JK, Friedman RA. Controversies in building a management algorithm for vestibular schwannomas. Curr Opin Otolaryngol Head Neck Surg 2006; 14:305-13. [PMID: 16974142 DOI: 10.1097/01.moo.0000244186.72645.d4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The present review examines the various mainstream treatment options, benefits and risks, and controversies involved in developing a management algorithm for treatment of vestibular schwannoma. RECENT FINDINGS Advances in microsurgery and radiosurgery have made tremendous contributions to management of vestibular schwannoma; however, considerable controversy still exists. The auditory and facial nerve functional outcomes have improved with use of intraoperative monitoring for vestibular schwannoma removal and with lower radiosurgery doses; however, risks to the facial and auditory nerves still exist. Observing vestibular schwannomas for growth with serial magnetic resonance imaging is an increasingly popular option for small vestibular schwannomas that allows patients to enjoy hearing and facial function. SUMMARY The risks and benefits of each treatment option must be weighed for each patient, and management decisions regarding vestibular schwannomas should be individualized for each patient depending on tumor anatomy, patient preferences, and symptoms.
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Affiliation(s)
- Joni K Doherty
- House Clinic and House Ear Institute, Los Angeles, California 90057, USA
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30
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Flickinger JC, Barker FG. Clinical Results: Radiosurgery and Radiotherapy of Cranial Nerve Schwannomas. Neurosurg Clin N Am 2006; 17:121-8, vi. [PMID: 16793504 DOI: 10.1016/j.nec.2006.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Stereotactic radiosurgery and fractionated radiotherapy are two attractive low-morbidity alternatives to surgical resection for managing cranial nerve schwannomas. Treatment outcomes from these radiation treatment approaches are well documented with long-term outcome studies from multiple institutions. Differences in outcome between these two modalities are difficult to define clearly. The low morbidity and high long-term tumor control rates with radiation treatment have made it the choice of many patients who opt for active initial management for small- or medium-sized cranial nerve schwannomas.
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Affiliation(s)
- John C Flickinger
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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