1
|
Fu W, Liang J, Li M, Song G, Guo J, Zheng H, Zhang X. Effect of modified facial paralysis rehabilitation nursing on patients with facial paralysis after vestibular schwannoma surgery. Heliyon 2024; 10:e35060. [PMID: 39157400 PMCID: PMC11327583 DOI: 10.1016/j.heliyon.2024.e35060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024] Open
Abstract
Background and objective After vestibular schwannoma (VS) surgery, some patients exhibit different degrees of peripheral facial paralysis, which can seriously affect their quality of life. The recovery of facial nerve function after surgery typically takes a considerable amount of time; therefore, the recovery of facial nerve function depends mainly on the rehabilitation treatment and nursing after discharge. In the past, we implemented conventional paralysis rehabilitation nursing program for patients with facial paralysis due to VS surgery. However, several patients with facial paralysis have bad compliance and do not achieve ideal facial nerve function recovery. Therefore, this study aimed to investigate whether modified facial paralysis rehabilitation nursing improves the effectiveness of rehabilitation of facial paralysis after VS surgery by analysing the clinical data of patients. Methods We screened the patients with facial paralysis after VS surgery from December 2019 to May 2023. The patients were divided into the conventional and modified groups based on the different nursing programs (conventional vs. modified facial paralysis rehabilitation nursing program) to compare the differences in facial nerve function, quality of life of patients, and compliance of rehabilitation between the two groups. Results We analysed 128 patients with facial paralysis after VS surgery who met the inclusion and exclusion criteria; 65 and 63 patients in the conventional and modified group, respectively. The number of patients in the modified group with House-Brackmann grade changes >0 in facial nerve function was significantly higher than that in the conventional group 3 months after surgery (82.5 % vs 63.1 %, p = 0.01). Except for the lacrimal control score, the mean scores of the Chinese version of the FaCE scale were significantly higher in the modified group than those in the conventional group at 1 and 3 months postoperatively. Conclusions The modified facial paralysis rehabilitation nursing, i.e., integrated use of facial expressive muscle exercises and facial massage with video-assisted education, substantially improved the facial nerve function, quality of life, and compliance of rehabilitation nursing of patients with facial paralysis after VS surgery.
Collapse
Affiliation(s)
- Wei Fu
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Gang Song
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Jing Guo
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Hongyu Zheng
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Xiaolei Zhang
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| |
Collapse
|
2
|
Suresh K, Elkahwagi MA, Garcia A, Naples JG, Corrales CE, Crowson MG. Development of a Predictive Model for Persistent Dizziness Following Vestibular Schwannoma Surgery. Laryngoscope 2023; 133:3534-3539. [PMID: 37092316 PMCID: PMC10593906 DOI: 10.1002/lary.30708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE In an era of vestibular schwannoma (VS) surgery where functional preservation is increasingly emphasized, persistent postoperative dizziness is a relatively understudied functional outcome. The primary objective was to develop a predictive model to identify patients at risk for developing persistent postoperative dizziness after VS resection. METHODS Retrospective review of patients who underwent VS surgery at our institution with a minimum of 12 months of postoperative follow-up. Demographic, tumor-specific, preoperative, and immediate postoperative features were collected as predictors. The primary outcome was self-reported dizziness at 3-, 6-, and 12-month follow-up. Binary and multiclass machine learning classification models were developed using these features. RESULTS A total of 1,137 cases were used for modeling. The median age was 67 years, and 54% were female. Median tumor size was 2 cm, and the most common approach was suboccipital (85%). Overall, 63% of patients did not report postoperative dizziness at any timepoint; 11% at 3-month follow-up; 9% at 6-months; and 17% at 12-months. Both binary and multiclass models achieved high performance with AUCs of 0.89 and 0.86 respectively. Features important to model predictions were preoperative headache, need for physical therapy on discharge, vitamin D deficiency, and systemic comorbidities. CONCLUSION We demonstrate the feasibility of a machine learning approach to predict persistent dizziness following vestibular schwannoma surgery with high accuracy. These models could be used to provide quantitative estimates of risk, helping counsel patients on what to expect after surgery and manage patients proactively in the postoperative setting. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3534-3539, 2023.
Collapse
Affiliation(s)
- Krish Suresh
- Department of Otolaryngology–Head & Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed A. Elkahwagi
- Department of Otolaryngology–Head & Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Otolaryngology–Head & Neck Surgery, Mansoura University, Egypt
| | - Alejandro Garcia
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - James G. Naples
- Department of Otolaryngology–Head & Neck Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - C. Eduardo Corrales
- Department of Otolaryngology–Head & Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew G. Crowson
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Pruijn IMJ, van Heemskerken P, Kunst HPM, Tummers M, Kievit W. Patient-preferred outcomes in patients with vestibular schwannoma: a qualitative content analysis of symptoms, side effects and their impact on health-related quality of life. Qual Life Res 2023; 32:2887-2897. [PMID: 37258945 PMCID: PMC10474211 DOI: 10.1007/s11136-023-03433-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE During counseling and management of patients with vestibular schwannoma (VS), the emphasis is shifting from tumour control and nerve preservation towards maintaining or improving health-related quality of life (HRQoL). Understanding the patients' perspective and impact of VS is, therefore, of utmost importance. The current study aimed to identify treatment outcomes preferred by patients and to explore the patient-reported VS symptoms and management-related side effects and their impact on HRQoL. METHODS Patients with VS were contacted through the Dutch VS association Stichting Hoormij and questioned using a semi-structured, cross-sectional online survey. Patients were asked to report and rank symptoms and side effects, with their impact on HRQoL and frequency of occurrence. Results were structured through qualitative content analysis. Coded symptoms, side effects, impacts, frequencies, and patient-preferred outcomes were analysed and summarized with descriptive statistics. RESULTS Of the 231 respondents, 71% were actively treated. Hearing (symptoms vs. side effects: 78.8% vs. 63.6%), balance (62.3%; 48.8%), and energy issues (33.8%; 32.6%) were the most frequently mentioned symptoms and management-related side effects. Fatigue, deafness, headaches, and hearing loss had the highest impact on HRQoL. The majority of patients identified hearing preservation (61%), balance preservation (38.5%), and reduced tinnitus (34.6%) to be the patient-preferred outcomes. CONCLUSION This qualitative study demonstrates that in this population many patients with VS encounter participation difficulties in their daily physical and social activities and value hearing and balance preservation, reduced tinnitus, and restored energy as preferred outcomes as they are hampered by symptoms and side effects related to hearing, balance, and energy. Healthcare professionals should consider these key points and use these and the patient-preferred outcomes in consultation, shared decision making, treatment, and follow-up to optimize patient-centred care.
Collapse
Affiliation(s)
- Ineke M J Pruijn
- Department of Otorhinolaryngology, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6525 EX, Nijmegen, The Netherlands.
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center, Nijmegen/Maastricht, The Netherlands.
| | - Phylisha van Heemskerken
- Department of Otorhinolaryngology, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6525 EX, Nijmegen, The Netherlands
- Department of Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6525 EX, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center, Nijmegen/Maastricht, The Netherlands
- Department of Otorhinolaryngology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcia Tummers
- Department of Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Wietske Kievit
- Department of Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| |
Collapse
|
4
|
Di Perna G, De Marco R, Baldassarre BM, Lo Bue E, Cofano F, Zeppa P, Ceroni L, Penner F, Melcarne A, Garbossa D, Lanotte MM, Zenga F. Facial nerve outcome score: a new score to predict long-term facial nerve function after vestibular schwannoma surgery. Front Oncol 2023; 13:1153662. [PMID: 37377918 PMCID: PMC10291180 DOI: 10.3389/fonc.2023.1153662] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Patients' quality of life (QoL), facial nerve (FN), and cochlear nerve (CN) (if conserved) functions should be pursued as final outcomes of vestibular schwannoma (VS) surgery. In regard to FN function, different morphologic and neurophysiological factors have been related to postoperative outcomes. The aim of the current retrospective study was to investigate the impact of these factors on the short- and long-term FN function after VS resection. The combination of preoperative and intraoperative factors resulted in designing and validating a multiparametric score to predict short- and long-term FN function. Methods A single-center retrospective analysis was performed for patients harboring non-syndromic VS who underwent surgical resection in the period 2015-2020. A minimum follow-up period of 12 months was considered among the inclusion criteria. Morphological tumor characteristics, intraoperative neurophysiological parameters, and postoperative clinical factors, namely, House-Brackmann (HB) scale, were retrieved in the study. A statistical analysis was conducted to investigate any relationships with FN outcome and to assess the reliability of the score. Results Seventy-two patients with solitary primary VS were treated in the period of the study. A total of 59.8% of patients showed an HB value < 3 in the immediate postoperative period (T1), reaching to 76.4% at the last follow-up evaluation. A multiparametric score, Facial Nerve Outcome Score (FNOS), was built. The totality of patients with FNOS grade A showed an HB value < 3 at 12 months, decreasing to 70% for those with FNOS grade B, whereas 100% of patients with FNOS grade C showed an HB value ≥ 3. The ordinal logistic regression showed three times increasing probability to see an HB value ≥ 3 at 3-month follow-up for each worsening point in FNOS score [Exp(B), 2,999; p < 0.001] that was even more probable [Exp(B), 5.486; p < 0.001] at 12 months. Conclusion The FNOS score resulted to be a reliable score, showing high associations with FN function both at short- and long-term follow-up. Although multicenter studies would be able to increase its reproducibility, it could be used to predict the FN damage after surgery and the potential of restoring its function on the long-term period.
Collapse
Affiliation(s)
- Giuseppe Di Perna
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Skull Base and Pituitary Surgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
- Spine Surgery Unit, Casa di Cura "Città di Bra", Bra, Cuneo, Italy
| | - Raffaele De Marco
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Skull Base and Pituitary Surgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
| | - Bianca Maria Baldassarre
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Skull Base and Pituitary Surgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
| | - Enrico Lo Bue
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Skull Base and Pituitary Surgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
| | - Fabio Cofano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
| | - Pietro Zeppa
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - Luca Ceroni
- Department of Psychology, University of Turin, Turin, Italy
| | - Federica Penner
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Skull Base and Pituitary Surgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
| | - Antonio Melcarne
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Neurosurgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Neurosurgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
| | - Michele Maria Lanotte
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Functional, Oncological and Stereotactic Neurosurgery Unit, “Città della Salute e delle Scienza” University Hospital, Turin, Italy
| | - Francesco Zenga
- Skull Base and Pituitary Surgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
- Neurosurgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
| |
Collapse
|
5
|
Bender M, Tatagiba M, Gharabaghi A. Quality of Life After Vestibular Schwannoma Surgery: A Question of Perspective. Front Oncol 2022; 11:770789. [PMID: 35223451 PMCID: PMC8873590 DOI: 10.3389/fonc.2021.770789] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectiveHealth-related quality of life (HRQoL) and self-reported outcome measures have a relevant impact on the medical decision-making process. They capture either the current status and allow for multiple prospective evaluations in the course of a treatment or rely on the retrospective comparison of health of patients before and after an intervention to assess its benefit. Importantly, these patient-assessed measures may be influenced by psychological factors. We compared HRQoL and perceived benefit in the course of surgical vestibular schwannoma (VS) treatment, as assessed by the patients from a prospective and retrospective point-of-view, and evaluated the influence of co-morbid depression.MethodsWithin a prospective observational single-center study, forty-three patients with VS were investigated before and after retrosigmoid tumor resection. SF-36, Beck Depression Inventory and patient-assessed clinical symptoms were acquired before surgery and at follow-up. At follow-up, the Glasgow Benefit Inventory (GBI) was acquired as well.ResultsSF-36 scores were significantly lower than the age and sex matched normative data in six and three out of eight categories before and after surgery, respectively. Three categories improved significantly after vs. before surgery; one of them (global health) reached a minimal clinical important difference. In contrast, patients reported predominantly a deterioration, when asked for a retrospective evaluation of the benefit (i.e., GBI). Depression correlated with both SF-36 and GBI, determined dissatisfaction, improved significantly after surgery and was the measure that had the largest impact on HRQoL.ConclusionProspective and retrospective HRQoL measures may lead to different findings and can be confounded by psychological factors.
Collapse
|
6
|
Quality of life in patients of unilateral vestibular schwannoma treated with microsurgery: A South-Asian tertiary care Hospital experience. J Clin Neurosci 2021; 89:264-270. [PMID: 34119279 DOI: 10.1016/j.jocn.2021.04.034] [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: 10/18/2020] [Revised: 04/09/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022]
Abstract
Majority of the published literature on the impact of microsurgery over quality-of-life (QOL) in vestibular schwannoma (VS) patients is retrospective in nature, with variable results, and there has been very little contribution from South-Asia. The authors designed this study to investigate the role of microsurgery in QOL alterations in VS patients, and to compare obtained QOL scores with that of control population. Between February 2017 and March 2018, a prospective/retrospective study was done at our institute. Prospective and retrospective cohorts included, 30 and 34 consecutive patients, respectively, of unilateral VS undergoing microsurgery. QOL assessment was done using Short Form-36 (SF-36), and the Penn Acoustic Neuroma Quality-Of-Life (PANQOL) questionnaires. Prospective cohort underwent QOL assessment at 3 junctures - pre-surgery, 3-months & 1-year post-surgery; while retrospective cohort was assessed only once, at 1-year post-surgery. Age- & sex- matched normal population and diabetic patients were used as controls. In the prospective cohort, patients showed drop in all PANQOL domain/ SF-36 dimension scores at 3-month post-surgery, exception being vitality and general health in SF-36; showed improvement at 1-year follow-up, with majority either levelling or improving their respective pre-surgery scores. Gross total resection, tumors ≤ 3 cm, and age ≤ 45 years had better PANQOL scores at 1-year post-surgery across all the domains. Patients in both the cohorts showed worse QOL compared to normal population, but the gap got narrower at 1-year post-surgery. Our study adds a South-Asian perspective to the pool of prospective knowledge available on QOL following microsurgery in VS patients.
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Hentschel MA, Hannink G, Steens SCA, Mulder JJS, Rovers MM, Kunst HPM. Development of a model to predict vestibular schwannoma growth: An opportunity to introduce new wait and scan strategies. Clin Otolaryngol 2020; 46:273-283. [PMID: 33090707 PMCID: PMC7821120 DOI: 10.1111/coa.13661] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/02/2020] [Accepted: 10/10/2020] [Indexed: 12/23/2022]
Abstract
Objectives To develop a prediction model to predict vestibular schwannoma (VS) growth for patients in a wait and scan (W&S) strategy. Design Retrospective cohort study. Setting Tertiary hospital (Radboud university medical center, Nijmegen, the Netherlands). Participants Patients with unilateral VS, entering a W&S strategy and at least one follow‐up MRI available. Data on demographics, symptoms, audiometry and MRI characteristics at time of diagnosis were collected from medical records. Main outcome measures Following multiple imputation, a multivariable Cox regression model was used to select variables, using VS growth (≥2 mm) as outcome. Decision curve analyses (DCA) were performed to compare the model to the current strategy. Results Of 1217 analysed VS patients, 653 (53.7%) showed growth during follow‐up. Balance complaints (HR 1.57 (95% CI: 1.31‐1.88)) and tinnitus complaints in the affected ear (HR 1.36 (95% CI: 1.15‐1.61)), Koos grade (Koos 1 is reference, Koos 2 HR 1.03 (95% CI: 0.80‐1.31), Koos 3 HR 1.55 (95% CI: 1.16‐2.06), Koos 4 HR 2.18 (95% CI: 1.60‐2.96)), time since onset of symptoms (IQR HR 0.83 (95% CI: 0.77‐0.88) and intrameatal diameter on MRI (IQR HR 1.67 (95% CI: 1.42‐1.96)) were selected as significant predictors. The model's discrimination (Harrell's C) was 0.69 (95% CI: 0.67‐0.71), and calibration was good. DCA showed that the model has a higher net benefit than the current strategy for probabilities of VS growth of >12%, 15% and 21% for the first consecutive 3 years, respectively. Conclusions Patients with balance and tinnitus complaints, a higher Koos grade, short duration of symptoms and a larger intrameatal diameter at time of diagnosis have a higher probability of future VS growth. After external validation, this model may be used to inform patients about their prognosis, individualise the W&S strategy and improve (cost‐)effectiveness.
Collapse
Affiliation(s)
- Mayke A Hentschel
- Department of Otolaryngology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Stefan C A Steens
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Jef J S Mulder
- Department of Otolaryngology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.,Department of Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Henricus P M Kunst
- Department of Otolaryngology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.,Department of Otolaryngology, Maastricht UMC+, Maastricht, The Netherlands
| |
Collapse
|
9
|
Ros-Sanjuán Á, Iglesias-Moroño S, Troya-Castilla M, Márquez-Márquez B, Herruzo-Cabrera I, Arráez-Sánchez MÁ. LINAC radiosurgery treatment for vestibular schwannoma. Neurocirugia (Astur) 2019; 30:179-187. [PMID: 30770322 DOI: 10.1016/j.neucir.2018.12.005] [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: 11/18/2018] [Revised: 12/15/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aims of our study were to evaluate tumour response in a series of patients with vestibular schwannoma (VS) treated with linear accelerator stereotactic radiosurgery (LINAC-RS), to describe the complications and to analyze the variables associated with the response to treatment. MATERIAL AND METHODS This retrospective descriptive study included 64 patients treated from 2010 to 2016 with a minimum follow-up of one year, excluding patients with neurofibromatosis. Clinical-radiological parameters were evaluated. The treatment was performed using LINAC-RS. The prescribed dose was 12Gy at 90% isodose. RESULTS The mean age at treatment was 53 years, 56% were women. Ninety-eight percent of the patients had hearing loss, 71% with grade III according to the Gardner-Robertson Classification. The mean volume at treatment was 2.92cc and the mean follow-up, 40.95 months. The overall therapeutic success was 90%, reaching 100% at 12 and 24 months, and 86% after 36 months of follow-up. The radiological result was significantly related to the initial tumour volume (p<0.037). In 20 patients there was evidence of transient tumour growth compatible with pseudoprogression. Acute complications were present in 37.5%, and transitory complications in 50%. Chronic complications were found in 20%, with 84% being permanent. The rate of acute complications was lower in patients with regression (p<0.016). Chronic complications were more frequent in the 41-60 year old age group (p<0.040). CONCLUSIONS In our study, the overall tumour control was in accordance with other published series. The radiological result significantly related to the tumour volume at the commencement of treatment. The rate of acute complications was lower in patients with regression.
Collapse
Affiliation(s)
- Ángela Ros-Sanjuán
- Department of Neurosurgery, Regional University Hospital of Malaga, Malaga, Spain.
| | - Sara Iglesias-Moroño
- Department of Neurosurgery, Regional University Hospital of Malaga, Malaga, Spain
| | - Marta Troya-Castilla
- Department of Neurosurgery, Regional University Hospital of Malaga, Malaga, Spain
| | | | | | | |
Collapse
|