1
|
King AM, Cooper JN, Oganezova K, Mittal J, McKenna K, Godur DA, Zalta M, Danesh AA, Mittal R, Eshraghi AA. Vestibular Schwannoma and Tinnitus: A Systematic Review of Microsurgery Compared to Gamma Knife Radiosurgery. J Clin Med 2024; 13:3065. [PMID: 38892775 PMCID: PMC11173275 DOI: 10.3390/jcm13113065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Vestibular schwannoma (VS) is a benign tumor of the eighth cranial nerve formed from neoplastic Schwann cells. Although VS can cause a variety of symptoms, tinnitus is one of the most distressing symptoms for patients and can greatly impact quality of life. The objective of this systematic review is to comprehensively examine and compare the outcomes related to tinnitus in patients undergoing treatment for VS. Specifically, it evaluates patient experiences with tinnitus following the removal of VS using the various surgical approaches of traditional surgical resection and gamma knife radiosurgery (GKS). By delving into various aspects such as the severity of tinnitus post-treatment, the duration of symptom relief, patient quality of life, new onset of tinnitus after VS treatment, and any potential complications or side effects, this review aims to provide a detailed analysis of VS treatment on tinnitus outcomes. Methods: Following PRISMA guidelines, articles were included from PubMed, Science Direct, Scopus, and EMBASE. Quality assessment and risk of bias analysis were performed using a ROBINS-I tool. Results: Although VS-associated tinnitus is variable in its intensity and persistence post-resection, there was a trend towards a decreased tinnitus burden in patients. Irrespective of the surgical approach or the treatment with GKS, there were cases of persistent or worsened tinnitus within the studied cohorts. Conclusion: The findings of this systematic review highlight the complex relationship between VS resection and tinnitus outcomes. These findings underscore the need for individualized patient counseling and tailored treatment approaches in managing VS-associated tinnitus. The findings of this systematic review may help in guiding clinicians towards making more informed and personalized healthcare decisions. Further studies must be completed to fill gaps in the current literature.
Collapse
Affiliation(s)
- Ava M. King
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Jaimee N. Cooper
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Karina Oganezova
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Jeenu Mittal
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Keelin McKenna
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Dimitri A. Godur
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Max Zalta
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Ali A. Danesh
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
- Department of Communication Sciences and Disorders, Florida Atlantic University, Boca Raton, FL 33431, USA
- Department of Integrated Medical Sciences, Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Rahul Mittal
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Adrien A. Eshraghi
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33143, USA
| |
Collapse
|
2
|
Fontana V, Sinosi FA, Marchioni D, Masotto B. Transcanal transpromontorial approach for vestibular schwannoma: experience of a single center. Eur Arch Otorhinolaryngol 2024; 281:2679-2690. [PMID: 38519593 DOI: 10.1007/s00405-024-08565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/16/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The expanded transpromontorial transcanal approach (ExpTTA) represents a recent addition to the surgical approaches available for the treatment of vestibular schwannoma. An initial purely endoscopic version has been complemented by the use of the microscope and it is now one of the possible surgical options for small to medium-sized vestibular schwannomas with a predominantly intracanalar development. METHODS This is a series of 54 patients who underwent microsurgical resection of sporadic, unilateral vestibular schwannoma, mainly Koos I-II with non-serviceable hearing, between January 2016 and January 2023 using the expanded transcanal transpromontorial approach. We describe the surgical technique, focusing on anatomical landmarks, and analyzing its advantages and shortcomings. Retrospective analysis of clinical outcomes is presented, including early and late complications. The mean follow-up was 46.7 months. RESULTS We achieved gross total resection of the lesion in all cases, confirmed on the first follow-up MRI at least 6 months after each procedure. We did not record any intraoperative complication nor disease recurrence. We recorded two postoperative severe facial nerve palsies, one of which was permanent. No cases of disabling vertigo or imbalance were reported, and all patients reported full recovery of autonomy in daily activities. Three cases of otoliquorrhea were managed conservatively successfully. CONCLUSIONS The transcanal transpromontorial approach combines the advantages of endoscopy with the possibilities provided by microsurgery. Our experience confirms its safety in terms of surgical complications and facial nerve outcome. This approach is amongst the treatment options for small-medium schwannomas in patients with impaired hearing, especially in young patients, ensuring radical resection, disease control, and minimal morbidity.
Collapse
Affiliation(s)
- Vincenzo Fontana
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy, Ospedale Civile Maggiore Verona, Verona, Italy.
| | - F A Sinosi
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy, Ospedale Civile Maggiore Verona, Verona, Italy
| | - D Marchioni
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - B Masotto
- Posterior Cranial Fossa Unit, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Civile Maggiore Verona, Verona, Italy
| |
Collapse
|
3
|
El Sayed Ahmad Y, Gallois Y, Sol JC, Boetto S, Attal J, Sabatier J, Debs R, Deguine O, Marx M. Evolution in the management of vestibular schwannoma: a single-center 15-year experience. Eur Arch Otorhinolaryngol 2023; 280:4885-4894. [PMID: 37195345 DOI: 10.1007/s00405-023-08009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To highlight the changes in the management of vestibular schwannoma (VS) since 2004 with a focus on small- to middle-size VS. METHODS Retrospective analysis of the decisions made in skull base tumor board between 2004 and 2021. RESULTS 1819 decisions were analyzed (average age 59.25, 54% females). Overall, 850 (47%) cases were allocated to a Wait and Scan (WS) approach, 416 (23%) received radiotherapy and 553 (30%) were treated surgically (MS). All stages considered WS increased from 39% before 2010 to 50% after 2010. Similarly, Stereotactic Radio Therapy (SRT) increased from 5 to 18%. MS decreased from 46 to 25%. It was more commonly proposed to younger patients and larger tumors, p < 0.001. For Koos stages 1, 2, and 3 there was a statistically significant increase in SRT, and a decrease in MS, p < 0.001. WS also increased for stages 1 and 2. However, such a trend was not observed for stage 3. MS remained the primary treatment modality for stage 4 tumors throughout the study period, p = 0.057. The significance of advanced age as a factor favoring SRT decreased over time. The opposite is true for serviceable hearing. There was also a decrease in the percentage of the justification "young age" in the MS category. CONCLUSION The is a continuing trend towards non-surgical treatment. Small- to medium-sized VS witnessed an increase in both WS and SRT. There is only an increase in SRT for moderately large VS. Physicians are less and less considering young age as a factor favoring MS over SRT. There is a tendency towards favoring SRT when hearing is serviceable.
Collapse
Affiliation(s)
- Youssef El Sayed Ahmad
- Department of Otology, Otoneurology and Pediatric Otolaryngology, Pierre-Paul Riquet Hospital, Toulouse University hospital, Toulouse, France.
| | - Yohan Gallois
- Department of Otology, Otoneurology and Pediatric Otolaryngology, Pierre-Paul Riquet Hospital, Toulouse University hospital, Toulouse, France
| | | | - Sergio Boetto
- Neuro-Surgery Department, CHU de Toulouse, Purpan, 31000, Toulouse, France
| | - Justine Attal
- Radiotherapy Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Jean Sabatier
- Department of Neuroradiology, Purpan Hospital, Toulouse, France
| | - Rachel Debs
- Department of Neurology, Pierre-Paul Riquet/Purpan University Hospital, Toulouse, France
| | - Olivier Deguine
- Department of Otology, Otoneurology and Pediatric Otolaryngology, Pierre-Paul Riquet Hospital, Toulouse University hospital, Toulouse, France
| | - Mathieu Marx
- Department of Otology, Otoneurology and Pediatric Otolaryngology, Pierre-Paul Riquet Hospital, Toulouse University hospital, Toulouse, France
| |
Collapse
|
4
|
Jung S, Kim IY, Moon KS, Jung TY, Jang WY, Kim YJ, Lee TK, Park SJ, Lim SH. Distinct Specialized Center of Excellence, the Story of Hwasun Neurosurgery at Chonnam National University Hwasun Hospital. Brain Tumor Res Treat 2023; 11:94-102. [PMID: 37151151 PMCID: PMC10172013 DOI: 10.14791/btrt.2023.0005] [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: 03/07/2023] [Accepted: 03/21/2023] [Indexed: 05/09/2023] Open
Abstract
The paper provides a comprehensive overview of the growth and development of Hwasun Neurosurgery at Chonnam National University Hwasun Hospital over the past 18 years. As the first brain tumor center in Korea when it was established in April 2004, Hwasun Neurosurgery has since become one of the leading institutions in brain tumor education and research in the country. Its impressive clinical and basic research capabilities, dedication to professional education, and numerous academic achievements have all contributed to its reputation as a top-tier institution. We hope this will become a useful guide for other brain tumor centers or educational institutions by sharing the story of Hwasun Neurosurgery.
Collapse
Affiliation(s)
- Shin Jung
- Department of Neurosurgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, Korea.
| | - In-Young Kim
- Department of Neurosurgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Woo-Youl Jang
- Department of Neurosurgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yeong Jin Kim
- Department of Neurosurgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Tae-Kyu Lee
- Department of Neurosurgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Sue Jee Park
- Department of Neurosurgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Sa-Hoe Lim
- Department of Neurosurgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, Korea
| |
Collapse
|
5
|
Aman RA, Petonengan DAA, Hafif M, Santoso F. Hearing Preservation, Facial Nerve Dysfunction, and Tumor Control in Small Vestibular Schwannoma: A Systematic Review of Gamma Knife Radiosurgery Versus Microsurgery. J Clin Neurol 2023; 19:304-311. [PMID: 36647227 PMCID: PMC10169925 DOI: 10.3988/jcn.2022.0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND PURPOSE Vestibular schwannoma (VS) is the most common type of tumor found in the cerebellopontine angle that accounts for 8% of all intracranial tumors. VS management is currently a challenge due to the unpredictable nature of the tumor. Few studies have compared the results and complications of various therapeutic approaches to VS. Therefore, as a treatment option for VSs smaller than 25 mm, we conducted a systematic review to compare Gamma Knife radiosurgery (GKRS) with conventional surgery. METHODS Literature searches were conducted of four online databases (PubMed, Google Scholar, Cochrane, and ScienceDirect) using the following keyword search: ("vestibular schwannoma" OR "acoustic neuroma") AND ("gamma knife" OR "gamma knife radiosurgery") AND ("resection" OR "open surgery") AND ("hearing preservation" OR "facial nerve" OR "tumor growth"). RESULTS We identified six retrospective cohort studies, five of which were of fair-to-good quality. All studies showed that GKRS was superior to surgery in hearing preservation. Two studies indicated that surgery was superior to GKRS in maintaining tumor control, one indicated that GKRS was superior, and the remainder indicated that there was no significant difference in maintaining tumor control between GKRS and microsurgery. CONCLUSIONS Based on the three outcomes chosen for this review, GKRS was superior to microsurgery in small VS.
Collapse
Affiliation(s)
- Renindra Ananda Aman
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jakarta, Indonesia.
| | - Don Augusto Alexandro Petonengan
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jakarta, Indonesia
| | - Muhammad Hafif
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jakarta, Indonesia
| | - Fabianto Santoso
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jakarta, Indonesia
| |
Collapse
|
6
|
Jakubeit T, Sturtz S, Sow D, Groß W, Mosch C, Patt M, Weingärtner V, Boström J, Goldbrunner R, Markes M. Single-fraction stereotactic radiosurgery versus microsurgical resection for the treatment of vestibular schwannoma: a systematic review and meta-analysis. Syst Rev 2022; 11:265. [PMID: 36503553 PMCID: PMC9743510 DOI: 10.1186/s13643-022-02118-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 11/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Vestibular schwannomas are benign tumours for which various treatments are available. We performed a systematic review of prospective controlled trials comparing the patient-relevant benefits and harms of single-fraction stereotactic radiosurgery (sfSRS) with microsurgical resection (MR) in patients with vestibular schwannoma. METHODS We searched for randomized controlled trials (RCTs) and non-randomized prospective controlled trials in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and study registries (last search: 09/2021) and also screened reference lists of relevant systematic reviews. Manufacturers were asked to provide unpublished data. Eligible studies investigated at least one patient-relevant outcome. We assessed the risk of bias (high or low) at the study and outcome level. If feasible, meta-analyses were performed. We graded the results into different categories (hint, indication, or proof of greater benefit or harm). RESULTS We identified three non-randomized prospective controlled trials of generally low quality with evaluable data on 339 patients with unilateral vestibular schwannoma. There was an indication of greater benefit of sfSRS compared with MR for facial palsy (OR 0.06, 95% CI 0.02-0.21, p < 0.001, 2 studies), hearing function (no pooled estimate available, 2 studies), and length of hospital stay (no pooled estimate available, 2 studies). We found no clinically relevant differences for mortality, vertigo, headaches, tinnitus, balance function, work disability, adverse events, and health-related quality of life. CONCLUSIONS Our systematic review indicates that sfSRS has greater benefits than MR in patients with unilateral vestibular schwannoma. However, it is unclear whether this conclusion still holds after 2 years, as long-term studies are lacking. It is also unclear whether the effects of sfSRS are similar in patients with bilateral vestibular schwannomas. Long-term prospective studies including patients with this condition would therefore be useful. SYSTEMATIC REVIEW REGISTRATION The full (German language) protocol and report (Commission No. N20-03) are available on the institute's website: www.iqwig.de/en/projects/n20-03.html.
Collapse
Affiliation(s)
- Thomas Jakubeit
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Sibylle Sturtz
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Dorothea Sow
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Wolfram Groß
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Christoph Mosch
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Mattea Patt
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Vera Weingärtner
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Jan Boström
- Department of Radiosurgery and Stereotactic Radiotherapy, MediClin Robert Janker Clinic and MediClin MVZ Bonn, Bonn, Germany
- Gamma Knife Zentrum Bochum, Department of Radiotherapy and Radio-Oncology, Universitätsklinikum Marien Hospital Herne, Bochum, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Martina Markes
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| |
Collapse
|
7
|
Smith H, Odeh A, Kallogjeri D, Piccirillo JF. Decision Making for Active Surveillance in Vestibular Schwannoma. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e022. [PMID: 38516575 PMCID: PMC10950155 DOI: 10.1097/ono.0000000000000022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 03/23/2024]
Abstract
Objective To describe the experiences of patients who elected for the active surveillance treatment option for their vestibular schwannoma (VS). Study Design Twenty-two patients participated in semistructured patient interviews. Setting Interviews were conducted between March and April 2021 via telephone with audio recordings and notes taken during each interview. Patients Adults diagnosed with a VS and at any point after their diagnosis underwent a period of active surveillance were recruited based on the diagnosis made by MRI. Patients were excluded if they chose to undergo treatment immediately, had a diagnosis of neurofibromatosis type 2, or if they had a confirmed alternative diagnosis. Intervention This intervention was a qualitative interview to assess patient experiences with their VS treatment decision. Main Outcome Measures Identifying abstract categories that represent many of the stories told by the participants that produces a theory grounded in the data with explanatory power. Results Factors that influenced patients' treatment decisions were perceived physician bias, selfeducation, and personal accounts of VS patients through support groups, and side effects/complications of the various treatment options. Conclusion Patients who opted for active surveillance as a treatment option reported high satisfaction with their decision and greater confidence in future treatments that would be necessary based on tumor growth. Future work should be done to increase shared decision making between the physician and patient to arrive at a treatment plan that aligns with their goals of care as well as potentially reducing overtreatment of VS.
Collapse
Affiliation(s)
- Harrison Smith
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai/New York Eye and Ear, New York, NY
| | - Ahmad Odeh
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology, Head and Neck Surgery, Washington University in St. Lous, Missouri
| | - Jay F. Piccirillo
- Department of Otolaryngology, Head and Neck Surgery, Washington University in St. Lous, Missouri
| |
Collapse
|
8
|
Smith HJ, Durakovic N, Patel B, Varagur K, Gupta S, Khan AM, Kallogjeri D, Kim AH, Piccirillo JF, Buchman CA. Clinical Staging to Estimate the Probability of Severe Postoperative Complications in Patients With Vestibular Schwannoma. JAMA Otolaryngol Head Neck Surg 2021; 147:991-998. [PMID: 34617972 DOI: 10.1001/jamaoto.2021.2626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Vestibular schwannomas have long been treated as a homogeneous entity. Clinical symptoms at presentation may help elucidate the underlaying pathophysiologic characteristics of tumor subtypes. Describing the heterogeneity of these benign tumors may assist in predicting clinical outcomes associated with their treatment. Objective To create a tumor staging system that incorporates symptoms at presentation and tumor size to predict severe surgical complications. Design, Setting, and Participants A retrospective cohort of patients at a single-center tertiary referral center from January 1, 1998, to October 13, 2020, was studied. Patients diagnosed with sporadic vestibular schwannoma surgically treated at Washington University in St Louis, Missouri, were included. Main Outcomes and Measures Severe surgical complications within 30 days of surgery as determined by the Clavien-Dindo classification system. Patients experiencing a complication of grade 3 or above were determined to have a severe complication. Results Of 185 patients evaluated, 40 (22%) had severe postoperative complications. Twenty of the 40 patients (50%) were women; mean (SD) age was 46 (13) years. Patients with severe complications were more likely to have large tumors (>2.5 cm in largest diameter), vestibular symptoms, and recent hearing loss at presentation. Using conjunctive consolidation, a 4-stage clinical severity staging system that incorporates clinical symptoms and tumor size at presentation was created to predict severe complications. The clinical severity staging system demonstrated an improvement in the ability to discriminate severe complications (C index, 0.754; 95% CI, 0.67-0.84) from a model of tumor size alone (C index, 0.706; 95% CI 0.62-0.79). Conclusions and Relevance This cohort study found that, among patients with vestibular schwannoma, symptoms present at initial evaluation, in addition to tumor size, served as predictors of severe postoperative complications. A new clinical severity staging system incorporating symptoms at presentation can be helpful for clinicians to identify patients at high risk for severe postoperative complications.
Collapse
Affiliation(s)
| | - Nedim Durakovic
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Bhuvic Patel
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Kaamya Varagur
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Shruti Gupta
- Medical student, Medical College of Georgia, Augusta
| | - Amish M Khan
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.,Statistics Editor, JAMA Otolaryngology-Head & Neck Surgery.,Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Albert H Kim
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.,Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.,Editor, JAMA Otolaryngology-Head & Neck Surgery
| | - Craig A Buchman
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| |
Collapse
|
9
|
The Natural History of Vestibular Schwannoma and When to Intervene. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00337-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
10
|
Barnes JH, Patel NS, Lohse CM, Tombers NM, Link MJ, Carlson ML. Impact of Treatment on Vestibular Schwannoma-Associated Symptoms: A Prospective Study Comparing Treatment Modalities. Otolaryngol Head Neck Surg 2021; 165:458-464. [PMID: 33494647 DOI: 10.1177/0194599820986564] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The degree to which various treatment modalities modify vestibular schwannoma (VS)-associated symptoms has received limited attention. The purpose of this study was to determine how different treatment modalities affect subjective symptoms in those presenting with VS. STUDY DESIGN Prospective survey. SETTING Tertiary neurotology referral center. METHODS Patients with sporadic VS who received treatment at our institution were prospectively surveyed with a VS symptom questionnaire. Those who completed a baseline survey prior to treatment and at least 1 posttreatment survey were included. The prospective survey evaluated the severity of self-reported symptoms (Likert scale, 1-10), including tinnitus, dizziness or imbalance, headaches, and hearing loss. RESULTS A total of 244 patients were included (mean age, 57 years). The mean duration of follow-up was 2.1 years, and the median number of surveys completed was 2 (interquartile range, 1-3). Seventy-eight (32%) cases were managed with observation, 118 (48%) with microsurgery, and 48 (20%) with radiosurgery. Multivariable analyses revealed no statistically significant difference in the change in tinnitus (P = .15), dizziness or imbalance (P = 0.66), or headaches (P = .24) among treatment groups. Evaluation of clinically important differences demonstrated that microsurgery leads to significant bidirectional changes in headaches. CONCLUSIONS Limited prospective data exist regarding the progression or resolution of subjective symptoms in those presenting with VS. This study suggests that tinnitus, dizziness or imbalance, and headaches are unlikely to be significantly modified by treatment modality and generally should not be used to direct treatment choice.
Collapse
Affiliation(s)
- Jason H Barnes
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Neil S Patel
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Christine M Lohse
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicole M Tombers
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|