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Silva VAR, Lavinsky J, Pauna HF, Vianna MF, Santos VM, Ikino CMY, Sampaio ALL, Tardim Lopes P, Lamounier P, Maranhão ASDA, Soares VYR, Polanski JF, Denaro MMDC, Chone CT, Bento RF, Castilho AM. Brazilian Society of Otology task force - Vestibular Schwannoma ‒ evaluation and treatment. Braz J Otorhinolaryngol 2023; 89:101313. [PMID: 37813009 PMCID: PMC10563065 DOI: 10.1016/j.bjorl.2023.101313] [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: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE To review the literature on the diagnosis and treatment of vestibular schwannoma. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. CONCLUSIONS Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO
| | - Joel Lavinsky
- Sociedade Brasileira de Otologia - SBO; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Ciências Morfológicas, Porto Alegre, RS, Brazil
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Melissa Ferreira Vianna
- Sociedade Brasileira de Otologia - SBO; Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Vanessa Mazanek Santos
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Cláudio Márcio Yudi Ikino
- Universidade Federal de Santa Catarina, Hospital Universitário, Departamento de Cirurgia, Florianópolis, SC, Brazil
| | - André Luiz Lopes Sampaio
- Sociedade Brasileira de Otologia - SBO; Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Paula Tardim Lopes
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Pauliana Lamounier
- Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), Departamento de Otorrinolaringologia, Goiânia, GO, Brazil
| | - André Souza de Albuquerque Maranhão
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Vitor Yamashiro Rocha Soares
- Hospital Flavio Santos e Hospital Getúlio Vargas, Grupo de Otologia e Base Lateral do Crânio, Teresina, PI, Brazil
| | - José Fernando Polanski
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil; Faculdade Evangélica Mackenzie do Paraná, Faculdade de Medicina, Curitiba, PR, Brazil
| | | | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Ricardo Ferreira Bento
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO.
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Song M, Wang D, Li J, Chen G, Zhang X, Wang H, Wang Q. Sudden sensorineural hearing loss as the initial symptom in patients with acoustic neuroma. Front Neurol 2022; 13:953265. [PMID: 36061993 PMCID: PMC9430658 DOI: 10.3389/fneur.2022.953265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Previous studies have shown that patients with acoustic neuroma (AN) sometimes present with sudden sensorineural hearing loss (SSNHL) as an initial symptom. The purpose of this research was to investigate the clinical characteristics, diagnosis, and treatment of AN in patients initially diagnosed with SSNHL. Materials and methods We reviewed retrospectively the medical records of all patients who were treated as SSNHL initially and were later diagnosed with AN after undergoing magnetic resonance imaging (MRI) at our hospital between 2008 and 2021. Patient demographics, associated complaints (mostly tinnitus and vertigo), the severity of hearing loss, audiogram configurations, auditory brainstem response (ABR), and MRI examination were reviewed and analyzed. In addition, treatment outcomes and management protocols were also included in this study. Results A total of 10 (0.7%, 10/1,383) patients presented with SSNHL as the initial symptom and were diagnosed as AN by MRI finally. Of the 10 patients enrolled in this study, four were men and six were women. The average age at the time of diagnosis of SSNHL was 46.2 ± 13.16 years. These patients exhibited varying severity of hearing loss and a variety of audiogram configurations. All patients showed an abnormal ABR. According to the Koos grading standard, there were 5 grade I (intracanalicular [IAC]) tumors, 3 grade II tumors, and 2 grade III tumors. The treatment outcome revealed that 2 patients exhibited recovery of the average hearing of impaired frequency by more than 15 dB, and 6 patients showed no recovery. Furthermore, four patients were referred to undergo surgical treatment after being diagnosed with AN, 1 patient accepted stereotactic radiation therapy, and the remaining 5 patients were on a “wait and scan” strategy. Conclusion The hearing loss of patients with AN presented with SSNHL may improve with drug treatment. Hearing recovery for SSNHL does not exclude the presence of AN, and all patients initially diagnosed with SSNHL should undergo MRI and ABR to prevent misdiagnosis and delays in potential treatment.
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Affiliation(s)
- Mengtao Song
- College of Otolaryngology, Head and Neck Surgery, Institute of Otolaryngology, Chinese People's Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Dayong Wang
- College of Otolaryngology, Head and Neck Surgery, Institute of Otolaryngology, Chinese People's Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Jin Li
- College of Otolaryngology, Head and Neck Surgery, Institute of Otolaryngology, Chinese People's Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Guohui Chen
- College of Otolaryngology, Head and Neck Surgery, Institute of Otolaryngology, Chinese People's Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Xiaolong Zhang
- College of Otolaryngology, Head and Neck Surgery, Institute of Otolaryngology, Chinese People's Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Hongyang Wang
- College of Otolaryngology, Head and Neck Surgery, Institute of Otolaryngology, Chinese People's Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Hongyang Wang
| | - Qiuju Wang
- College of Otolaryngology, Head and Neck Surgery, Institute of Otolaryngology, Chinese People's Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- *Correspondence: Qiuju Wang
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Wang L, Zhang X, Zhao M, Wang Q. Assessment of epidermoid cyst with trigeminal neuralgia before neuroendoscopy: A high-resolution MR study based on 3D-FIESTA and MR angiography. Clin Imaging 2022; 91:9-13. [PMID: 35973272 DOI: 10.1016/j.clinimag.2022.08.006] [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: 03/19/2022] [Revised: 06/29/2022] [Accepted: 08/07/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the value of preoperative 3D-FIESTA and MR angiography (MRA) in endoscopic resection of epidermoid cysts presenting with trigeminal neuralgia (TN). METHODS 3D-FIESTA and MRA were performed before neuroendoscopy in 32 cases of epidermoid cysts with TN, and the tumors were grouped into types A, B, C, and D according to the relationship between the tumor and adjacent nerves and arteries (Hitoshi Kobata's classification). Evaluation of the neuroendoscopic resectability of different types of tumors, included gross total tumor removal (GTR), subtotal tumor removal (STR), and partial tumor removal (PTR). During the 5-year follow-up, symptoms were assessed based on facial pain relief using the Barrow Neurological Institute (BNI) score. RESULTS The coincidence rate between MRI classification of the tumor and the operation was 100%. Type B tumors were the most common (18/32, 56.3%). Type A tumors showed the highest resectability (9/9, 100%), followed by type B tumors (14/18, 77.8%). Moreover, microvascular decompression was performed in all 4 cases of type C and 1 case of type D tumors. During follow-up, 23 patients showed marked improvement in symptoms (15, 8 of BNI I or II), 8 cases showed partial improvement (BNI III), and only 1 case of type C tumor was associated with poor facial pain relief, which recurred 5 years later (BNI IV). CONCLUSIONS Preoperative high-resolution MR can accurately analyze the relationship between epidermoid cysts and adjacent nerves and arteries. It could act as a powerful tool in the evaluation of tumor resectability and the prognosis of surgery.
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Affiliation(s)
- Long Wang
- Department of Radiology, Jining No. 1 People's Hospital, Six Jiankang Road, Jining, China
| | - Xiaoming Zhang
- Department of Radiology, Qilu Hospital of Shandong University, No.107 Wenhuaxi Road, Jinan, China
| | - Meng Zhao
- Department of Radiology, Qilu Hospital of Shandong University, No.107 Wenhuaxi Road, Jinan, China
| | - Qian Wang
- Department of Radiology, Qilu Hospital of Shandong University, No.107 Wenhuaxi Road, Jinan, China.
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Zidan MA, Almansor N. Presence of vascular loop in patients with audio-vestibular symptoms: is it a significant finding? Evaluation with 3-tesla MRI 3D constructive interference steady state (CISS) sequence. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00238-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Inner ear MRI: Is it always useful to manage intravenous contrast? RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
PURPOSE OF REVIEW Of the tumors found in the cerebellopontine angle (CPA), vestibular schwannomas are by far the most common. Modern diagnostic imaging enables excellent visualization of the CPA and detection of very small tumors while optimizing patient comfort and time. This review addresses the current imaging tools available for diagnosis of vestibular schwannomas. RECENT FINDINGS The current gold-standard imaging study for vestibular schwannomas is a gadolinium-enhanced T1-weighted MRI. The yield of this expensive study is only about 3-4% given the low incidence of vestibular schwannomas, thus there is utility in screening with noncontrast T2-weighted MRI, which is a quicker and more economical study. SUMMARY Vestibular schwannomas are best evaluated with gadolinium-enhanced T1-weighted MRI, which can detect tumors as small as 2-3 mm. Recent studies have found that the reported sensitivity and specificity of noncontrast MRI is almost equivalent to that of gadolinium-enhanced T1-weighted MRI. As such, this modality is increasingly being adopted by institutions for both diagnosis and surveillance of vestibular schwannomas and shows promise for broader implementation. Newer protocols, such as FLAIR and DTI may provide additional information and further aid preoperative counseling and surgical planning in the future.
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Uetani H, Nakaura T, Kitajima M, Yamashita Y, Hamasaki T, Tateishi M, Morita K, Sasao A, Oda S, Ikeda O, Yamashita Y. A preliminary study of deep learning-based reconstruction specialized for denoising in high-frequency domain: usefulness in high-resolution three-dimensional magnetic resonance cisternography of the cerebellopontine angle. Neuroradiology 2020; 63:63-71. [PMID: 32794075 DOI: 10.1007/s00234-020-02513-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Deep learning-based reconstruction (DLR) has been developed to reduce image noise and increase the signal-to-noise ratio (SNR). We aimed to evaluate the efficacy of DLR for high spatial resolution (HR)-MR cisternography. METHODS This retrospective study included 35 patients who underwent HR-MR cisternography. The images were reconstructed with or without DLR. The SNRs of the CSF and pons, contrast of the CSF and pons, and sharpness of the normal-side trigeminal nerve using full width at half maximum (FWHM) were compared between the two image types. Noise quality, sharpness, artifacts, and overall image quality of these two types of images were qualitatively scored. RESULTS The SNRs of the CSF and pons were significantly higher with DLR than without DLR (CSF 21.81 ± 7.60 vs. 15.33 ± 4.03, p < 0.001; pons 5.96 ± 1.38 vs. 3.99 ± 0.48, p < 0.001). There were no significant differences in the contrast of the CSF and pons (p = 0.225) and sharpness of the normal-side trigeminal nerve using FWHM (p = 0.185) without and with DLR, respectively. Noise quality and the overall image quality were significantly higher with DLR than without DLR (noise quality 3.95 ± 0.19 vs. 2.53 ± 0.44, p < 0.001; overall image quality 3.97 ± 0.17 vs. 2.97 ± 0.12, p < 0.001). There were no significant differences in sharpness (p = 0.371) and artifacts (p = 1) without and with DLR. CONCLUSION DLR can improve the image quality of HR-MR cisternography by reducing image noise without sacrificing contrast or sharpness.
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Affiliation(s)
- Hiroyuki Uetani
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan.
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan
| | - Mika Kitajima
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan
| | - Yuichi Yamashita
- Canon Medical Systems Corporation, MRI Sales Department, Sales Engineer Group, 70-1, Yanagi-cho, Saiwai-ku, Kawasaki-shi, Kanagawa, 212-0015, Japan
| | - Tadashi Hamasaki
- Department of Diagnostic, Neurosurgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan
| | - Machiko Tateishi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan
| | - Kosuke Morita
- Department of Radiology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan
| | - Akira Sasao
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan
| | - Osamu Ikeda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan
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Basura GJ, Adams ME, Monfared A, Schwartz SR, Antonelli PJ, Burkard R, Bush ML, Bykowski J, Colandrea M, Derebery J, Kelly EA, Kerber KA, Koopman CF, Kuch AA, Marcolini E, McKinnon BJ, Ruckenstein MJ, Valenzuela CV, Vosooney A, Walsh SA, Nnacheta LC, Dhepyasuwan N, Buchanan EM. Clinical Practice Guideline: Ménière's Disease. Otolaryngol Head Neck Surg 2020; 162:S1-S55. [PMID: 32267799 DOI: 10.1177/0194599820909438] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies. PURPOSE The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.
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Affiliation(s)
| | | | | | | | | | | | - Matthew L Bush
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Julie Bykowski
- University of California San Diego, San Diego, California, USA
| | - Maria Colandrea
- Duke University School of Nursing and Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | | | | | - Kevin A Kerber
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | | | | | - Evie Marcolini
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brian J McKinnon
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | - Sandra A Walsh
- Consumers United for Evidence-Based Healthcare, Baltimore, Maryland, USA
| | - Lorraine C Nnacheta
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | - Erin M Buchanan
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
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Sepúlveda Villegas CA, Santos Armentia E, Utrera Pérez E, Jurado Basildo C, Novoa Ferro M, Del Campo Estepar S. Inner ear MRI: is it always useful to manage intravenous contrast? RADIOLOGIA 2020; 62:376-383. [PMID: 32089257 DOI: 10.1016/j.rx.2020.01.002] [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: 08/28/2019] [Revised: 12/30/2019] [Accepted: 01/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the added value of administering intravenous contrast (IVC) routinely to the MRI of patients with audiovestibular symptoms in the assessment of a neuroradiologist and a resident. MATERIALS AND METHODS Retrospective study including patients who had an inner ear MRI for two months. Two radiologists reviewed independently and blinded the images. A first assessment was made analyzing just the sequences acquired without contrast and then a second evaluation of all the sequences, including post-contrast T1 sequences. The interobserver correlation and the correlation between MRI findings and the reason for requesting the study were calculated. RESULTS 40 patients were included. The range age was 36-80 years. The most frequent reason for request the MRI was hearing loss (52.5%). Neuroradiologist without IVC found 82.5% of extraotic pathology and 17.5% of otic pathology, highlighting the neurinoma of the VIII pair (7.5%); ossifying labyrinthitis, retrofenestrated otosclerosis and cholesteatoma. After IVC administration, findings were similar. The resident identified otic pathology in 5% in baseline sequences and 20% using CIV. The interobserver correlation using IVC was excellent (0.97), but weak without IVC (0.52). There was a correlation between the reasons for request the MRI and the findings in the ears, both in protocols without IVC (p = 0.004) and in protocols with IVC (p = 0.002). CONCLUSION Inner ear MRI without contrast gives relevant information to assess audiovestibular symptoms. The use of IVC increases the degree of confidence in a novel radiologist, while in the expert its use is less relevant. A protocol should be proposed in which gadolinium is used in selected patients.
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Affiliation(s)
| | - E Santos Armentia
- Departamento de Radiología, Hospital Povisa, Vigo, Pontevedra, España
| | - E Utrera Pérez
- Departamento de Radiología, Hospital Povisa, Vigo, Pontevedra, España
| | - C Jurado Basildo
- Departamento de Radiología, Hospital Povisa, Vigo, Pontevedra, España
| | - M Novoa Ferro
- Departamento de Radiología, Hospital Povisa, Vigo, Pontevedra, España
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Non-contrast Magnetic Resonance Imaging for Diagnosis and Monitoring of Vestibular Schwannomas: A Systematic Review and Meta-analysis. Otol Neurotol 2019; 40:1126-1133. [DOI: 10.1097/mao.0000000000002416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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