1
|
Nernekli K, Persad AR, Hori YS, Yener U, Celtikci E, Sahin MC, Sozer A, Sozer B, Park DJ, Chang SD. Automatic Segmentation of Vestibular Schwannomas: A Systematic Review. World Neurosurg 2024; 188:35-44. [PMID: 38685346 DOI: 10.1016/j.wneu.2024.04.145] [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: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Vestibular schwannomas (VSs) are benign tumors often monitored over time, with measurement techniques for assessing growth rates subject to significant interobserver variability. Automatic segmentation of these tumors could provide a more reliable and efficient for tracking their progression, especially given the irregular shape and growth patterns of VS. METHODS Various studies and segmentation techniques employing different Convolutional Neural Network architectures and models, such as U-Net and convolutional-attention transformer segmentation, were analyzed. Models were evaluated based on their performance across diverse datasets, and challenges, including domain shift and data sharing, were scrutinized. RESULTS Automatic segmentation methods offer a promising alternative to conventional measurement techniques, offering potential benefits in precision and efficiency. However, these methods are not without challenges, notably the "domain shift" that occurs when models trained on specific datasets underperform when applied to different datasets. Techniques such as domain adaptation, domain generalization, and data diversity were discussed as potential solutions. CONCLUSIONS Accurate measurement of VS growth is a complex process, with volumetric analysis currently appearing more reliable than linear measurements. Automatic segmentation, despite its challenges, offers a promising avenue for future investigation. Robust well-generalized models could potentially improve the efficiency of tracking tumor growth, thereby augmenting clinical decision-making. Further work needs to be done to develop more robust models, address the domain shift, and enable secure data sharing for wider applicability.
Collapse
Affiliation(s)
- Kerem Nernekli
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Amit R Persad
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Yusuke S Hori
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Ulas Yener
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Emrah Celtikci
- Department of Neurosurgery, Gazi University, Ankara, Turkey
| | | | - Alperen Sozer
- Department of Neurosurgery, Gazi University, Ankara, Turkey
| | - Batuhan Sozer
- Department of Neurosurgery, Gazi University, Ankara, Turkey
| | - David J Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
2
|
Ruiz-García C, Lassaletta L, López-Larrubia P, Varela-Nieto I, Murillo-Cuesta S. Tumors of the nervous system and hearing loss: Beyond vestibular schwannomas. Hear Res 2024; 447:109012. [PMID: 38703433 DOI: 10.1016/j.heares.2024.109012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
Hearing loss is a common side effect of many tumor treatments. However, hearing loss can also occur as a direct result of certain tumors of the nervous system, the most common of which are the vestibular schwannomas (VS). These tumors arise from Schwann cells of the vestibulocochlear nerve and their main cause is the loss of function of NF2, with 95 % of cases being sporadic and 5 % being part of the rare neurofibromatosis type 2 (NF2)-related Schwannomatosis. Genetic variations in NF2 do not fully explain the clinical heterogeneity of VS, and interactions between Schwann cells and their microenvironment appear to be critical for tumor development. Preclinical in vitro and in vivo models of VS are needed to develop prognostic biomarkers and targeted therapies. In addition to VS, other tumors can affect hearing. Meningiomas and other masses in the cerebellopontine angle can compress the vestibulocochlear nerve due to their anatomic proximity. Gliomas can disrupt several neurological functions, including hearing; in fact, glioblastoma multiforme, the most aggressive subtype, may exhibit early symptoms of auditory alterations. Besides, treatments for high-grade tumors, including chemotherapy or radiotherapy, as well as incomplete resections, can induce long-term auditory dysfunction. Because hearing loss can have an irreversible and dramatic impact on quality of life, it should be considered in the clinical management plan of patients with tumors, and monitored throughout the course of the disease.
Collapse
Affiliation(s)
- Carmen Ruiz-García
- Department of Otorhinolaryngology, La Paz University Hospital. Paseo La Castellana 261, Madrid 28046, Spain; Research in Otoneurosurgery. Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Universidad Autónoma de Madrid), Paseo La Castellana 261, Madrid 28046, Spain; Neuropathology of Hearing and Myelinopathies, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM. Arturo Duperier 4, Madrid 28029, Spain; PhD Program in Medicine and Surgery, Autonomous University of Madrid, Madrid, Spain
| | - Luis Lassaletta
- Department of Otorhinolaryngology, La Paz University Hospital. Paseo La Castellana 261, Madrid 28046, Spain; Research in Otoneurosurgery. Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Universidad Autónoma de Madrid), Paseo La Castellana 261, Madrid 28046, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Monforte de Lemos 9-11, Madrid 28029, Spain
| | - Pilar López-Larrubia
- Biomedical Magnetic Resonance, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM. Arturo Duperier 4, Madrid 28029, Spain
| | - Isabel Varela-Nieto
- Research in Otoneurosurgery. Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Universidad Autónoma de Madrid), Paseo La Castellana 261, Madrid 28046, Spain; Neuropathology of Hearing and Myelinopathies, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM. Arturo Duperier 4, Madrid 28029, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Monforte de Lemos 9-11, Madrid 28029, Spain.
| | - Silvia Murillo-Cuesta
- Research in Otoneurosurgery. Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Universidad Autónoma de Madrid), Paseo La Castellana 261, Madrid 28046, Spain; Neuropathology of Hearing and Myelinopathies, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM. Arturo Duperier 4, Madrid 28029, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Monforte de Lemos 9-11, Madrid 28029, Spain.
| |
Collapse
|
3
|
Kocharyan A, Daher GS, Curry SD, Klimara MJ, Farrokhian N, Coleman S, Oleson J, Manzoor NF, Carlson ML. Outcomes of Near-Total and Subtotal Resection of Sporadic Vestibular Schwannoma: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2024. [PMID: 38822753 DOI: 10.1002/ohn.823] [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: 12/03/2023] [Revised: 03/25/2024] [Accepted: 04/06/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE To evaluate tumor control and facial nerve outcomes after gross-total (GTR), near-total (NTR), and subtotal resection (STR) of sporadic vestibular schwannomas (VS). DATA SOURCES PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases were searched in August 2021 through inception following PRISMA guidelines. REVIEW METHODS English language articles reporting tumor control and facial nerve outcomes of adults (≥18 years) with NTR and STR of VS were evaluated. Study characteristics, demographics data, tumor characteristics, type of surgical intervention, and outcome measures on tumor control and facial nerve function were collected. Pooled relative risk (RR) estimates for tumor recurrence and facial nerve outcomes were calculated and stratified by extent of resection. RESULTS From an initial search of 2504 articles, 48 studies were included in the analysis. When comparing 1108 patients who underwent NTR to 3349 patients with GTR, the pooled RR of recurrence in the NTR cohort was 2.94 (95% confidence interval [CI] 1.65-5.24, P = .0002). When comparing 1016 patients who underwent STR to 6171 patients with GTR, the pooled RR of recurrence in the STR cohort was 11.50 (95% CI 6.64-19.92, P < .0001). Estimates for risk of tumor regrowth for less-than-complete resection are presented. There was no elevated risk of adverse facial nerve outcome (defined as House-Brackmann grade III and above) in each category of extent of resection compared to GTR. CONCLUSION Extent of resection predicts risk of tumor recurrence/regrowth following microsurgical resection. Favorable facial nerve outcome should be weighed against the increased risk of regrowth and the potential need for further treatment.
Collapse
Affiliation(s)
| | - Ghazal S Daher
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Miles J Klimara
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
| | - Nathan Farrokhian
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sarah Coleman
- Department of Biostatistics, The University of Iowa, Iowa City, Iowa, USA
| | - Jacob Oleson
- Department of Biostatistics, The University of Iowa, Iowa City, Iowa, USA
| | - Nauman F Manzoor
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
4
|
Kujawa A, Dorent R, Connor S, Thomson S, Ivory M, Vahedi A, Guilhem E, Wijethilake N, Bradford R, Kitchen N, Bisdas S, Ourselin S, Vercauteren T, Shapey J. Deep learning for automatic segmentation of vestibular schwannoma: a retrospective study from multi-center routine MRI. Front Comput Neurosci 2024; 18:1365727. [PMID: 38784680 PMCID: PMC11111906 DOI: 10.3389/fncom.2024.1365727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Automatic segmentation of vestibular schwannoma (VS) from routine clinical MRI has potential to improve clinical workflow, facilitate treatment decisions, and assist patient management. Previous work demonstrated reliable automatic segmentation performance on datasets of standardized MRI images acquired for stereotactic surgery planning. However, diagnostic clinical datasets are generally more diverse and pose a larger challenge to automatic segmentation algorithms, especially when post-operative images are included. In this work, we show for the first time that automatic segmentation of VS on routine MRI datasets is also possible with high accuracy. We acquired and publicly release a curated multi-center routine clinical (MC-RC) dataset of 160 patients with a single sporadic VS. For each patient up to three longitudinal MRI exams with contrast-enhanced T1-weighted (ceT1w) (n = 124) and T2-weighted (T2w) (n = 363) images were included and the VS manually annotated. Segmentations were produced and verified in an iterative process: (1) initial segmentations by a specialized company; (2) review by one of three trained radiologists; and (3) validation by an expert team. Inter- and intra-observer reliability experiments were performed on a subset of the dataset. A state-of-the-art deep learning framework was used to train segmentation models for VS. Model performance was evaluated on a MC-RC hold-out testing set, another public VS datasets, and a partially public dataset. The generalizability and robustness of the VS deep learning segmentation models increased significantly when trained on the MC-RC dataset. Dice similarity coefficients (DSC) achieved by our model are comparable to those achieved by trained radiologists in the inter-observer experiment. On the MC-RC testing set, median DSCs were 86.2(9.5) for ceT1w, 89.4(7.0) for T2w, and 86.4(8.6) for combined ceT1w+T2w input images. On another public dataset acquired for Gamma Knife stereotactic radiosurgery our model achieved median DSCs of 95.3(2.9), 92.8(3.8), and 95.5(3.3), respectively. In contrast, models trained on the Gamma Knife dataset did not generalize well as illustrated by significant underperformance on the MC-RC routine MRI dataset, highlighting the importance of data variability in the development of robust VS segmentation models. The MC-RC dataset and all trained deep learning models were made available online.
Collapse
Affiliation(s)
- Aaron Kujawa
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Reuben Dorent
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Steve Connor
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Neuroradiology, King's College Hospital, London, United Kingdom
- Department of Radiology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Suki Thomson
- Department of Neuroradiology, King's College Hospital, London, United Kingdom
| | - Marina Ivory
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ali Vahedi
- Department of Neuroradiology, King's College Hospital, London, United Kingdom
| | - Emily Guilhem
- Department of Neuroradiology, King's College Hospital, London, United Kingdom
| | - Navodini Wijethilake
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Robert Bradford
- Queen Square Radiosurgery Centre (Gamma Knife), National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Neil Kitchen
- Queen Square Radiosurgery Centre (Gamma Knife), National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Sotirios Bisdas
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Jonathan Shapey
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| |
Collapse
|
5
|
Suresh K, Luo G, Bartholomew RA, Brown A, Juliano AF, Lee DJ, Welling DB, Cai W, Crowson MG. An External Validation Study for Automated Segmentation of Vestibular Schwannoma. Otol Neurotol 2024; 45:e193-e197. [PMID: 38361299 DOI: 10.1097/mao.0000000000004125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To validate how an automated model for vestibular schwannoma (VS) segmentation developed on an external homogeneous dataset performs when applied to internal heterogeneous data. PATIENTS The external dataset comprised 242 patients with previously untreated, sporadic unilateral VS undergoing Gamma Knife radiosurgery, with homogeneous magnetic resonance imaging (MRI) scans. The internal dataset comprised 10 patients from our institution, with heterogeneous MRI scans. INTERVENTIONS An automated VS segmentation model was developed on the external dataset. The model was tested on the internal dataset. MAIN OUTCOME MEASURE Dice score, which measures agreement between ground truth and predicted segmentations. RESULTS When applied to the internal patient scans, the automated model achieved a mean Dice score of 61% across all 10 images. There were three tumors that were not detected. These tumors were 0.01 ml on average (SD = 0.00 ml). The mean Dice score for the seven tumors that were detected was 87% (SD = 14%). There was one outlier with Dice of 55%-on further review of this scan, it was discovered that hyperintense petrous bone had been included in the tumor segmentation. CONCLUSIONS We show that an automated segmentation model developed using a restrictive set of siloed institutional data can be successfully adapted for data from different imaging systems and patient populations. This is an important step toward the validation of automated VS segmentation. However, there are significant shortcomings that likely reflect limitations of the data used to train the model. Further validation is needed to make automated segmentation for VS generalizable.
Collapse
Affiliation(s)
- Krish Suresh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Guibo Luo
- Department of Radiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Ryan A Bartholomew
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Alyssa Brown
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - D Bradley Welling
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Wenli Cai
- Department of Radiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Matthew G Crowson
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
6
|
Schouten SM, Cornelissen S, Langenhuizen PPHJ, Jansen TTG, Mulder JJS, Derks J, Verheul JB, Kunst HPM. Wait-and-scan management in sporadic Koos grade 4 vestibular schwannomas: A longitudinal volumetric study. Neurooncol Adv 2024; 6:vdad144. [PMID: 38187870 PMCID: PMC10771273 DOI: 10.1093/noajnl/vdad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Background Volumetric natural history studies specifically on large vestibular schwannomas (VSs), commonly classified as Koos grade 4, are lacking. The aim of the current study is to present the volumetric tumor evolution in sporadic Koos grade 4 VSs and possible predictors for tumor growth. Methods Volumetric tumor measurements and tumor evolution patterns from serial MRI studies were analyzed from selected consecutive patients with Koos grade 4 VS undergoing initial wait-and-scan management between January 2001 and July 2020. The significant volumetric threshold was defined as a change in volume of ≥10%. Results Among 215 tumors with a median size (IQR) of 2.7 cm3 (1.8-4.2), 147 tumors (68%) demonstrated growth and 75 tumors (35%) demonstrated shrinkage during follow-up. Growth-free survival rates (95% CI) at 1, 2, 5, and 10 years were 55% (48-61), 36% (29-42), 29% (23-36), and 28% (21-34), respectively and did not significantly differ in tumors> 20 mm (Chi-square = .40; P-value = .53). Four tumor evolution patterns (% of total) were observed: continued growth (60); initial growth then shrinkage (7); continued shrinkage (27); and stability (5). Good hearing (adjusted HR 2.21, 95% CI 1.48-3.30; P < .001) and peritumoral edema (adjusted HR 2.22, 95% CI 1.18-4.13; P = .01) at diagnosis were significantly associated with an increased likelihood of growth. Conclusions Koos grade 4 VSs show a wide variety in size and growth. Due to variable growth patterns, an initial wait-and-scan strategy with short scan intervals may be an acceptable option in selected tumors, if no significant clinical symptoms of mass effect that warrant treatment are present.
Collapse
Affiliation(s)
- Sammy M Schouten
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Otolaryngology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Stefan Cornelissen
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Patrick P H J Langenhuizen
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Thijs T G Jansen
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
| | - Jef J S Mulder
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
| | - Jolanda Derks
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
| | - Jeroen B Verheul
- Gamma Knife Center, Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Henricus P M Kunst
- Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Otolaryngology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Dutch Academic Alliance Skull Base Pathology Radboudumc/MUMC+, Nijmegen and Maastricht, The Netherlands
| |
Collapse
|
7
|
Hildrew DM, Perez PL, Mady LJ, Li J, Nilsen ML, Hirsch BE. CyberKnife Stereotactic Radiosurgery for Growing Vestibular Schwannoma: Longitudinal Tumor Control, Hearing Outcomes, and Predicting Post-Treatment Hearing Status. Laryngoscope 2024; 134 Suppl 1:S1-S12. [PMID: 37178050 DOI: 10.1002/lary.30731] [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: 11/07/2022] [Revised: 04/11/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES (1) To determine tumor control rates for treating growing vestibular schwannoma (VS) with CyberKnife stereotactic radiosurgery (CK SRS); (2) to determine hearing outcomes after CK SRS; (3) to propose a set of variables that could be used to predict hearing outcomes for patients receiving CK SRS for VS. STUDY DESIGN Retrospective case series review. METHODS 127 patients who received CK SRS for radiographically documented growing VS were reviewed. Tumors were monitored for post-procedure growth radiographically with linear measurements and three-dimensional segmental volumetric analysis (3D-SVA). Hearing outcomes were reviewed for 109 patients. Cox proportional hazard modeling was used to identify variables correlated with hearing outcomes. RESULTS Tumor control rate was 94.5% for treating VS with CK SRS. Hearing outcomes were categorized using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification system. As of their last available audiogram, 33.3% of patients with pre-treatment class A and 26.9% of patients with class B retained their hearing in that class. 15.3% of patients starting with class A or B with extended follow-up (>60 months), maintained hearing within this same grouping. Our final model proposed to predict hearing outcomes included age, fundal cap distance (FCD), tumor volume, and maximum radiation dose to the cochlea; however, FCD was the only statistically significant variable. CONCLUSION CK SRS is an effective treatment for control of VS. Hearing preservation by class was achieved in a third of patients. Finally, FCD was found to be protective against hearing loss. LEVEL OF EVIDENCE 4 Laryngoscope, 134:S1-S12, 2024.
Collapse
Affiliation(s)
- Douglas M Hildrew
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Philip L Perez
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Leila J Mady
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Jinhong Li
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Marci L Nilsen
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Barry E Hirsch
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| |
Collapse
|
8
|
Balossier A, Delsanti C, Troude L, Thomassin JM, Roche PH, Régis J. Assessing Tumor Volume for Sporadic Vestibular Schwannomas: A Comparison of Methods of Volumetry. Stereotact Funct Neurosurg 2023; 101:265-276. [PMID: 37531945 DOI: 10.1159/000531337] [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: 12/16/2022] [Accepted: 05/16/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION The size of vestibular schwannomas (VS) is a major factor guiding the initial decision of treatment and the definition of tumor control or failure. Accurate measurement and standardized definition are mandatory; yet no standard exist. Various approximation methods using linear measures or segmental volumetry have been reported. We reviewed different methods of volumetry and evaluated their correlation and agreement using our own historical cohort. METHODS We selected patients treated for sporadic VS by Gammaknife radiosurgery (GKRS) in our department. Using the stereotactic 3D T1 enhancing MRI on the day of GKRS, 4 methods of volumetry using linear measurements (5-axis, 3-axis, 3-axis-averaged, and 1-axis) and segmental volumetry were compared to each other. The degree of correlation was evaluated using an intraclass correlation test (ICC 3,1). The agreement between the different methods was evaluated using Bland-Altman diagrams. RESULTS A total of 2,188 patients were included. We observed an excellent ICC between 5-axis volumetry (0.98), 3-axis volumetry (0.96), and 3-axis-averaged volumetry (0.96) and segmental volumetry, respectively, irrespective of the Koos grade or Ohata classification. The ICC for 1-axis volumetry was lower (0.72) and varied depending on the Koos and Ohata subgroups. None of these methods were substitutable. CONCLUSION Although segmental volumetry is deemed the most accurate method, it takes more effort and requires sophisticated computation systems compared to methods of volumetry using linear measurements. 5-axis volumetry affords the best adequacy with segmental volumetry among all methods under assessment, irrespective of the shape of the tumor. 1-axis volumetry should not be used.
Collapse
Affiliation(s)
- Anne Balossier
- Functional and Stereotactic Neurosurgery, AP-HM, Timone Hospital, Marseille, France
- INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France
| | - Christine Delsanti
- Functional and Stereotactic Neurosurgery, AP-HM, Timone Hospital, Marseille, France
| | - Lucas Troude
- Department of Neurosurgery, AP-HM, North University Hospital, Marseille, France
| | - Jean-Marc Thomassin
- Department of Head and Neck Surgery, AP-HM, Timone Hospital, Marseille, France
| | - Pierre-Hugues Roche
- Department of Neurosurgery, AP-HM, North University Hospital, Marseille, France
| | - Jean Régis
- Functional and Stereotactic Neurosurgery, AP-HM, Timone Hospital, Marseille, France
- INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France
| |
Collapse
|
9
|
Arambula AM, Wichova H, Lucas JC, Schelbar N, Harn N, Ledbetter L, Chamoun RB, Camarata PJ, Lin J, Staecker H. Analysis of Imaging Results for Semisitting Compared with Supine Positioning in the Retrosigmoid Approach for Resection of Cerebellopontine Angle Vestibular Schwannomas. Otol Neurotol 2023; 44:266-272. [PMID: 36662641 DOI: 10.1097/mao.0000000000003814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To compare the completeness of resection of vestibular schwannomas using three-dimensional segmented volumetric analysis of pre- and postoperative magnetic resonance imaging (MRI) of patients undergoing supine and semisitting positioning for the retrosigmoid approach. STUDY DESIGN Retrospective chart review. SETTING Tertiary medical center. PATIENTS Patients with vestibular schwannomas undergoing surgical resection via the retrosigmoid approach. INTERVENTIONS Tumor resection via the retrosigmoid approach with different patient positioning: standard supine versus semisitting. MAIN OUTCOME MEASURES Preoperative versus postoperative three-dimensional segmented volumetric MRI analysis of vestibular schwannomas. RESULTS A total of 43 patients (15 supine and 28 semisitting) underwent retrosigmoid craniotomy for resection of vestibular schwannomas. For the conventional supine and semisitting positioning, mean preoperative tumor volumes were 12.65 and 8.73 cm 3 ( p = 0.15), respectively. Postoperative mean tumor volumes for the supine and semisitting positions were 2.09 and 0.48 cm 3 ( p = 0.13), respectively. There were 11 cases of postoperative sigmoid sinus thrombosis, 3 in the conventional supine group and 8 in the semisitting groups, and there were 6 cases of postoperative cerebrospinal fluid leaks, all in the semisitting group. The mean House-Brackmann scores for the supine and semisitting groups were 2.9 and 2.3, respectively. There was no statistically significant difference between groups in the rates of these or any other postoperative complications. CONCLUSIONS The semisitting position for the suboccipital retrosigmoid approach for vestibular schwannoma resection does not compromise the ability to adequately resect the tumor as seen by volumetric MRI results. Further studies are needed to establish the safety of this position compared with the traditional supine approach.
Collapse
Affiliation(s)
- Alexandra M Arambula
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | | | - Jacob C Lucas
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | | | - Nicholas Harn
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Luke Ledbetter
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Roukoz B Chamoun
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Paul J Camarata
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | - James Lin
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Hinrich Staecker
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| |
Collapse
|
10
|
Pseudoprogression of Vestibular Schwannoma after Stereotactic Radiosurgery with Cyberknife ®: Proposal for New Response Criteria. Cancers (Basel) 2023; 15:cancers15051496. [PMID: 36900290 PMCID: PMC10000564 DOI: 10.3390/cancers15051496] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
(1) Background: Transient increase in volume of vestibular schwannomas (VS) after stereotactic radiosurgery (SRS) is common and complicates differentiation between treatment-related changes (pseudoprogression, PP) and tumor recurrence (progressive disease, PD). (2) Methods: Patients with unilateral VS (n = 63) underwent single fraction robotic-guided SRS. Volume changes were classified according to existing RANO criteria. A new response type, PP, with a >20% transient increase in volume was defined and divided into early (within the first 12 months) and late (>12 months) occurrence. (3) Results: The median age was 56 (range: 20-82) years, the median initial tumor volume was 1.5 (range: 0.1-8.6) cm3. The median radiological and clinical follow-up time was 66 (range: 24-103) months. Partial response was observed in 36% (n = 23), stable disease in 35% (n = 22) and PP in 29% (n = 18) of patients. The latter occurred early (16%, n = 10) or late (13%, n = 8). Using these criteria, no case of PD was observed. (4) Conclusion: Any volume increase after SRS for vs. assumed to be PD turned out to be early or late PP. Therefore, we propose modifying RANO criteria for SRS of VS, which may affect the management of vs. during follow-up in favor of further observation.
Collapse
|
11
|
Cass ND, Lindquist NR, Zhu Q, Li H, Oguz I, Tawfik KO. Machine Learning for Automated Calculation of Vestibular Schwannoma Volumes. Otol Neurotol 2022; 43:1252-1256. [PMID: 36109146 DOI: 10.1097/mao.0000000000003687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS Machine learning-derived algorithms are capable of automated calculation of vestibular schwannoma tumor volumes without operator input. BACKGROUND Volumetric measurements are most sensitive for detection of vestibular schwannoma growth and important for patient counseling and management decisions. Yet, manually measuring volume is logistically challenging and time-consuming. METHODS We developed a deep learning framework fusing transformers and convolutional neural networks to calculate vestibular schwannoma volumes without operator input. The algorithm was trained, validated, and tested on an external, publicly available data set consisting of magnetic resonance imaging images of medium and large tumors (178-9,598 mm 3 ) with uniform acquisition protocols. The algorithm was then trained, validated, and tested on an internal data set of variable size tumors (5-6,126 mm 3 ) with variable acquisition protocols. RESULTS The externally trained algorithm yielded 87% voxel overlap (Dice score) with manually segmented tumors on the external data set. The same algorithm failed to translate to accurate tumor detection when tested on the internal data set, with Dice score of 36%. Retraining on the internal data set yielded Dice score of 82% when compared with manually segmented images, and 85% when only considering tumors of similar size as the external data set (>178 mm 3 ). Manual segmentation by two experts demonstrated high intraclass correlation coefficient (0.999). CONCLUSION Sophisticated machine learning algorithms delineate vestibular schwannomas with an accuracy exceeding established norms of up to 20% error for repeated manual volumetric measurements-87% accuracy on a homogeneous data set, and 82% to 85% accuracy on a more varied data set mirroring real world neurotology practice. This technology has promise for clinical applicability and time savings.
Collapse
Affiliation(s)
- Nathan D Cass
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center
| | - Nathan R Lindquist
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center
| | - Qibang Zhu
- Department of Computer Science, Vanderbilt University
| | | | | | - Kareem O Tawfik
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center
| |
Collapse
|
12
|
Weiner S, Strinitz M, Herfurth J, Hessenauer F, Nauroth-Kreß C, Kampf T, Homola GA, Üçeyler N, Sommer C, Pham M, Schindehütte M. Dorsal Root Ganglion Volumetry by MR Gangliography. AJNR Am J Neuroradiol 2022; 43:769-775. [PMID: 35450855 PMCID: PMC9089252 DOI: 10.3174/ajnr.a7487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/12/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Dorsal root ganglion MR imaging (MR gangliography) is increasingly gaining clinical-scientific relevance. However, dorsal root ganglion morphometry by MR imaging is typically performed under the assumption of ellipsoid geometry, which remains to be validated. MATERIALS AND METHODS Sixty-four healthy volunteers (37 [57.8%] men; mean age, 31.5 [SD, 8.3] years) underwent MR gangliography of the bilateral L4-S2 levels (3D-T2WI TSE spectral attenuated inversion recovery-sampling perfection with application-optimized contrasts by using different flip angle evolution, isotropic voxels = 1.1 mm³, TE = 301 ms). Ground truth dorsal root ganglion volumes were bilaterally determined for 96 dorsal root ganglia (derivation cohort) by expert manual 3D segmentation by 3 independent raters. These ground truth dorsal root ganglion volumes were then compared with geometric ellipsoid dorsal root ganglion approximations as commonly practiced for dorsal root ganglion morphometry. On the basis of the deviations from ellipsoid geometry, improved volume estimation could be derived and was finally applied to a large human validation cohort (510 dorsal root ganglia). RESULTS Commonly used equations of ellipsoid geometry underestimate true dorsal root ganglion volume by large degrees (factor = 0.42-0.63). Ground truth segmentation enabled substantially optimizing dorsal root ganglion geometric approximation using its principal axes lengths by deriving the dorsal root ganglion volume term of [Formula: see text]. Using this optimization, the mean volumes of 510 lumbosacral healthy dorsal root ganglia were as follows: L4: 211.3 (SD, 52.5) mm³, L5: 290.7 (SD, 90.9) mm³, S1: 384.2 (SD, 145.0) mm³, and S2: 192.4 (SD, 52.6) mm³. Dorsal root ganglion volume increased from L4 to S1 and decreased from S1 to S2 (P < .001). Dorsal root ganglion volume correlated with subject height (r = . 22, P < .001) and was higher in men (P < .001). CONCLUSIONS Dorsal root ganglion volumetry by measuring its principal geometric axes on MR gangliography can be substantially optimized. By means of this optimization, dorsal root ganglion volume distribution was estimated in a large healthy cohort for the clinically most relevant lumbosacral levels, L4-S2.
Collapse
Affiliation(s)
- S Weiner
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - M Strinitz
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - J Herfurth
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - F Hessenauer
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - C Nauroth-Kreß
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - T Kampf
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - G A Homola
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - N Üçeyler
- Neurology (N.U., C.S.), University Hospital Würzburg, Würzburg, Germany
| | - C Sommer
- Neurology (N.U., C.S.), University Hospital Würzburg, Würzburg, Germany
| | - M Pham
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| | - M Schindehütte
- From the Department of Neuroradiology (S.W., M.S., J.H., F.H., C.N.-K., T.K., G.A.H., M.P., M.S.)
| |
Collapse
|
13
|
Brown A, Early S, Vasilijic S, Stankovic KM. Sporadic Vestibular Schwannoma Size and Location Do not Correlate With the Severity of Hearing Loss at Initial Presentation. Front Oncol 2022; 12:836504. [PMID: 35372070 PMCID: PMC8965062 DOI: 10.3389/fonc.2022.836504] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/14/2022] [Indexed: 11/24/2022] Open
Abstract
Vestibular schwannoma (VS) is a non-malignant intracranial neoplasm arising from the vestibular branch of the 8th cranial nerve; sensorineural hearing loss (SNHL) is the most common associated symptom. Understanding whether VS imaging characteristics at the time of VS diagnosis can be associated with severity of VS-induced SNHL can impact patient counseling and define promising areas for future research. Patients diagnosed with VS at Massachusetts Eye and Ear (MEE) from 1994 through 2018 were analyzed if magnetic resonance imaging at VS presentation and sequential audiometry were available. Results were compared with original studies available in PubMed, written in English, on VS imaging characteristics and their impact on hearing in patients. A total of 477 patients with unilateral VS from the MEE database demonstrated no significant correlation between any features of tumor imaging at the time of VS diagnosis, such as VS size, impaction or location, and any hearing loss metric. Twenty-three published studies on the impact of VS imaging characteristics on patient hearing met inclusion criteria, with six solely involving NF2 patients and three including both sporadic and NF2-related VS patients. Fifteen studies reported a significant relationship between SNHL and at least one VS imaging characteristic; however, these trends were universally limited to NF2 patients or involved small patient populations, and were not reproduced in larger studies. Taken together, SNHL in sporadic VS patients is not readily associated solely with any tumor imaging characteristics. This finding motivates future studies to define how VS microenvironment and secreted molecules influence VS-induced SNHL.
Collapse
Affiliation(s)
- Alyssa Brown
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, United States
| | - Samuel Early
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Department of Otolaryngology Head and Neck Surgery, University of California, San Diego, San Diego Medical Center, San Diego, CA, United States
| | - Sasa Vasilijic
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Konstantina M Stankovic
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| |
Collapse
|
14
|
King S, Dahlem K, Karmali F, Stankovic KM, Welling DB, Lewis RF. Imbalance and dizziness caused by unilateral vestibular schwannomas correlate with vestibulo-ocular reflex precision and bias. J Neurophysiol 2022; 127:596-606. [PMID: 35080420 PMCID: PMC8858680 DOI: 10.1152/jn.00725.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Imbalance and dizziness are disabling symptoms for many patients with vestibular schwannomas (VS) but symptom severity typically does not correlate with the vestibulo-ocular reflex (VOR) amplitude-based metrics used to assess peripheral vestibular damage. In this study, we tested the hypothesis that imbalance and dizziness in patients with VS relate to VOR metrics that are not based on response amplitude. Twenty-four patients with unilateral, sporadic VS tumors were studied, and objective (balance) and subjective (dizziness) vestibular dysfunction was quantified. The VOR was tested using two yaw-axis motion stimuli, low-frequency en-bloc sinusoidal, and high-frequency head-on-body impulsive rotations. Imbalance correlated with VOR precision (the inverse of the trial-to-trial variability) and with low-frequency VOR dynamics (quantified with the time constant), and these two metrics were also strongly correlated. Dizziness correlated with the VOR bias caused by an imbalance in static central vestibular tone, but not with dynamic VOR metrics. VOR accuracy (mean response amplitude relative to the ideal response) was not correlated with the severity of imbalance or dizziness or with measures of VOR precision or time constant. Imbalance in patients with VS, therefore, scales with VOR precision and time constant, both of which appear to reflect the central vestibular signal-to-noise ratio, but not with VOR slow-phase accuracy, which is based on the magnitude of the central vestibular signals. Dizziness was related to the presence of a static central tone imbalance but not to any VOR metrics, suggesting that abnormal perception in VS may be affected by factors that are not captured by yaw-axis VOR measurements.NEW & NOTEWORTHY The severity of symptoms associated with unilateral vestibular schwannomas (VS) is poorly correlated with standard yaw-axis vestibulo-ocular reflex (VOR) metrics that are based on response amplitude. In this study, we show that the balance and perceptual dysfunction experienced by patients with VS scales with VOR metrics that capture information about the central signal-to-noise ratio (balance) and central static tone (dizziness), but are not correlated with the VOR gain, which reflects central signal amplitude.
Collapse
Affiliation(s)
- Susan King
- 1Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Kilian Dahlem
- 1Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Faisal Karmali
- 1Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts,2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | | | - D. Bradley Welling
- 2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Richard F. Lewis
- 1Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts,2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts,3Department of Neurology, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
15
|
Fink KR, Nobles SE, Zeitler DM. Comparing the Precision and Reliability Between Three Radiographic Techniques for Measuring Sporadic Vestibular Schwannomas. Acad Radiol 2022; 29:69-76. [PMID: 33158707 DOI: 10.1016/j.acra.2020.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES Several methods exist for measuring vestibular schwannoma (VS) size radiographically. Our aim was to compare the precision and reproducibility of three different radiographic measurement techniques for assessing VS tumor size. MATERIAL AND METHODS Twenty patients with unilateral, sporadic VS previously untreated were identified. All patients had thin-slice T1 weighted, postcontrasted magnetization prepared rapid acquisition gradient echo images. Three measurement techniques were performed using within-subject and between-subject comparison. Experimental comparison of interobserver agreement between techniques was calculated. Interobserver intraclass correlation coefficients, repeatability coefficients, and relative smallest detectable difference were calculated and compared. RESULTS Mean tumor measurements were: 10.3 mm (maximum linear dimension, [MLD]), 495.9 mm3 (orthogonal volumetric analysis, [OVA]), and 572.1 mm3 (segmented volumetric analysis, [SVA]). Interobserver correlation coefficient was excellent for all measurement techniques, but highest for segmented volumetric analysis. Repeatability coefficient was 1.44 mm for MLD, 298.9 mm3 for OVA, and 174.8 mm3 for SVA. The smallest detectable difference was 13.9% for MLD, 60.2% for OVA, and 30.6% for SVA. A subgroup analysis was performed for small tumors (<14 mm) and large tumors (>14 mm) and demonstrated increased precision of segmented volumetric analysis for larger tumors. CONCLUSION Semi-automated segmented volumetric analysis appears more precise than either linear measurement or orthogonal volumetric analysis for reporting VS tumor size, and becomes increasingly precise for larger tumors. Tumor volume and tumor volume change over time using SVA may be more sensitive in surveilling VS than current measurement techniques.
Collapse
|
16
|
Totten DJ, Sherry AD, Manzoor NF, Perkins EL, Cass ND, Khattab MH, Cmelak AJ, Haynes DS, Aulino JM. Diameter-Based Volumetric Models May Inadequately Calculate Jugular Paraganglioma Volume Following Sub-Total Resection. Otol Neurotol 2021; 42:e1339-e1345. [PMID: 34149025 DOI: 10.1097/mao.0000000000003226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND As gross total resection of jugular paragangliomas (JPs) may result in cranial nerve deficits, JPs are increasingly managed with subtotal resection (STR) with postoperative radiological monitoring. However, the validity of commonly used diameter-based models that calculate postoperative volume to determine residual tumor growth is dubious. The purpose of this study was to assess the accuracy of these models compared to manual volumetric slice-by-slice segmentation. METHODS A senior neuroradiologist measured volumes via slice-by-slice segmentation of JPs pre- and postoperatively from patients who underwent STR from 2007 to 2019. Volumes from three linear-based models were calculated. Models with absolute percent error (APE) > 20% were considered unsatisfactory based on a common volumetric definition for residual growth. Bland-Altman plots were used to evaluate reproducibility, and Wilcoxon matched-pairs signed rank test evaluated model bias. RESULTS Twenty-one patients were included. Median postoperative APE exceeded the established 20% threshold for each of the volumetric models as cuboidal, ellipsoidal, and spherical model APE were 63%, 28%, and 27%, respectively. The postoperative cuboidal model had significant systematic bias overestimating volume (p = 0.002) whereas the postoperative ellipsoidal and spherical models lacked systematic bias (p = 0.11 and p = 0.82). CONCLUSION Cuboidal, ellipsoidal, and spherical models do not provide accurate assessments of postoperative JP tumor volume and may result in salvage therapies that are unnecessary or inappropriately withheld due to inaccurate assessment of residual tumor growth. While more time-consuming, slice-by-slice segmentation by an experienced neuroradiologist provides a substantially more accurate and precise measurement of tumor volume that may optimize clinical management.
Collapse
Affiliation(s)
| | | | - Nauman F Manzoor
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Elizabeth L Perkins
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Nathan D Cass
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Mohamed H Khattab
- Department of Radiation Oncology, Vanderbilt University Medical Center
| | - Anthony J Cmelak
- Department of Radiation Oncology, Vanderbilt University Medical Center
| | - David S Haynes
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Joseph M Aulino
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
17
|
Gurewitz J, Schnurman Z, Nakamura A, Navarro RE, Patel DN, McMenomey SO, Roland JT, Golfinos JG, Kondziolka D. Hearing loss and volumetric growth rate in untreated vestibular schwannoma. J Neurosurg 2021; 136:768-775. [PMID: 34416729 DOI: 10.3171/2021.2.jns203609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study, the authors aimed to clarify the relationship between hearing loss and tumor volumetric growth rates in patients with untreated vestibular schwannoma (VS). METHODS Records of 128 treatment-naive patients diagnosed with unilateral VS between 2012 and 2018 with serial audiometric assessment and MRI were reviewed. Tumor growth rates were determined from initial and final tumor volumes, with a median follow-up of 24.3 months (IQR 8.5-48.8 months). Hearing changes were based on pure tone averages, speech discrimination scores, and American Academy of Otolaryngology-Head and Neck Surgery hearing class. Primary outcomes were the loss of class A hearing and loss of serviceable hearing, estimated using the Kaplan-Meier method and with associations estimated from Cox proportional hazards models and reported as hazard ratios. RESULTS Larger initial tumor size was associated with an increased risk of losing class A (HR 1.5 for a 1-cm3 increase; p = 0.047) and serviceable (HR 1.3; p < 0.001) hearing. Additionally, increasing volumetric tumor growth rate was associated with elevated risk of loss of class A hearing (HR 1.2 for increase of 100% per year; p = 0.031) and serviceable hearing (HR 1.2; p = 0.014). Hazard ratios increased linearly with increasing growth rates, without any evident threshold growth rate that resulted in a large, sudden increased risk of hearing loss. CONCLUSIONS Larger initial tumor size and faster tumor growth rates were associated with an elevated risk of loss of class A and serviceable hearing.
Collapse
Affiliation(s)
| | | | | | | | | | - Sean O McMenomey
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York
| | - J Thomas Roland
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York
| | | | | |
Collapse
|
18
|
Assessment of Tumor Volume Dynamics and Outcome After Radiosurgery for the Treatment of Vestibular Schwannoma: A Single-Center Experience. Otol Neurotol 2021; 42:e750-e757. [PMID: 34111052 DOI: 10.1097/mao.0000000000003056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the factors affecting early local and audiometric outcomes in vestibular schwannoma (VS) patients treated with stereotactic radiosurgery (SRS). STUDY DESIGN A retrospective review of medical records. SETTING Tertiary referral center. PATIENTS Records of all adult patients who underwent SRS between 2010 and 2016 for the treatment of VS were retrospectively reviewed. Patients treated with microsurgery or multi-fractionation schemes, and those who had neurofibromatosis type 2, were excluded. INTERVENTION SRS, tumor volume/size measurements. MAIN OUTCOME MEASURES The impact of tumor volume dynamics on the early local and hearing-related outcomes, together with the factors that influence them following SRS, and comparison of different tumor size measurement methods. RESULTS From 2010 to 2016, 53 patients underwent single fraction SRS of 12 Gy. Median follow-up time was 32 months (range, 6-79). At the last follow-up, only one patient had clinical progression. Age less than or equal to 65 years (p = 0.04; odds ratio [OR]: 0.17; 95% confidence interval [CI]: 0.03-0.93) and baseline pure-tone average (PTA) level less than or equal to 30 dB (p = 0.03; OR: 0.90; 95% CI: 0.84-0.96) were associated with maintenance of serviceable hearing. On multivariate analysis, PTA remained significant (p = 0.01; OR: 0.04; 95% CI: 0.003-0.45). In patients with a loss of serviceable hearing, the mean volume increase tended to be higher than in the patients whose hearing was maintained. The linear measurement method underestimated, and the A × B × C/2 equation overestimated, the radiological progression compared with 3D-volumetric delineations. CONCLUSION During the median observation period of almost 3 years, we reported our early outcome results. Tumor volume increase may have an impact on serviceable hearing loss after SRS. Currently there is no widely accepted method for the evaluation of post-SRS response. Linear measurement and the A × B × C/2 equation produce less reliable estimates of radiological progression compared with 3D-volumetric delineations. Accurate volume measurements with 3D delineations should be considered as part of clinical routine for assessing progression and deciding on salvage therapies.
Collapse
|
19
|
Reznitsky M, Petersen MMBS, West N, Stangerup SE, Cayé-Thomasen P. The natural history of vestibular schwannoma growth-prospective 40-year data from an unselected national cohort. Neuro Oncol 2021; 23:827-836. [PMID: 33068429 DOI: 10.1093/neuonc/noaa230] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Optimal management of vestibular schwannoma (VS) is still debated and thus international consensus has not been achieved. Treatment options are observation, radiotherapy, and surgery. Knowledge on the natural history of tumor growth is essential for choice of treatment modality. The aim is to present intra-/extrameatal tumor growth and management data from a prospective, unselected national cohort of patients diagnosed with VS during the period 1976-2015. METHODS Since 1976, all data from patients diagnosed with sporadic VS in Denmark have been referred to our national treatment center, where they have been entered prospectively into the national database. Data on tumor localization, growth, and treatment were retrieved. Growth definition: >2 mm by linear measurement, in accordance with the Tokyo 2001 consensus-meeting recommendations. RESULTS 3637 cases of VS were diagnosed, in which 1304 patients had surgery and 21 received radiotherapy post diagnosis. 2312 patients were observed with mean follow-up of 7.33 years. Of these, 434(19%; 102 intra-and 332 extrameatal tumors) changed to active treatment during the observation period due to tumor growth. 5 years after diagnosis, 21% of the intrameatal tumors exhibited growth during observation, whereas 37% of extrameatal tumors had grown, increasing to 25% intrameatal and 42% extrameatal after 10 years. Following growth, the intrameatal tumors were mostly observed further and the extrameatal mostly underwent surgery. Tumor growth occurred mainly within the first 5 years post diagnosis. CONCLUSION This natural history study documents the growth occurrence of both intra-and extrameatal VS during the first 12 years after diagnosis and should be used in patient counseling, management, and treatment decision making.
Collapse
Affiliation(s)
- Martin Reznitsky
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Niels West
- 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
| | - Sven-Eric Stangerup
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- 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
| |
Collapse
|
20
|
Postural Sway Predicts Growth in Untreated Vestibular Schwannoma: A Retrospective Volumetric Study. Otol Neurotol 2021; 42:e495-e502. [PMID: 33443976 DOI: 10.1097/mao.0000000000003032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND One in three vestibular schwannomas (VS) will grow within 3 years after diagnosis, but no reliable baseline parameter has been found to predict such growth. OBJECTIVE To determine if postural sway is associated with growth of untreated VS. METHODS Patients with newly diagnosed sporadic VS assigned to a wait-and-scan protocol were identified from a prospectively maintained database. Postural sway was measured by posturography at baseline and patients were classified as steady or unsteady. Observer-blinded volumetric tumor measurements were performed on the diagnostic MRI and a 3-year control MRI. Tumor growth quantified as relative growth (%) and volume-doubling time (VDT and VDT-1) were investigated as dependent variables against baseline parameters. RESULTS Out of 204 VS patients, 53 (26%) were classified as unsteady on the platform at baseline. Median tumor volume was 0.32 cm3 (range 0.02-4.79), and 51% demonstrated significant growth within 3 years. Unsteady patients had significantly faster-growing tumors, with a mean relative growth of 172.5% compared to 79.5% in steady patients (p < 0.006). Seventy-seven percent of unsteady patients had >20% volume increase, compared to 42% in steady patients (p < 0.001). Mean VDT-1 was 0.65 doublings per year for unsteady patients, and 0.22 for steady patients (p < 0.001). Multivariate regression analysis including demographic and clinical parameters showed an OR of 5.6 (95% CI 2.6, 11.8) for growth in unsteady patients. CONCLUSIONS This is the first demonstrated association between a measurable parameter and future growth in untreated VS. Our findings may help clinicians identify patients with a higher risk for tumor growth and provide closer monitoring or early treatment.
Collapse
|
21
|
Trau G, Venkatasamy A, Charpiot A. Vestibular schwannomas with spontaneous shrinkage: about 35 cases. Eur Arch Otorhinolaryngol 2021; 278:4235-4241. [PMID: 33388984 DOI: 10.1007/s00405-020-06530-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
PURPOSES The first aim is to describe the epidemiological, clinical, and radiological characteristics of regressive vestibular schwannomas (VS), based on volumetric measurements on MRI to define which regressions are significant. The secondary aim is to look for a correlation between a shrinkage of the tumor and the medical history, and the presence of clinical symptoms. METHODS We first selected all patients presenting with a VS who underwent two or more MRI of the internal auditory canal on the same 3 T MRI machine retrospectively between January 2013 and June 2018. All MRI images were evaluated independently by two radiologists. The volumetric analysis was performed contrast-enhanced 2D spin-echo T1-weighted sequence and expressed in cubic centimeters. RESULTS Thirty-five patients presented with a regressive VS on MRI (14%). The annual mean shrinkage rate was 0.08 cm3/year. Eighty percent of the patients present both a shrinkage by more than 0.01 cm3/year and a decrease of the initial tumor volume by more than 20%. The majority of patients are asymptomatic or presented moderate balance disorders, which remained stable or improved over time. Tinnitus was observed in 47% and was stable or improved in the majority of cases and the mean annual mean hearing loss was by < or = 4 dB/year. CONCLUSION Out of 247 VS, 14% decreased using follow-up (by > or = 2 MRI), and a spontaneous shrinkage greater than 0.01 cm3/year and greater than 20% could be considered significant.
Collapse
Affiliation(s)
- Guillaume Trau
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Strasbourg, 1 Avenue Molière, Strasbourg, France.
| | - Aïna Venkatasamy
- Institute of Image-Guided Surgery, IHU Strasbourg, 1 place de l'Hôpital, Strasbourg, France
| | - Anne Charpiot
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Strasbourg, 1 Avenue Molière, Strasbourg, France
| |
Collapse
|
22
|
Patel EJ, Deep NL, Schecht M, Hagiwara M, Roland JT. Tracking Spontaneous Vestibular Schwannoma Regression with Volumetric Measurements. Laryngoscope 2020; 131:E1647-E1652. [PMID: 33103767 DOI: 10.1002/lary.29201] [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: 08/13/2020] [Revised: 10/01/2020] [Accepted: 10/11/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To characterize a series of patients with MRI evidence of spontaneous vestibular schwannoma (VS) regression. STUDY DESIGN Retrospective case series. METHODS Retrospective review between 2012 and 2020 from a single, tertiary-care center of all patients with an untreated, sporadic VS and spontaneous regression in volumetric tumor size over the course of observation. The main outcome measures included VS size and location, presenting symptoms, medication use, changes in pure-tone averages and word recognition scores. RESULTS The 13 treatment-naïve patients (62% female, mean age 67.1 years) with spontaneous VS regression represented 3.9% of all patients undergoing observation with serial imaging during the study period. Median tumor size from initial MRI was 529.0 mm3 (range: 108 mm3 -13,180 mm3 ). The mean interval between MRI measurements was 5.5 years (SD 4.4 years). The average percent decrease in tumor size was 36.1% (SD 21.9%) and the average rate of volume decrease was 15.8 mm3 /yr (SD 25.4 mm3 /yr). Five patients were classified as having major regression, defined by a relative decrease in volume of >40%, while eight patients had minor regression (<40% relative volume reduction). No significant differences in initial tumor size, rate of regression, or audiometric changes were observed between the major and minor regression cohorts. CONCLUSIONS Patients with evidence of a spontaneously shrinking VS have a heterogeneous presentation. Due to the scarcity of this phenomenon, predicting which tumors will eventually undergo regression remains unclear. Employing volumetric measurements to compare serial MRI scans may improve the accuracy of detecting shrinking tumors. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1647-E1652, 2021.
Collapse
Affiliation(s)
- Evan J Patel
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Michael Schecht
- Department of Radiology, NYU Langone Health, New York, New York, U.S.A
| | - Mari Hagiwara
- Department of Radiology, NYU Langone Health, New York, New York, U.S.A
| | - John T Roland
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| |
Collapse
|
23
|
George-Jones NA, Wang K, Wang J, Hunter JB. Automated Detection of Vestibular Schwannoma Growth Using a Two-Dimensional U-Net Convolutional Neural Network. Laryngoscope 2020; 131:E619-E624. [PMID: 32304338 DOI: 10.1002/lary.28695] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/20/2020] [Accepted: 03/31/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if an automated vestibular schwannoma (VS) segmentation model has comparable performance to using the greatest linear dimension to detect growth. STUDY DESIGN Case-control Study. METHODS Patients were selected from an internal database who had an initial gadolinium-enhanced T1-weighted magnetic resonance imaging scan and a follow-up scan captured at least 5 months later. Two observers manually segmented the VS to compute volumes, and one observer's segmentations were used to train a convolutional neural network model to automatically segment the VS and determine the volume. The results of automatic segmentation were compared to the observer whose measurements were not used in model development to measure agreement. We then examined the sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) to compare automated volumetric growth detection versus using the greatest linear dimension. Growth detection determined by the external observer's measurements served as the gold standard. RESULTS A total of 65 patients and 130 scans were studied. The automated method of segmentation demonstrated excellent agreement with the observer whose measurements were not used for model development for the initial scan (interclass correlational coefficient [ICC] = 0.995; 95% confidence interval [CI]: 0.991-0.997) and follow-up scan (ICC = 0.960; 95% CI: 0.935-0.975). The automated method of segmentation demonstrated increased sensitivity (72.2% vs. 63.9%), specificity (79.3% vs. 69.0%), and AUC (0.822 vs. 0.701) compared to using the greatest linear dimension for growth detection. CONCLUSIONS In detecting VS growth, a convolutional neural network model outperformed using the greatest linear dimension, demonstrating a potential application of artificial intelligence methods to VS surveillance. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E619-E624, 2021.
Collapse
Affiliation(s)
- Nicholas A George-Jones
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kai Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jing Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
24
|
Patel NS, Huang AE, Dowling EM, Lees KA, Tombers NM, Lohse CM, Marinelli JP, Van Gompel JJ, Neff BA, Driscoll CLW, Link MJ, Carlson ML. The Influence of Vestibular Schwannoma Tumor Volume and Growth on Hearing Loss. Otolaryngol Head Neck Surg 2020; 162:530-537. [PMID: 31986971 DOI: 10.1177/0194599819900396] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To ascertain the relationship among vestibular schwannoma (VS) tumor volume, growth, and hearing loss. STUDY DESIGN Retrospective cohort study. SETTING Single tertiary center. SUBJECTS AND METHODS Adults with observed VS and serviceable hearing at diagnosis were included. The primary outcome was the development of nonserviceable hearing as estimated using the Kaplan-Meier method. Associations of tumor volume with baseline hearing were assessed using Spearman rank correlation coefficients. Associations of volume and growth with the development of nonserviceable hearing over time were assessed using Cox proportional hazards models and summarized with hazard ratios (HRs). RESULTS Of 230 patients with VS and serviceable hearing at diagnosis, 213 had serial volumetric tumor data for analysis. Larger tumor volume at diagnosis was associated with increased pure-tone average (PTA) (P < .001) and decreased word recognition score (WRS) (P = .014). Estimated rates of maintaining serviceable hearing at 6 and 10 years following diagnosis were 67% and 49%, respectively. Larger initial tumor volume was associated with development of nonserviceable hearing in a univariable setting (HR for 1-cm3 increase: 1.36, P = .040) but not after adjusting for PTA and WRS. Tumor growth was not significantly associated with time to nonserviceable hearing (HR, 1.57; P = .14), although estimated rates of maintaining serviceable hearing during observation were poorer in the group that experienced growth. CONCLUSION Larger initial VS tumor volume was associated with poorer hearing at baseline. Larger initial tumor volume was also associated with the development of nonserviceable hearing during observation in a univariable setting; however, this association was not statistically significant after adjusting for baseline hearing status.
Collapse
Affiliation(s)
- Neil S Patel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alice E Huang
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric M Dowling
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine A Lees
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicole M Tombers
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian A Neff
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Colin L W Driscoll
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic 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
|
25
|
Shapey J, Wang G, Dorent R, Dimitriadis A, Li W, Paddick I, Kitchen N, Bisdas S, Saeed SR, Ourselin S, Bradford R, Vercauteren T. An artificial intelligence framework for automatic segmentation and volumetry of vestibular schwannomas from contrast-enhanced T1-weighted and high-resolution T2-weighted MRI. J Neurosurg 2019; 134:171-179. [PMID: 31812137 DOI: 10.3171/2019.9.jns191949] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Automatic segmentation of vestibular schwannomas (VSs) from MRI could significantly improve clinical workflow and assist in patient management. Accurate tumor segmentation and volumetric measurements provide the best indicators to detect subtle VS growth, but current techniques are labor intensive and dedicated software is not readily available within the clinical setting. The authors aim to develop a novel artificial intelligence (AI) framework to be embedded in the clinical routine for automatic delineation and volumetry of VS. METHODS Imaging data (contrast-enhanced T1-weighted [ceT1] and high-resolution T2-weighted [hrT2] MR images) from all patients meeting the study's inclusion/exclusion criteria who had a single sporadic VS treated with Gamma Knife stereotactic radiosurgery were used to create a model. The authors developed a novel AI framework based on a 2.5D convolutional neural network (CNN) to exploit the different in-plane and through-plane resolutions encountered in standard clinical imaging protocols. They used a computational attention module to enable the CNN to focus on the small VS target and propose a supervision on the attention map for more accurate segmentation. The manually segmented target tumor volume (also tested for interobserver variability) was used as the ground truth for training and evaluation of the CNN. We quantitatively measured the Dice score, average symmetric surface distance (ASSD), and relative volume error (RVE) of the automatic segmentation results in comparison to manual segmentations to assess the model's accuracy. RESULTS Imaging data from all eligible patients (n = 243) were randomly split into 3 nonoverlapping groups for training (n = 177), hyperparameter tuning (n = 20), and testing (n = 46). Dice, ASSD, and RVE scores were measured on the testing set for the respective input data types as follows: ceT1 93.43%, 0.203 mm, 6.96%; hrT2 88.25%, 0.416 mm, 9.77%; combined ceT1/hrT2 93.68%, 0.199 mm, 7.03%. Given a margin of 5% for the Dice score, the automated method was shown to achieve statistically equivalent performance in comparison to an annotator using ceT1 images alone (p = 4e-13) and combined ceT1/hrT2 images (p = 7e-18) as inputs. CONCLUSIONS The authors developed a robust AI framework for automatically delineating and calculating VS tumor volume and have achieved excellent results, equivalent to those achieved by an independent human annotator. This promising AI technology has the potential to improve the management of patients with VS and potentially other brain tumors.
Collapse
Affiliation(s)
- Jonathan Shapey
- 1Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London
- 2Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London
- 3School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Guotai Wang
- 1Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London
- 3School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
- 4School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Reuben Dorent
- 3School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Alexis Dimitriadis
- 6Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London
| | - Wenqi Li
- 3School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Ian Paddick
- 5Queen Square Radiosurgery Centre (Gamma Knife) and
| | - Neil Kitchen
- 2Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London
- 5Queen Square Radiosurgery Centre (Gamma Knife) and
| | - Sotirios Bisdas
- 6Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London
| | - Shakeel R Saeed
- 2Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London
- 7The Ear Institute, University College London; and
- 8The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Sebastien Ourselin
- 3School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Robert Bradford
- 2Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London
- 5Queen Square Radiosurgery Centre (Gamma Knife) and
| | - Tom Vercauteren
- 3School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| |
Collapse
|
26
|
Current Volumetric Models Overestimate Vestibular Schwannoma Size Following Stereotactic Radiosurgery. Otol Neurotol 2019; 41:e262-e267. [PMID: 31789797 DOI: 10.1097/mao.0000000000002488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Accurate volume assessment is essential for the management of vestibular schwannoma after stereotactic radiosurgery (SRS). A cuboidal approximation for volume is the standard surveillance method; however, this may overestimate tumor volume. We sought to evaluate several volumetric models and their suitability for post-SRS surveillance. STUDY DESIGN Retrospective cohort study. SETTING Tertiary referral center. PATIENTS We evaluated 54 patients with vestibular schwannoma before and after SRS. INTERVENTION(S) Gold-standard volumes were obtained by a radiation oncologist using contouring software. Volume was also calculated by cuboidal, ellipsoidal, and spherical formulae using tumor diameters obtained by a neuroradiologist. MAIN OUTCOME MEASURE(S) Percent error (PE) and absolute percent error (APE) were calculated. Paired t test evaluated bias, and the Bland-Altman method evaluated reproducibility. Linear regression evaluated predictors of model error. RESULTS All models overestimated volume compared with the gold standard. The cuboidal model was not reproducible before SRS (p < 0.001), and no model was reproducible after SRS (cuboidal p < 0.001; ellipsoidal p = 0.02; spherical p = 0.02). Significant bias was present before SRS for the cuboidal model (p < 0.001), and post-SRS for all models [cuboidal (p < 0.001), ellipsoidal (p < 0.02), and spherical (p = 0.005)]. Model error was negatively associated with pretreatment volume for the cuboidal (PE p = 0.03; APE p = 0.03), ellipsoidal (PE p = 0.03; APE p = 0.04), and spherical (PE p = 0.02; APE p = 0.03) methods and lost linearity post-SRS. CONCLUSIONS The standard cuboidal practice for following vestibular schwannoma tumor volume after SRS overestimates size. Ellipsoidal and spherical estimations have improved performance but also overestimate volume and lack reliability post-SRS. The development of other volumetric models or application of contouring software should be investigated.
Collapse
|
27
|
Schnurman Z, Nakamura A, McQuinn MW, Golfinos JG, Roland JT, Kondziolka D. Volumetric growth rates of untreated vestibular schwannomas. J Neurosurg 2019; 133:742-748. [PMID: 31374553 DOI: 10.3171/2019.5.jns1923] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There remains a large discrepancy among surgeons in expectations of vestibular schwannoma (VS) growth. The anticipated growth rate of a VS and its potential clinical impact are important factors when deciding whether to observe the lesion over time or to intervene. Previous studies of VS natural growth remain limited, mostly confined to linear measurements, often without high-resolution, thin-sequence imaging. The present study comprehensively assessed natural tumor growth rates using volumetric measurements. METHODS Between 2012 and 2018, 212 treatment-naïve patients diagnosed with a unilateral VS were evaluated. A total of 699 MR images were assessed, with a range of 2-11 MR images per patient. All MR images preceded any intervention, with patients subsequently being observed through completion of data analysis (36%) or treated with stereotactic radiosurgery (32%) or microsurgical resection (32%). To determine precise tumor volumes, the tumor area was outlined on every slice, and the products of the area and slice thickness were summed (99% of scans were ≤ 1-mm slice thickness). A multilevel model with random effects was used to assess the mean volume change over time. Each tumor was categorized as one of the following: growing (volume increase by more than 20% per year), fast growing (volume increase by more than 100% per year), stable (volume change between 20% decrease and 20% increase per year), and shrinking (volume decrease by more than 20% per year). RESULTS The mean VS volumetric growth rate was 33.5% per year (95% CI 26.9%-40.5%, p < 0.001). When assessing the frequencies of individual tumor annual growth rates, 66% demonstrated growth (30% fast growing), 33% were stable, and 1% exhibited shrinking over an average interval of 25 months. Larger tumors were associated with increased absolute growth, but there was no relationship between tumor size and proportional growth rate. There was also no relationship between patient age and tumor growth rate. CONCLUSIONS This study comprehensively assessed VS volumetric growth rates using high-resolution images and was conducted in a large and diverse patient sample. The majority of the tumors exhibited growth, with about one-third growing at a rate of 100% per year. These findings may contribute to a consensus understanding of tumor behavior and inform clinical decisions regarding whether to intervene or observe.
Collapse
Affiliation(s)
| | | | | | | | - J Thomas Roland
- 2Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York
| | | |
Collapse
|
28
|
Comparing Linear and Volumetric Vestibular Schwannoma Measurements Between T1 and T2 Magnetic Resonance Imaging Sequences. Otol Neurotol 2019; 40:S67-S71. [DOI: 10.1097/mao.0000000000002208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Outcomes of large vestibular schwannomas following subtotal resection: early post-operative volume regression and facial nerve function. J Neurooncol 2019; 143:281-288. [PMID: 30989621 DOI: 10.1007/s11060-019-03157-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Subtotal resection (STR) of vestibular schwannoma (VS) tumors remains controversial and little is known regarding post-operative volume changes. METHODS Authors retrospective reviewed the medical records from January 1st 2002 to January 1st 2018, for all patients who had undergone primary STR of large VS at a single tertiary academic institution. RESULTS Our series consists of 34 patients with a mean age of 53.9 (median 53; range 21-87) years that had STR of their VS tumor. The mean pre-operative tumor diameter and volume was 3.9 cm (median 3.0 cm; range 1.6-6.0 cm) and 11.7 cm3 (median 9.6 cm3; range 2.8-44.3 cm3), respectively, with a mean extent of resection of 86% (median 90%; range 53-99%). The mean radiographic and clinical follow-up was 40 months (range 6-120 months) and 51 months (range 7-141 months), respectively. 85% of patients had optimal House-Brackmann (HB) scores (Grade 1 & 2) immediately post-operatively, and 91% at 1 year; 94% of patients had normal (HB 1) at last follow-up. There was significant regression of residual tumor volume at 1 year (p = 0.006) and 2 years (p = 0.02), but not at 3 years (p = 0.08), when compared to the prior year. There was significant regression of size over time, with a mean slope estimate of - 0.70 units per year (p < 0.001). CONCLUSION Excellent clinical facial nerve outcomes can be obtained with STR of large VS tumors. Maximal reduction in tumor size occurs at 2-year post-operatively. Thus, in patients undergoing surgery for large VS, STR and a "watch and wait" strategy is a reasonable treatment option that may optimize facial nerve outcomes.
Collapse
|
30
|
Marinelli JP, Lees KA, Tombers NM, Lohse CM, Carlson ML. Impact of Aspirin and Other NSAID Use on Volumetric and Linear Growth in Vestibular Schwannoma. Otolaryngol Head Neck Surg 2019; 160:1081-1086. [DOI: 10.1177/0194599819827812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives Conflicting research exists surrounding the utility of aspirin to prevent tumor growth in the medical management of vestibular schwannoma (VS). Recent studies demonstrated no association between aspirin and VS growth using linear tumor measurements. Given the heightened sensitivity of volumetric analyses to monitor tumor growth, the current study was conceived with the chief objective of assessing the association between aspirin or other nonsteroidal anti-inflammatory drug (NSAID) use and VS growth using volumetric analyses. Study Design Retrospective review. Setting Tertiary referral center. Subjects and Methods A total of 361 patients totaling 1601 volumetrically analyzed magnetic resonance imaging studies who underwent initial observation since January 1, 2003. Results In total, 123 (35%) patients took 81 mg aspirin daily, 23 (7%) took 325 mg aspirin daily, and 41 (11%) reported other NSAID use. Among those taking aspirin, 112 (72%) exhibited volumetric tumor growth during observation compared to 33 (80%) among other NSAID users and 137 (67%) among nonaspirin users. Patients taking aspirin or other NSAIDs were significantly older at time of diagnosis (median, 66 vs 56 years; P < .001). Neither aspirin use (hazard ratio [HR], 0.96; P = .73) nor other NSAID use (HR, 1.39; P = .081) was significantly associated with a reduced risk of volumetric tumor growth. These results were similar following age adjustment ( P = .81 and .087, respectively). When separating aspirin users by 81-mg or 325-mg dosing, neither group exhibited a reduced risk of growth ( P = .95 and .73, respectively). Conclusion Despite promising initial results, the preponderance of existing literature suggests that aspirin and other NSAID use does not prevent tumor growth in VS.
Collapse
Affiliation(s)
- John P. Marinelli
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine A. Lees
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicole M. Tombers
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M. Lohse
- Department of Health Sciences Research, 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
|
31
|
Sadik ZHA, Lie ST, Leenstra S, Hanssens PEJ. Volumetric changes and clinical outcome for petroclival meningiomas after primary treatment with Gamma Knife radiosurgery. J Neurosurg 2018; 129:1623-1629. [DOI: 10.3171/2017.7.jns17380] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 07/24/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPetroclival meningiomas (PCMs) can cause devastating clinical symptoms due to mass effect on cranial nerves (CNs); thus, patients harboring these tumors need treatment. Many neurosurgeons advocate for microsurgery because removal of the tumor can provide relief or result in symptom disappearance. Gamma Knife radiosurgery (GKRS) is often an alternative for surgery because it can cause tumor shrinkage with improvement of symptoms. This study evaluates qualitative volumetric changes of PCM after primary GKRS and its impact on clinical symptoms.METHODSThe authors performed a retrospective study of patients with PCM who underwent primary GKRS between 2003 and 2015 at the Gamma Knife Center of the Elisabeth-Tweesteden Hospital in Tilburg, the Netherlands. This study yields 53 patients. In this study the authors concentrate on qualitative volumetric tumor changes, local tumor control rate, and the effect of the treatment on trigeminal neuralgia (TN).RESULTSLocal tumor control was 98% at 5 years and 93% at 7 years (Kaplan-Meier estimates). More than 90% of the tumors showed regression in volume during the first 5 years. The mean volumetric tumor decrease was 21.2%, 27.1%, and 31% at 1, 3, and 6 years of follow-up, respectively. Improvement in TN was achieved in 61%, 67%, and 70% of the cases at 1, 2, and 3 years of follow-up, respectively. This was associated with a mean volumetric tumor decrease of 25% at the 1-year follow-up to 32% at the 3-year follow-up.CONCLUSIONSGKRS for PCMs yields a high tumor control rate with a low incidence of neurological deficits. Many patients with TN due to PCM experienced improvement in TN after radiosurgery. GKRS achieves significant volumetric tumor decrease in the first years of follow-up and thereafter.
Collapse
Affiliation(s)
- Zjiwar H. A. Sadik
- 1Gamma Knife Center and
- 2Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg; and
- 3Department of Neurosurgery, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Suan Te Lie
- 1Gamma Knife Center and
- 2Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg; and
| | - Sieger Leenstra
- 1Gamma Knife Center and
- 2Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg; and
| | | |
Collapse
|
32
|
Choi Y, Kim S, Kwak DW, Lee HS, Kang MK, Lee DK, Hur WJ. Maximum diameter versus volumetric assessment for the response evaluation of vestibular schwannomas receiving stereotactic radiotherapy. Radiat Oncol J 2018; 36:114-121. [PMID: 29983031 PMCID: PMC6074071 DOI: 10.3857/roj.2018.00031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To explore the feasibility of maximum diameter as a response assessment method for vestibular schwannomas (VS) after stereotactic radiosurgery or fractionated stereotactic radiotherapy (RT), we analyzed the concordance of RT responses between maximum diameters and volumetric measurements. Materials and Methods Forty-two patients receiving curative stereotactic radiosurgery or fractionated stereotactic RT for VS were analyzed retrospectively. Twelve patients were excluded: 4 did not receive follow-up magnetic resonance imaging (MRI) scans and 8 had initial MRI scans with a slice thickness >3 mm. The maximum diameter, tumor volume (TV), and enhanced tumor volume (ETV) were measured in each MRI study. The percent change after RT was evaluated according to the measurement methods and their concordances were calculated with the Pearson correlation. The response classifications were determined by the assessment modalities, and their agreement was analyzed with Cohen kappa statistics. Results Median follow-up was 31.0 months (range, 3.5 to 86.5 months), and 90 follow-up MRI studies were analyzed. The percent change of maximum diameter correlated strongly with TV and ETV (r(p) = 0.85, 0.63, p = 0.000, respectively). Concordance of responses between the Response Evaluation Criteria in Solid Tumors (RECIST) using the maximum diameters and either TV or ETV were moderate (kappa = 0.58; 95% confidence interval, 0.32-0.85) or fair (kappa = 0.32; 95% confidence interval, 0.05-0.59), respectively. Conclusion The percent changes in maximum diameter and the responses in RECIST were significantly concordant with those in the volumetric measurements. Therefore, the maximum diameters can be used for the response evaluation of VS following stereotactic RT.
Collapse
Affiliation(s)
- Youngmin Choi
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
| | - Sungmin Kim
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
| | - Dong-Won Kwak
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
| | - Hyung-Sik Lee
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
| | - Myung-Koo Kang
- Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Dong-Kun Lee
- Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Won-Joo Hur
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
| |
Collapse
|
33
|
Lees KA, Tombers NM, Link MJ, Driscoll CL, Neff BA, Van Gompel JJ, Lane JI, Lohse CM, Carlson ML. Natural History of Sporadic Vestibular Schwannoma: A Volumetric Study of Tumor Growth. Otolaryngol Head Neck Surg 2018; 159:535-542. [DOI: 10.1177/0194599818770413] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective (1) Assess 3-dimensional volumetric growth of untreated sporadic vestibular schwannomas (VSs) in a large cohort of patients treated with conservative observation. (2) Compare volumetric and conventional linear diameter measurements for detecting tumor growth. Study Design Case series with chart review. Setting Tertiary skull base referral center. Subjects and Methods Patients with sporadic VS who elected initial conservative treatment with at least 2 serial magnetic resonance imaging (MRI) scans were included. Tumor volume was determined with 3-dimensional segmentation of MRI sequences. The volumetric threshold for tumor growth was an increase ≥20% from baseline tumor volume. Tumor size based on linear diameter was assessed with the 1995 American Academy of Otolaryngology—Head and Neck Surgery Foundation guidelines for VS outcome reporting, with growth defined as an increase ≥2 mm. Results A total of 361 patients were included with a median radiologic follow-up of 4.1 years (interquartile range [IQR], 2.5-6.8). At diagnosis, 232 VSs (64%) were purely intracanalicular, and 129 (36%) extended into the cerebellopontine angle. The median baseline tumor volume was 0.161 cm3 (IQR, 0.054-0.418). Overall, 69% of tumors demonstrated volumetric growth at a median of 1.1 years (IQR, 0.6-2.1) after initial MRI. In contrast, based on linear measurement assessment, 48% of tumors demonstrated growth at a median of 1.8 years (IQR, 0.8-3.1) from first MRI scan. Disequilibrium, facial hypoesthesia, aural fullness, initial tumor size, and nonincidental diagnosis were associated with tumor growth. Conclusion Three-dimensional volumetric assessment of VS provides a more sensitive measure of tumor growth when compared with linear diameter assessment. Through volumetric analysis, the current study revealed that a significant proportion of VSs demonstrate growth during observation.
Collapse
Affiliation(s)
- Katherine A. Lees
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Nicole M. Tombers
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Michael J. Link
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Colin L. Driscoll
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Brian A. Neff
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Jamie J. Van Gompel
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - John I. Lane
- Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Christine M. Lohse
- Department of Health Sciences Research, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Matthew L. Carlson
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| |
Collapse
|
34
|
A Comparison of Repeatability and Usability of Semi-Automated Volume Segmentation Tools for Measurement of Vestibular Schwannomas. Otol Neurotol 2018; 39:e496-e505. [PMID: 29649049 DOI: 10.1097/mao.0000000000001796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Semi-automated volume segmentation tools (SAVST) offer a less time consuming technique compared with manual volume segmentation method. No data exists to suggest which of the available applications are optimal for use with vestibular schwannomas (VS). This study aims to compare repeatability and usability of three different SAVST for measurement of VS. STUDY DESIGN Experimental comparison of three SAVST. SETTING Tertiary skull base unit. PATIENTS Twenty-four patients with a unilateral VS imaged with T1-weighted Gadolinium enhanced MRI. INTERVENTION Repeated measurements made to determine intra and inter-observer agreement. This was repeated using three different SAVST. MAIN OUTCOME MEASURES 1) Intra- and inter-observer intraclass correlation coefficients (ICC), repeatability coefficients (RC), and relative smallest detectable differences (%SDD).2) Usability as determined by the mean number of steps and time required per tumor measurement and the proportion of cases where manual editing was required. RESULTS Intra-observer ICCs were significantly better for SliceOmatic and OleaSphere than AW VolumeShare (0.998 versus 0.994, p < 0.05). Inter-observer ICCs were also better for SliceOmatic (0.994) and OleaSphere (0.989) compared with AW VolumeShare (0.976), however, this was only significant for SliceOmatic (p = 0.012). SliceOmatic had a poorer usability profile requiring more manual editing, time, and individual steps per measurement but its "watershed segmentation" algorithm was better at measuring cystic or heterogenous tumors. CONCLUSIONS This is the first study to compare three SAVST for measurement of VS. While SliceOmatic had the highest repeatability, Olea Sphere combined comparable repeatability with improved usability and a greater degree of automation and was, therefore, deemed optimal for use in routine clinical practice.
Collapse
|
35
|
Calculating the Tumor Volumes in Vestibular Schwannomas: Are the ABC/2 and Volumetric Methods Comparable? Otol Neurotol 2018; 38:889-894. [PMID: 28394785 DOI: 10.1097/mao.0000000000001423] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the efficacy of the ABC/2 method for calculating the volume of vestibular schwannomas as compared with 3-D planimetric method. STUDY DESIGN Retrospective. METHODS Fifty eight cases of pathologically confirmed sporadic vestibular schwannomas (VS) were analyzed. Tumors volumes were calculated for each tumor twice, once through semiautomated 3-D volumetric method and subsequently through ABC/2 (AP × ML × CC/2) methodology after calculating the maximal tumor dimensions in anteroposterior (AP), coronal (ML), and craniocaudal (CC) dimensions. Tumor volumes were initially correlated as a group and subsequently by dividing them into three groups using the Hannover classification. RESULTS The two methodologies were highly correlated when tumors were analyzed as a group (rho = 0.913, p < 0.0001). In the sub-group analysis, tumor volumes were again strongly correlated for larger tumors (rho = 0.918, p < 0.0001) but the correlation progressively reduced as tumor volumes decreased. CONCLUSION Given the ease and universal accessibility of linear measurement applications, the ABC/2 methodology is a robust substitute for calculating tumor volumes, especially for larger tumors.
Collapse
|
36
|
Ho HH, Li YH, Lee JC, Wang CW, Yu YL, Hueng DY, Ma HI, Hsu HH, Juan CJ. Vestibular schwannomas: Accuracy of tumor volume estimated by ice cream cone formula using thin-sliced MR images. PLoS One 2018; 13:e0192411. [PMID: 29438424 PMCID: PMC5810994 DOI: 10.1371/journal.pone.0192411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 01/08/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We estimated the volume of vestibular schwannomas by an ice cream cone formula using thin-sliced magnetic resonance images (MRI) and compared the estimation accuracy among different estimating formulas and between different models. METHODS The study was approved by a local institutional review board. A total of 100 patients with vestibular schwannomas examined by MRI between January 2011 and November 2015 were enrolled retrospectively. Informed consent was waived. Volumes of vestibular schwannomas were estimated by cuboidal, ellipsoidal, and spherical formulas based on a one-component model, and cuboidal, ellipsoidal, Linskey's, and ice cream cone formulas based on a two-component model. The estimated volumes were compared to the volumes measured by planimetry. Intraobserver reproducibility and interobserver agreement was tested. Estimation error, including absolute percentage error (APE) and percentage error (PE), was calculated. Statistical analysis included intraclass correlation coefficient (ICC), linear regression analysis, one-way analysis of variance, and paired t-tests with P < 0.05 considered statistically significant. RESULTS Overall tumor size was 4.80 ± 6.8 mL (mean ±standard deviation). All ICCs were no less than 0.992, suggestive of high intraobserver reproducibility and high interobserver agreement. Cuboidal formulas significantly overestimated the tumor volume by a factor of 1.9 to 2.4 (P ≤ 0.001). The one-component ellipsoidal and spherical formulas overestimated the tumor volume with an APE of 20.3% and 29.2%, respectively. The two-component ice cream cone method, and ellipsoidal and Linskey's formulas significantly reduced the APE to 11.0%, 10.1%, and 12.5%, respectively (all P < 0.001). CONCLUSION The ice cream cone method and other two-component formulas including the ellipsoidal and Linskey's formulas allow for estimation of vestibular schwannoma volume more accurately than all one-component formulas.
Collapse
Affiliation(s)
- Hsing-Hao Ho
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Hui Li
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan
| | - Jih-Chin Lee
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Wang
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Lin Yu
- Department of Neurological Surgery, Tri-Service General Hospital, Taipei, Taiwan
- Department of Neurological Surgery, National Defense Medical Center, Taipei, Taiwan
| | - Dueng-Yuan Hueng
- Department of Neurological Surgery, Tri-Service General Hospital, Taipei, Taiwan
- Department of Neurological Surgery, National Defense Medical Center, Taipei, Taiwan
- Department of Biochemistry, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-I Ma
- Department of Neurological Surgery, Tri-Service General Hospital, Taipei, Taiwan
- Department of Neurological Surgery, National Defense Medical Center, Taipei, Taiwan
- * E-mail: (CJJ); (H-IM)
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Jung Juan
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan
- * E-mail: (CJJ); (H-IM)
| |
Collapse
|
37
|
MacKeith S, Das T, Graves M, Patterson A, Donnelly N, Mannion R, Axon P, Tysome J. A comparison of semi-automated volumetric vs linear measurement of small vestibular schwannomas. Eur Arch Otorhinolaryngol 2018; 275:867-874. [PMID: 29335780 PMCID: PMC5838150 DOI: 10.1007/s00405-018-4865-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/03/2018] [Indexed: 12/02/2022]
Abstract
Objective Accurate and precise measurement of vestibular schwannoma (VS) size is key to clinical management decisions. Linear measurements are used in routine clinical practice but are prone to measurement error. This study aims to compare a semi-automated volume segmentation tool against standard linear method for measuring small VS. This study also examines whether oblique tumour orientation can contribute to linear measurement error. Study design Experimental comparison of observer agreement using two measurement techniques. Setting Tertiary skull base unit. Participants Twenty-four patients with unilateral sporadic small (< 15 mm maximum intracranial dimension) VS imaged with 1 mm-thickness T1-weighted Gadolinium enhanced MRI. Main outcome measures (1) Intra and inter-observer intraclass correlation coefficients (ICC), repeatability coefficients (RC), and relative smallest detectable difference (%SDD). (2) Mean change in maximum linear dimension following reformatting to correct for oblique orientation of VS. Results Intra-observer ICC was higher for semi-automated volumetric when compared with linear measurements, 0.998 (95% CI 0.994–0.999) vs 0.936 (95% CI 0.856–0.972), p < 0.0001. Inter-observer ICC was also higher for volumetric vs linear measurements, 0.989 (95% CI 0.975–0.995) vs 0.946 (95% CI 0.880–0.976), p = 0.0045. The intra-observer %SDD was similar for volumetric and linear measurements, 9.9% vs 11.8%. However, the inter-observer %SDD was greater for volumetric than linear measurements, 20.1% vs 10.6%. Following oblique reformatting to correct tumour angulation, the mean increase in size was 1.14 mm (p = 0.04). Conclusion Semi-automated volumetric measurements are more repeatable than linear measurements when measuring small VS and should be considered for use in clinical practice. Oblique orientation of VS may contribute to linear measurement error.
Collapse
Affiliation(s)
- Samuel MacKeith
- Cambridge Skull Base Unit, Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, CB2 0QQ, UK.
| | - Tilak Das
- Department of Neuroradiology, Addenbrookes Hospital, Cambridge, UK
| | - Martin Graves
- Department of Radiology, Addenbrookes Hospital, Cambridge, UK
| | | | - Neil Donnelly
- Cambridge Skull Base Unit, Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, CB2 0QQ, UK
| | - Richard Mannion
- Department of Neurosurgery, Addenbrookes Hospital, Cambridge, UK
| | - Patrick Axon
- Cambridge Skull Base Unit, Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, CB2 0QQ, UK
| | - James Tysome
- Cambridge Skull Base Unit, Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, CB2 0QQ, UK
| |
Collapse
|
38
|
Long-term beneficial outcome of fractionated stereotactic radiotherapy for smaller and larger vestibular schwannomas. JOURNAL OF RADIOTHERAPY IN PRACTICE 2017. [DOI: 10.1017/s1460396917000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground and purposeFractionated stereotactic radiotherapy (FSRT) is an alternative treatment for large vestibular schwannomas (VS), if patients are not fit for or refuse surgery. In this study, we compared long-term clinical and radiological outcome in both small–medium sized and larger tumours.Material and methodsA retrospective study was performed of patients with sporadic VS who underwent primarily conventional FSRT. In total, 50 consecutive patients were divided into two groups by volume. Clinical and volumetric parameters were analysed.ResultsIn all, 41 patients (82%) had large tumours affecting the 4thventricle (modified Koos stage 4). Definitive expansion of VS occurred in eight out of 50 patients (16%). After 7·2 years (median) the overall freedom from clinical failure was 100% in smaller and 92% in larger schwannomas (arbitrarily sized >7·4 cc). Useful hearing was preserved in only 35% of the patients. The facial nerve remained intact in all cases, while new deficit of the trigeminal nerve occurred in 20% of the cases. Of the larger tumours 20% needed a cerebrospinal fluid (CSF) shunt.ConclusionsFSRT is a treatment in its own right as it is highly effective in both smaller and larger VS without causing permanent disabling complications. The outcome is beneficial also in larger tumours that affect the 4thventricle.
Collapse
|
39
|
Correlation Between Aspirin Intake and Reduced Growth of Human Vestibular Schwannoma: Volumetric Analysis. Otol Neurotol 2017; 37:1428-34. [PMID: 27631829 DOI: 10.1097/mao.0000000000001180] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether people with sporadic vestibular schwannoma (VS) who take aspirin for unrelated medical reasons exhibit less tumor growth than nonaspirin users. We previously demonstrated the efficacy of salicylates in inhibiting VS growth in vitro, corroborating the results of our retrospective clinical study, which found halted VS growth (based on linear tumor measurements) in aspirin users. The current study evaluates this association using more accurate tumor volumetric measurements, and quantifies the degree of frequency-specific, VS-induced hearing loss. STUDY DESIGN Retrospective analysis. SETTING Tertiary care hospital. PATIENTS Diagnosed with VS between 1980 and 2012, followed by serial magnetic resonance imaging for at least 1 year. MAIN OUTCOME MEASURES Patient history of aspirin intake; change in VS volume over time of observation; frequency-specific, VS-induced audiometric threshold shifts. RESULTS Of the 347 patients followed by serial magnetic resonance imaging scans, 86 had sequential scans available for 3D-segmented volumetric analysis for up to 11 years of follow-up (median 53 mo). Twenty-five (29%) had documented history of aspirin intake; 8 (32%) of these demonstrated VS growth. Of the 61 (71%) nonusers, 36 (59%) demonstrated growth. A significant inverse association was found among aspirin users and VS growth: odds ratio 0.32, 95% confidence interval 0.11 to 0.91. VS-induced audiometric thresholds shifts were larger above than below 2000 Hz. CONCLUSION Our volumetric analysis of VS growth reaffirms the results of our linear analysis and suggests that aspirin may inhibit VS growth. The audiometric findings are consistent with the previously reported VS-induced predominantly high-frequency sensorineural hearing loss.
Collapse
|
40
|
Vestibular Schwannomas: Do Linear and Volumetric Parameters on MRI Correlate With Hearing Loss? Otol Neurotol 2017; 37:1168-73. [PMID: 27466888 DOI: 10.1097/mao.0000000000001150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine if two-dimensional and volumetric imaging parameters in vestibular schwannomas (VS) correlate with hearing loss at presentation. STUDY DESIGN Retrospective. METHODS Forty-one cases of pathologically confirmed sporadic VS were analyzed. Maximal tumor dimensions in anteroposterior (AP), coronal (ML), and craniocaudal (CC) dimensions were obtained along with tumor-fundus distance and internal auditory canal (IAC) porus diameters. Volumetric analysis was done on 37 cases. Tumors volumes were calculated through both 3-D volumetric and ABC/2 [AP × ML × CC/2] methodology. With the 3-D method, total tumor volume (TTV), and cerebellopontine angle (CPA) tumor volume were separately calculated and IAC volumes obtained by subtracting CPA tumor volumes from TTV. Pure tone average (PTA) and speech discrimination scores (SDS) were correlated with tumor dimensions. RESULTS Non-volumetric analysis was performed on 41 tumors. The AP and ML dimensions correlated with both PTA and SDS (p < 0.05). No significant correlations were seen between hearing loss and tumor-fundus distance or porus diameters. The tumor volume calculated through ABC/2 methodology correlated with PTA and SDS (p < 0.05). The 3-D TTV and CPA volumes only correlated with PTA. IAC tumor volumes did not correlate with hearing loss. CONCLUSION Maximal AP and ML dimensions are the only non-volumetric variables, which significantly correlate with hearing loss. Tumor volume calculated through ABC/2 method significantly correlates with hearing impairment while the 3-D TTV and CPA tumor volumes only correlated significantly with PTA scores but not SDS scores.
Collapse
|
41
|
Torres R, Nguyen Y, Vanier A, Smail M, Ferrary E, Sterkers O, Kalamarides M, Bernardeschi D. Multivariate Analysis of Factors Influencing Facial Nerve Outcome following Microsurgical Resection of Vestibular Schwannoma. Otolaryngol Head Neck Surg 2016; 156:525-533. [PMID: 28248607 DOI: 10.1177/0194599816677711] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To assess through multivariate analysis the clinical pre- and intraoperative factors of facial nerve outcomes at day 8 and 1-year recovery of facial palsy, as compared with day 8 status among patients who underwent total resection of unilateral vestibular schwannoma. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods This study included 229 patients with preoperative normal facial function and anatomic preservation of the facial nerve. Clinical, radiologic, and intraoperative factors were assessed according to facial nerve function at day 8 and 1 year. Results We observed that 74% and 84% of patients had good facial function (House-Brackmann [HB] I-II) at day 8 and 1 year, respectively. Of 60 patients, 26 (43%) who had impaired facial function (HB III-VI) at day 8 recovered good facial function (HB I-II) 1 year after surgery. A structured equation model showed that advanced tumor stage and strong facial nerve adhesion were independently associated with facial nerve conduction block at day 8. No predictive factor of impaired facial function recovery was seen at 1 year. In terms of the extracanalicular diameter of the tumor, the cutoff point to minimize the risk of impaired facial function was 16 mm. Conclusion At day 8 after vestibular schwannoma resection, facial function was impaired in the case of large tumors or strong facial nerve adhesion to the tumor. After 1 year, less than half of the patients recovered good facial function, and no predictive factor was found to be associated with this possible recovery.
Collapse
Affiliation(s)
- Renato Torres
- 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,2 Sorbonne Universities, UPMC Univ, France.,3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France
| | - Yann Nguyen
- 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,2 Sorbonne Universities, UPMC Univ, France.,3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France
| | - Antoine Vanier
- 2 Sorbonne Universities, UPMC Univ, France.,4 Biostatistics Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Mustapha Smail
- 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Evelyne Ferrary
- 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,2 Sorbonne Universities, UPMC Univ, France.,3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France
| | - Olivier Sterkers
- 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,2 Sorbonne Universities, UPMC Univ, France.,3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France
| | - Michel Kalamarides
- 2 Sorbonne Universities, UPMC Univ, France.,5 Neurosurgery Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Daniele Bernardeschi
- 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,2 Sorbonne Universities, UPMC Univ, France.,3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France
| |
Collapse
|
42
|
Lawson McLean AC, McLean AL, Rosahl SK. Evaluating vestibular schwannoma size and volume on magnetic resonance imaging: An inter- and intra-rater agreement study. Clin Neurol Neurosurg 2016; 145:68-73. [DOI: 10.1016/j.clineuro.2016.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/01/2016] [Accepted: 04/08/2016] [Indexed: 11/25/2022]
|
43
|
Heesterman B, Verbist B, van der Mey A, Bayley J, Corssmit E, Hes F, Jansen J. Measurement of head and neck paragangliomas: is volumetric analysis worth the effort? A method comparison study. Clin Otolaryngol 2016; 41:571-8. [DOI: 10.1111/coa.12562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 01/26/2023]
Affiliation(s)
- B.L. Heesterman
- Department of Otolaryngology; Leiden University Medical Center; Leiden the Netherlands
| | - B.M. Verbist
- Department of Radiology; Leiden University Medical Center; Leiden the Netherlands
| | - A.G.L. van der Mey
- Department of Otolaryngology; Leiden University Medical Center; Leiden the Netherlands
| | - J.P. Bayley
- Department of Human Genetics; Leiden University Medical Center; Leiden the Netherlands
| | - E.P.M. Corssmit
- Department of Endocrinology; Leiden University Medical Center; Leiden the Netherlands
| | - F.J. Hes
- Department of Clinical Genetics; Leiden University Medical Center; Leiden the Netherlands
| | - J.C. Jansen
- Department of Otolaryngology; Leiden University Medical Center; Leiden the Netherlands
| |
Collapse
|
44
|
Analysis of vestibular schwannoma size: A literature review on consistency with measurement techniques. Clin Neurol Neurosurg 2015; 138:72-7. [DOI: 10.1016/j.clineuro.2015.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/05/2015] [Indexed: 11/19/2022]
|
45
|
3D quantitative assessment of response to fractionated stereotactic radiotherapy and single-session stereotactic radiosurgery of vestibular schwannoma. Eur Radiol 2015; 26:849-57. [PMID: 26139318 DOI: 10.1007/s00330-015-3895-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/19/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine clinical outcome of patients with vestibular schwannoma (VS) after treatment with fractionated stereotactic radiotherapy (FSRT) and single-session stereotactic radiosurgery (SRS) by using 3D quantitative response assessment on MRI. MATERIALS This retrospective analysis included 162 patients who underwent radiation therapy for sporadic VS. Measurements on T1-weighted contrast-enhanced MRI (in 2-year post-therapy intervals: 0-2, 2-4, 4-6, 6-8, 8-10, 10-12 years) were taken for total tumour volume (TTV) and enhancing tumour volume (ETV) based on a semi-automated technique. Patients were considered non-responders (NRs) if they required subsequent microsurgical resection or developed radiological progression and tumour-related symptoms. RESULTS Median follow-up was 4.1 years (range: 0.4-12.0). TTV and ETV decreased for both the FSRT and SRS groups. However, only the FSRT group achieved significant tumour shrinkage (p < 0.015 for TTV, p < 0.005 for ETV over time). The 11 NRs showed proportionally greater TTV (median TTV pre-treatment: 0.61 cm(3), 8-10 years after: 1.77 cm(3)) and ETV despite radiation therapy compared to responders (median TTV pre-treatment: 1.06 cm(3); 10-12 years after: 0.81 cm(3); p = 0.001). CONCLUSION 3D quantification of VS showed a significant decrease in TTV and ETV on FSRT-treated patients only. NR had significantly greater TTV and ETV over time. KEY POINTS Only FSRT not GK-treated patients showed significant tumour shrinkage over time. Clinical non-responders showed significantly less tumour shrinkage when compared to responders. 3D volumetric assessment of vestibular schwannoma shows advantages over unidimensional techniques.
Collapse
|
46
|
Treatment Outcomes in Patients Treated With CyberKnife Radiosurgery for Vestibular Schwannoma. Otol Neurotol 2014; 35:162-70. [DOI: 10.1097/mao.0b013e3182a435f5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|