1
|
Patel AA, Kennedy D, Dupuis G, Levi JR, Weber PC. Determining the Impact of Preoperative Psychiatric Comorbidities on Readmission After Resection of Vestibular Schwannoma. Otol Neurotol 2024; 45:e602-e606. [PMID: 39142317 DOI: 10.1097/mao.0000000000004277] [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: 08/16/2024]
Abstract
OBJECTIVE To determine the impact of comorbid depression on readmission after vestibular schwannoma resection. STUDY DESIGN Retrospective database analysis. SETTING National database of readmitted patients. PATIENTS The Nationwide Readmission Database (NRD) was retrospectively reviewed for patients with history of vestibular schwannoma, identified by International Classification of Disease, Ninth Revision (ICD-9) code 225.1 and ICD-10 code D33.3, who underwent surgical resection (ICD-9 04.01, ICD-10-PCS 00BN0ZZ) in 2020. INTERVENTIONS Therapeutic. MAIN OUTCOME MEASURES Need for rehabilitation, need for procedures, length of stay, cost of readmission, and insurance status. RESULTS A total of 1997 patients were readmitted after resection of vestibular schwannoma in 2020. Of these patients, 290 had history of a comorbid depressive disorder.A significantly higher proportion of patients with history of comorbid depression were transferred to a rehabilitation facility after readmission (11.30% versus 4.30%, p < 0.001). Length of stay (p = 0.227) and total readmission cost (p = 0.723) did not differ significantly, but a significantly lower proportion had private insurance (55.40% versus 64.40%, p = 0.027). CONCLUSION Depression is associated with higher utilization of postoperative rehabilitation services and higher rates of medical comorbidities, and should be considered during preoperative evaluation.
Collapse
Affiliation(s)
| | | | - Genevieve Dupuis
- Boston University School of Public Health, Boston, Massachusetts
| | | | | |
Collapse
|
2
|
Daloiso A, Cazzador D, Concheri S, Tealdo G, Zanoletti E. Long-Term Hearing Outcome For Vestibular Schwannomas After Microsurgery And Radiotherapy: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2024. [PMID: 39045727 DOI: 10.1002/ohn.910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/27/2024] [Accepted: 07/06/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Hearing loss is a common symptom associated with vestibular schwannoma (VS), either because of the tumor's effects on the cochlear nerve or due to active treatments such as surgery or stereotactic radiosurgery (SRS). Treatment decisions for VS are based on factors including tumor size, hearing status, patient symptoms, and institutional preference. The study aimed to investigate long-term auditory outcomes in VS patients undergoing active treatments with a hearing preservation intent. DATA SOURCES A systematic literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching Scopus, Pubmed, and Web of Science databases from inception to January 2024. REVIEW METHODS Studies meeting inclusion criteria, including a minimum 5-year follow-up and assessment of pre- and posttreatment hearing outcomes, were included. Pooled prevalence estimates for serviceable hearing after SRS and microsurgery were calculated using MetaXL software. Risk of bias assessment was performed with the Risk of Bias in Non-randomized Studies of Interventions tool. RESULTS Nine studies met the inclusion criteria, with 356 patients included for analysis. The pooled prevalence of maintaining serviceable hearing after SRS at 10 years was 18.1% (95% confidence interval [CI]: 1.7%-43.3%), with wide prediction intervals indicating variability in outcomes. Microsurgery demonstrated a higher prevalence of maintaining long-term serviceable hearing, with a pooled estimate of 74.5% (95% CI: 63.5%-84.1%). CONCLUSION This systematic review underscores the importance of long-term follow-up in evaluating auditory outcomes in VS treatment. Despite the biases inherent to pretreatment patients selection, hearing preservation microsurgery for sporadic VS removal demonstrated favorable and stable long-term serviceable hearing.
Collapse
Affiliation(s)
- Antonio Daloiso
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - Diego Cazzador
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - Stefano Concheri
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - Giulia Tealdo
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - Elisabetta Zanoletti
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| |
Collapse
|
3
|
Ölander C, Feychting M, Eriksson PO, Laurell G, Talbäck M, Ek S. Fall-related injury among patients with vestibular schwannoma. PLoS One 2024; 19:e0304184. [PMID: 38875269 PMCID: PMC11178211 DOI: 10.1371/journal.pone.0304184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/06/2024] [Indexed: 06/16/2024] Open
Abstract
Vestibular schwannoma can cause vestibular dysfunction; however, conflicting evidence exists regarding whether this affects the incidence of fall-related injuries in this patient population. This matched cross-sectional and cohort study assess the risk of fall-related injuries in patients with vestibular schwannoma. The study included patients with vestibular schwannoma treated at a tertiary referral hospital in Sweden between 1988 and 2014. Information on fall-related injuries was obtained from the National Patient Register, and matched population comparisons were randomly selected in a 1:25 ratio. Fall-related injuries occurring pre- (within 5 years before the diagnosis of vestibular schwannoma) and post-diagnostically (up to 3 years after diagnosis or intervention) were registered. The association between vestibular schwannoma and fall-related injuries was estimated using logistic regression and Cox proportional hazards analyses. We identified 1153 patients with vestibular schwannoma (569 [49%] women and 584 [51%] men), and 28815 population comparisons. Among the patients, 9% and 7% had pre- and post-diagnostic fall-related injuries, respectively, and among the comparisons, 8% and 6% had pre- and post-diagnostic fall-related injuries, respectively. There was no increased risk of pre- (OR 1.14; CI 0.92-1.41) or post-diagnostic 1 year (HR 1.16; CI 0.87-1.54) or 3 years (HR 1.11; CI 0.89-1.29) fall-related injury among the total patient cohort. In age-stratified analyses, we found an increased risk of pre-diagnostic fall-related injury among patients aged 50-69 years (OR 1.42; CI 1.10-1.88). Patients who underwent middle fossa surgery, regardless of age, had an increased risk of post-surgery fall-related injury within 3 years of follow-up (HR 2.68; CI 1.06-6.81). We conclude that patients with vestibular schwannoma have a low risk of enduring fall-related injuries. Middle-aged patients with dizziness and fall-related injuries should be considered for a vestibular clinical evaluation. Our results highlight the importance of rehabilitation in avoiding future fall-related injuries among patients undergoing middle fossa surgery.
Collapse
Affiliation(s)
- Christine Ölander
- Department of Surgical Sciences, Section of Otolaryngology and Head Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Per Olof Eriksson
- Department of Surgical Sciences, Section of Otolaryngology and Head Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otolaryngology and Head Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
4
|
Homer AS, Kasthuri VS, Homer BJ, Jain R, Gall EK, Noonan KY. The Association Between Medicaid Expansion and Disparities in Vestibular Schwannoma Incidence. Laryngoscope 2024. [PMID: 38837793 DOI: 10.1002/lary.31517] [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: 01/15/2024] [Revised: 03/26/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES The effect of Medicaid expansion as a part of the Affordable Care Act on vestibular schwannoma (VS) incidence overall and in marginalized populations has not yet been elucidated. The goal of this study was to determine if Medicaid expansion was associated with increases in VS incidence overall, as well as in patients of non-white race or in counties of low socioeconomic status (SES). METHODS We performed a difference-in-difference (DiD) analysis from January 1st 2010-December 31st 2017 utilizing the Surveillance, Epidemiology, and End Results (SEER) database. Our DiD method compared the change in VS rate between counties that did and did not expand Medicaid among patients of white and non-white race, in low and high SES counties, before and after expansion. RESULTS The study included 17,312 cases across 1020 counties. Medicaid expansion was associated with a 15% increase (incidence rate ratio 95% CI: [11%, 19]) in VS incidence. White populations saw a 10% increase (CI: [1.06, 1.19]), Black populations saw a 20% increase (CI: [1.10, 1.29]), and patients of other races saw a 44% increase in incidence associated with expansion (CI: [1.21, 1.70]). Low SES counties saw an increase in incidence 1.12 times higher than that of high SES counties (CI:[1.04, 1.20]). CONCLUSION Medicaid expansion was associated with increases in VS incidence across populations. Furthermore, this increase was more evident in disadvantaged populations, such as patients of non-white race and those from low SES counties. These findings emphasize the impact of Medicaid expansion on healthcare utilization for VS diagnosis. LEVEL OF EVIDENCE Step/Level 3-Retrospective Cohort Study Laryngoscope, 2024.
Collapse
Affiliation(s)
- Alexander S Homer
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Viknesh S Kasthuri
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Benjamin J Homer
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Rishubh Jain
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Emily K Gall
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Kathryn Y Noonan
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| |
Collapse
|
5
|
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
|
6
|
King AM, Cooper JN, Oganezova K, Mittal J, McKenna K, Godur DA, Zalta M, Danesh AA, Mittal R, Eshraghi AA. Vestibular Schwannoma and Tinnitus: A Systematic Review of Microsurgery Compared to Gamma Knife Radiosurgery. J Clin Med 2024; 13:3065. [PMID: 38892775 PMCID: PMC11173275 DOI: 10.3390/jcm13113065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Vestibular schwannoma (VS) is a benign tumor of the eighth cranial nerve formed from neoplastic Schwann cells. Although VS can cause a variety of symptoms, tinnitus is one of the most distressing symptoms for patients and can greatly impact quality of life. The objective of this systematic review is to comprehensively examine and compare the outcomes related to tinnitus in patients undergoing treatment for VS. Specifically, it evaluates patient experiences with tinnitus following the removal of VS using the various surgical approaches of traditional surgical resection and gamma knife radiosurgery (GKS). By delving into various aspects such as the severity of tinnitus post-treatment, the duration of symptom relief, patient quality of life, new onset of tinnitus after VS treatment, and any potential complications or side effects, this review aims to provide a detailed analysis of VS treatment on tinnitus outcomes. Methods: Following PRISMA guidelines, articles were included from PubMed, Science Direct, Scopus, and EMBASE. Quality assessment and risk of bias analysis were performed using a ROBINS-I tool. Results: Although VS-associated tinnitus is variable in its intensity and persistence post-resection, there was a trend towards a decreased tinnitus burden in patients. Irrespective of the surgical approach or the treatment with GKS, there were cases of persistent or worsened tinnitus within the studied cohorts. Conclusion: The findings of this systematic review highlight the complex relationship between VS resection and tinnitus outcomes. These findings underscore the need for individualized patient counseling and tailored treatment approaches in managing VS-associated tinnitus. The findings of this systematic review may help in guiding clinicians towards making more informed and personalized healthcare decisions. Further studies must be completed to fill gaps in the current literature.
Collapse
Affiliation(s)
- Ava M. King
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Jaimee N. Cooper
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Karina Oganezova
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Jeenu Mittal
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Keelin McKenna
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Dimitri A. Godur
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Max Zalta
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Ali A. Danesh
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
- Department of Communication Sciences and Disorders, Florida Atlantic University, Boca Raton, FL 33431, USA
- Department of Integrated Medical Sciences, Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Rahul Mittal
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
| | - Adrien A. Eshraghi
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.K.); (J.N.C.); (J.M.); (K.M.); (D.A.G.); (M.Z.); (A.A.D.); (R.M.)
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33143, USA
| |
Collapse
|
7
|
Rodriguez-Martín M, González-Aguado R, Salvatierra-Vicario B, Dierssen-Sotos T, Morales-Angulo C. Sudden Hearing Loss as an Initial Symptom of Vestibular Schwannoma. World Neurosurg 2024; 185:e549-e554. [PMID: 38382763 DOI: 10.1016/j.wneu.2024.02.072] [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: 12/20/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE This study aims to determine the prevalence of vestibular schwannoma (VS) among patients presenting with sudden hearing loss (SHL) and to characterize the clinical features of individuals diagnosed with both VS and SHL. METHODS We conducted an observational retrospective review at a tertiary referral center, spanning a 30-year period, focusing on patients diagnosed with SHL where VS was confirmed as the underlying cause. We included patients meeting these criteria while excluding those lacking imaging or with a pre-existing diagnosis of VS. We evaluated the audiological characteristics at the time of diagnosis and assessed clinical outcomes following treatment. RESULTS Among the 403 patients presenting with SHL during the study period, 9 (2.2%) were diagnosed with VS, aged between 25 and 72 years. Although audiometric profiles varied, high-frequency hearing loss predominated, mostly categorized as mild to moderate. Six patients (66%) had Koos grade I-II schwannomas. Only 2 patients achieved complete hearing recovery post-treatment, while 4 showed no improvement. CONCLUSIONS VS is a rare etiology of SHL, accounting for slightly over 2% of cases. Its symptomatology, severity, and audiometric patterns do not significantly differ from SHL caused by other factors. Tumor size does not correlate with hearing characteristics. Treatment modalities resemble those for other SHL cases, and hearing improvement does not obviate the necessity for follow-up magnetic resonance imaging (MRI) scans.
Collapse
Affiliation(s)
- Minerva Rodriguez-Martín
- Otolaryngology and Head and Neck Surgery Department, Attending Surgeon, Hospital de Urduliz-Alfredo Espinosa, Vizcaya, Vasque Country, Spain
| | - Rocío González-Aguado
- Otolaryngology and Head and Neck Surgery Department, Attending Surgeon, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Belén Salvatierra-Vicario
- Otolaryngology and Head and Neck Surgery Department, Attending Surgeon, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Tinidad Dierssen-Sotos
- Department of Medical and Surgical Sciences Medicine School, Preventive Medicine and Public Health, University of Cantabria, Santander, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; IDIVAL, Santander, Cantabria, Spain
| | - Carmelo Morales-Angulo
- IDIVAL, Santander, Cantabria, Spain; Department of Otolaryngology and Head and Neck Surgery, Marqués de Valdecilla University Hospital, Santander, Spain.
| |
Collapse
|
8
|
Flores-Milan G, Rainone GJ, Piper K, Peto I, Danner C, Allen KP, Liu SS, van Loveren H, Agazzi S. Temporal lobe injury with middle fossa approach to intracanalicular vestibular schwannomas: a systematic review. Neurosurg Rev 2024; 47:188. [PMID: 38658423 DOI: 10.1007/s10143-024-02425-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 04/26/2024]
Abstract
There are several surgical approaches for vestibular schwannoma (VS) resection. However, management has gradually shifted from microsurgical resection, toward surveillance and radiosurgery. One of the arguments against microsurgery via the middle fossa approach (MFA) is the risk of temporal lobe retraction injury or sequelae. Here, we sought to evaluate the incidence of temporal lobe retraction injury or sequela from a MFA via a systematic review of the existing literature. This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Relevant studies reporting temporal lobe injury or sequela during MFA for VS were identified. Data was aggregated and subsequently analyzed to evaluate the incidence of temporal lobe injury. 22 studies were included for statistical analysis, encompassing 1522 patients that underwent VS resection via MFA. The overall rate of temporal lobe sequelae from this approach was 0.7%. The rate of CSF leak was 5.9%. The rate of wound infection was 0.6%. Meningitis occurred in 1.6% of patients. With the MFA, 92% of patients had good facial outcomes, and 54.9% had hearing preservation. Our series and literature review support that temporal lobe retraction injury or sequelae is an infrequent complication from an MFA for intracanalicular VS resection.
Collapse
Affiliation(s)
- Gabriel Flores-Milan
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA
| | - Gersham J Rainone
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA.
| | - Keaton Piper
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA
| | - Ivo Peto
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA
| | - Christopher Danner
- Tampa Bay Hearing and Balance Center, 5 Tampa General Cir, Ste 610, Tampa, FL, USA
| | - Kyle P Allen
- Tampa Bay Hearing and Balance Center, 5 Tampa General Cir, Ste 610, Tampa, FL, USA
| | - Shih Sing Liu
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA
| | - Harry van Loveren
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA
| | - Siviero Agazzi
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, USA
| |
Collapse
|
9
|
Almufarrij I, Hannan CJ, King AT, Vail A, Heal C, Whitfield G, Pathmanaban ON, Lloyd SK, Munro KJ. Reported Hearing Outcome Measures Following Stereotactic Radiosurgery for Vestibular Schwannoma: A Scoping Review. J Neurol Surg B Skull Base 2024; 85:123-130. [PMID: 38449586 PMCID: PMC10914468 DOI: 10.1055/a-2021-8762] [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: 09/15/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023] Open
Abstract
Background Evidence on hearing outcome measures when assessing hearing preservation following stereotactic radiosurgery (SRS) for adults with vestibular schwannoma (VS) has not previously been collated in a structured review. Objective The objective of the present study was to perform a scoping review of the evidence regarding the choice of hearing outcomes and other methodological characteristics following SRS for adults with VS. Methods The protocol was registered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) and reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses extension guidelines for scoping reviews. A systematic search of five online databases revealed 1,591 studies, 247 of which met the inclusion criteria. Results The majority of studies ( n = 213, 86%) were retrospective cohort or case series with the remainder ( n = 34, 14%) prospective cohort. Pure-tone audiometry and speech intelligibility were included in 222 (90%) and 158 (64%) studies, respectively, often summarized within a classification scheme and lacking procedural details. Fifty-nine (24%) studies included self-report measures. The median duration of follow-up, when reported, was 43 months (interquartile range: 29, 4-150). Conclusion Evidence on hearing disability after SRS for VS is based on low-quality studies which are inherently susceptible to bias. This review has highlighted an urgent need for a randomized controlled trial assessing hearing outcomes in patients with VS managed with radiosurgery or radiological observation. Similarly, consensus and coproduction of a core outcome set to determine relevant hearing and communication outcome domains is required. This will ensure that patient priorities, including communication abilities in the presence of background noise and reduced participation restrictions, are addressed.
Collapse
Affiliation(s)
- Ibrahim Almufarrij
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Cathal John Hannan
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Centre, Manchester, United Kingdom
| | - Andrew Thomas King
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Centre, Manchester, United Kingdom
| | - Andy Vail
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Calvin Heal
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Gillian Whitfield
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Omar Nathan Pathmanaban
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Simon K. Lloyd
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Otolaryngology, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Department of Otolaryngology, Northern Care Alliance, Salford Royal Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Kevin J. Munro
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| |
Collapse
|
10
|
Iivanainen A, Raitanen J, Auvinen A. Incidence of vestibular schwannoma in Finland, 1990-2017. Acta Oncol 2024; 63:111-117. [PMID: 38578202 DOI: 10.2340/1651-226x.2024.20352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/06/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND An increasing trend in incidence of vestibular schwannomas (VS) has been reported, though not consistently, across populations. Materials and methods: We obtained data from the Finnish Cancer Registry on 1,149 VS cases diagnosed in 1990-2017 with tabular data up to 2022. We calculated age-standardised incidence rates (ASR) overall, by sex, and for 10-year age groups. We analysed time trends using Poisson and joinpoint regression. RESULTS The average ASR of VS in Finland during 1990-2017 was 8.6/1,000,000 person-years for women and 7.5/1,000,000 for men. A declining trend was found with an average annual percent change of -1.7% (95% confidence interval [CI]: -2.8%, -0.6%) for women, -2.2% (95% CI: -3.6%, -0.7%) for men, and -1.9% (95% CI: -2.9%, -1.0%) for both sexes combined. The ASR in women was 11.6/1,000,000 person-years in 1990 and it decreased to 8.2/1,000,000 by 2017. Correspondingly, the incidence in men was 7.1/1,000,000 in 1990 and decreased to 5.1/1,000,000 by 2017. Some decline in incidence over time was found in all age groups below 80 years, but the decline (2.3-3.1% per year) was statistically significant only in age groups 40-49, 50-59, and 60-69 years. In the oldest age group (80+ years), the incidence of VS increased by 16% per year. For 2018-2022, the ASR was 7.6/1,000,000 for both sexes combined, with a decline by -1.7% (95% CI: -2.3%, -1.2%) annually for the entire period 1990-2022. CONCLUSION In contrast to the increasing incidence reported in some studies, we found a decreasing trend in VS incidence for both sexes in Finland.
Collapse
Affiliation(s)
- Aino Iivanainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Jani Raitanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland; UKK Institute for Health Promotion Research, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland; STUK - Radiation and Nuclear Safety Authority, Environmental Surveillance, Vantaa, Finland
| |
Collapse
|
11
|
Lu Q, Guo X, Kou T, Chen J, Shen W. Establishment of Nomogram for Prediction of Hearing Preservation after Retrosigmoid Approach in Patients with Vestibular Schwannoma. Otol Neurotol 2024; 45:e186-e192. [PMID: 38291779 DOI: 10.1097/mao.0000000000004108] [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: 02/01/2024]
Abstract
OBJECTIVE To derive and validate a prognostic nomogram for the prediction of hearing preservation (HP) after retrosigmoid approach (RSA) in patients with vestibular schwannoma (VS) and further assist in clinical decision-making. STUDY DESIGN Retrospective study. SETTING Tertiary referral center. PATIENTS A total of 111 patients diagnosed with VS with serviceable hearing from January 2013 to March 2023. INTERVENTIONS All patients underwent surgery via RSA, and hearing outcomes were reviewed 2 weeks postoperatively. MAIN OUTCOME MEASURES Preoperative and postoperative hearing were analyzed and stratified according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). RESULTS In multivariate analysis of the primary group, preoperative hearing, tumor size, and tumor origin were significantly related to postoperative HP ( p = 0.029, p = 0.043, and p = 0.018, respectively). Factors derived from the multivariate analysis were all assembled into the nomogram. The receiver operating characteristic (ROC) curves showed good predictive accuracy of the nomogram model in both primary and validation groups with area under the ROC curve (AUC) values of 0.802 and 0.797, respectively. CONCLUSION Independent predictors of postoperative HP in patients with VS were selected to create the nomogram. The nomogram was able to stratify patients into different risk groups and assist in clinical decision making.
Collapse
Affiliation(s)
| | | | | | - Jiyue Chen
- Department of Otolaryngology Head and Neck Surgery. The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Weidong Shen
- Department of Otolaryngology Head and Neck Surgery. The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
12
|
Esser J, Walger M, Pollet N, Klußmann JP, Ruge M, Goldbrunner R, Lüers JC. [Vestibular Schwannoma: Factors in Therapy Decision-Making]. Laryngorhinootologie 2024; 103:176-186. [PMID: 38128578 DOI: 10.1055/a-2222-0878] [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: 12/23/2023]
Abstract
The treatment of vestibular schwannomas (VS) has always posed a challenge for physicians. Three essential treatment principles are available: wait-and-scan, surgery, and stereotactic radiotherapy. In addition to the type of treatment, decisions must be made regarding the optimal timing of therapy, the combination of different treatment modalities, the potential surgical approach, and the type and intensity of radiation. Factors influencing the therapy decision include tumor location and size or stage, patient age, comorbidities, symptoms, postoperative hearing rehabilitation options, patient preferences, and, not least, the experience of the surgeons and the personnel and technical capabilities of the clinical site. This article begins with a brief overview of vestibular schwannomas, then outlines the fundamental interdisciplinary treatment options, and finally discusses the ENT (ear, nose, and throat)-relevant factors in the therapy decision.
Collapse
Affiliation(s)
- Julia Esser
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, DE 50937, Germany
| | - Martin Walger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, DE 50937, Germany
| | - Naomi Pollet
- Universität zu Köln, Medizinische Fakultät, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf und Hals-Chirurgie, Uniklinik Köln, Köln, DE 50937, Germany
| | - Jens Peter Klußmann
- Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, DE 50937, Germany
| | - Maximilian Ruge
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Universität zu Köln Medizinische Fakultät, Köln, Germany
| | - Roland Goldbrunner
- Universität zu Köln, Medizinische Fakultät, Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Universität zu Köln Medizinische Fakultät, Köln, Germany
| | - Jan Christoffer Lüers
- Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, Germany
| |
Collapse
|
13
|
Zhang L, Kuo HC, Duhon BH, Adunka OF, Dodson EE, Hardesty DA, Prevedello DM, Otero JJ, Ren Y. Identifying Tumor Microenvironment Biomarkers in Adherent and Cystic Vestibular Schwannomas. Otol Neurotol 2024; 45:e113-e122. [PMID: 38082472 PMCID: PMC10843289 DOI: 10.1097/mao.0000000000004073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE A subset of vestibular schwannomas (VSs), including cystic tumors, have higher postoperative morbidity because of the presence of adhesions between the tumor, facial nerve (FN), and brainstem. We identify tumor microenvironment (TME) biomarkers to better classify these tumors and predict the degree of tumor adherence. STUDY DESIGN Retrospective case series. SETTING Tertiary skull base referral center. METHODS Adult patients with cystic and solid VS matched in tumor size who underwent surgical resection were included. Expressions of seven biomarkers of extracellular matrix remodeling and tumor immune response were quantified via immunohistochemistry. The distribution of CD45+ immune cells was evaluated in intratumoral and perivascular compartments. The degree of tumor adherence was categorized as none, adherent to FN, or adherent to both FN and brainstem. RESULTS Twenty-eight patients were included. Cystic VSs were significantly more adherent than solid VSs ( p = 0.02). Patients with adherent VS had shorter duration of symptoms and were more likely to undergo subtotal resection. In solid tumors, matrix metalloproteinase (MMP)-2 expression ( p = 0.02) and CD163+ macrophage infiltration ( p = 0.007) were correlated with tumor size. Linear discriminant analyses (LDAs) demonstrated MMP-2, MMP-14, CD80, CD163, and perivascular CD45 to be individually predictive of the degree of tumor adherence (all p < 0.05), with perivascular CD45 being the best independent predictor ( p = 0.005). An LDA model including these biomarkers demonstrated 100% accurate discrimination of all three levels of tumor adherence ( p = 0.04). CONCLUSIONS Adherent VS have a distinct proinflammatory TME characterized by elevated MMP expression, enrichment of tumor-associated macrophages, and perivascular immune cell infiltration.
Collapse
Affiliation(s)
- Lisa Zhang
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology – Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Hsuan-Chih Kuo
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology – Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bailey H. Duhon
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology – Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Oliver F. Adunka
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology – Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Edward E. Dodson
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology – Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Douglas A. Hardesty
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel M. Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jose J. Otero
- Division of Neuropathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Yin Ren
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology – Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
14
|
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
|
15
|
Zhang L, Ostrander BT, Duhon B, Moshitaghi O, Lee J, Harris M, Hardesty DA, Prevedello DM, Schwartz MS, Dodson EE, Friedman RA, Adunka OF, Ren Y. Comparison of Postoperative Outcomes in Cystic Versus Solid Vestibular Schwannoma in a Multi-institutional Cohort. Otol Neurotol 2024; 45:92-99. [PMID: 38085765 PMCID: PMC10993235 DOI: 10.1097/mao.0000000000004062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Cystic vestibular schwannomas (cVSs) have more variable and less favorable clinical outcomes after microsurgical resection compared with solid VS (sVS). This study compares the preoperative presentation and postoperative outcomes between cVS and sVS. STUDY DESIGN Retrospective cohort study. SETTING Two tertiary skull base referral centers. METHODS Consecutive adult patients who underwent VS resection from 2016 to 2021 were included. Univariate and multivariate analyses compared differences in baseline symptoms and postoperative outcomes between cVS and sVS. RESULTS There were a total of 315 patients (64% female; mean age, 54 yrs) and 46 (15%) were cystic. cVS were significantly larger than sVS (maximum diameter, 28 vs. 18 mm, p < 0.001) and had higher rates of dysphagia and dysphonia preoperatively (p < 0.02). cVSs were more likely to undergo translabyrinthine resection (76 vs. 50%, p = 0.001) and have a higher rate of subtotal resection (STR) compared with sVS (30 vs. 13%, p = 0.003). At latest follow-up, fewer cVS achieved good facial nerve (FN) outcome (House-Brackmann [HB] I/II) (80 vs. 90%, p = 0.048). Subanalysis of cVS and sVS matched in tumor size, and surgical approach did not show differences in the rate of STR or FN outcomes (HB I/II, 82 vs. 78%, p = 0.79). CONCLUSION In this large multi-institutional series, cVSs represent a distinct entity and are characterized by larger tumor size and higher incidence of atypical symptoms. Although cVSs were more likely to undergo STR and portend worse FN outcomes than sVSs, this may be due to their larger tumor size rather than the presence of the cystic component.
Collapse
Affiliation(s)
- Lisa Zhang
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Benjamin T. Ostrander
- Division of Otolaryngology—Head and Neck Surgery, Department of Otolaryngology, University of California, San Diego, La Jolla, California
| | - Bailey Duhon
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Omid Moshitaghi
- Division of Otolaryngology—Head and Neck Surgery, Department of Otolaryngology, University of California, San Diego, La Jolla, California
| | - Joshua Lee
- Division of Otolaryngology—Head and Neck Surgery, Department of Otolaryngology, University of California, San Diego, La Jolla, California
| | - Micah Harris
- Department of Otolaryngology, University of Pittsburgh
| | - Douglas A. Hardesty
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Daniel M. Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Marc S. Schwartz
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Edward E. Dodson
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rick A. Friedman
- Division of Otolaryngology—Head and Neck Surgery, Department of Otolaryngology, University of California, San Diego, La Jolla, California
| | - Oliver F. Adunka
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yin Ren
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
16
|
Benson JC, Carlson ML, Lane JI. Peritumoral Signal on Postcontrast FLAIR Images: Description and Proposed Biomechanism in Vestibular Schwannomas. AJNR Am J Neuroradiol 2023; 44:1171-1175. [PMID: 37652582 PMCID: PMC10549947 DOI: 10.3174/ajnr.a7979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND PURPOSE Anecdotally, postcontrast FLAIR images of vestibular schwannomas can show peritumoral hyperintense signal, hypothesized to represent gadolinium extravasation. This study assessed the incidence of this phenomenon in a cohort of patients with treatment-naïve sporadic vestibular schwannomas. MATERIALS AND METHODS A retrospective review of 20 patients with presumed vestibular schwannoma based on characteristic imaging findings and with dedicated internal auditory canal imaging, including postcontrast T1W1 and postcontrast FLAIR, was performed. Tumor size and location were recorded, as was the presence or absence of a fundal fluid cleft. Images were reviewed for the presence of peritumoral hyperintense signal on FLAIR images (a "halo") and for both subjectively and objectively elevated signal in the ipsilateral cochlea and fundus. RESULTS Patients were randomly selected from an institutional vestibular schwannoma registry. Eleven (55.0%) were women. A peritumoral halo was present in 90% of patients, averaging 1.0 (SD, 0.2) mm in thickness. The maximum mean FLAIR signal in the ipsilateral fundus (205.9 [SD, 110.2]) was significantly greater than on the contralateral side (121.6 [SD, 27.8]) (P = .02). Maximum mean ipsilateral intracochlear signal (167.8 [SD, 104.5]) was also significantly greater than on the contralateral side (113.4 [SD, 40.1]) (P = .04). CONCLUSIONS A peritumoral halo on postcontrast FLAIR images was present in 90% of our cohort with randomly selected, treatment-naïve sporadic vestibular schwannomas. Although its mechanism is unknown, this signal is hypothesized to represent gadolinium extravasation, given an ipsilateral increased signal in the adjacent internal auditory canal fundus and cochlea.
Collapse
Affiliation(s)
- John C Benson
- From the Department of Radiology (J.C.B., J.I.L.), Mayo Clinic, Rochester, Minnesota
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, Rochester, Minnesota
| | - John I Lane
- From the Department of Radiology (J.C.B., J.I.L.), Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
17
|
Fernández-Méndez R, Wan Y, Axon P, Joannides A. Incidence and presentation of vestibular schwannoma: a 3-year cohort registry study. Acta Neurochir (Wien) 2023; 165:2903-2911. [PMID: 37452904 PMCID: PMC10542718 DOI: 10.1007/s00701-023-05665-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/01/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Vestibular schwannoma (VS) is the most common benign tumour arising in the lateral skull base. Reported incidence rates of VS vary across geographical locations and over time. There is scarce updated evidence over the past decade on the epidemiology and mode of presentation of VS. OBJECTIVE To describe the epidemiology and mode of presentation of VS in the East of England between 2013 and 2016. METHODS A retrospective epidemiological analysis of data from a national VS registry and electronic patient records was conducted, including all newly diagnosed adult patients in a UK tertiary referral centre, between April 1st, 2013, and March 31st, 2016. RESULTS There were 391 new cases identified resulting in an overall mean incidence of 2.2 VS cases per 100,000 person-year. The incidence rate for all patients in the <40 age group ranged between 0.3 and 0.7 per 100,000 person-year, increasing to a range of 5.7 to 6.1 per 100,000 person-year in the 60-69 age group. The top three combinations of symptoms on presentation per patient were hearing loss and tinnitus (97, 24.8%), hearing loss alone (79, 20.2%) and hearing loss, tinnitus, and balance symptoms (61, 15.6%). The median duration of symptoms was 12 months, with a wide range from 1.4 to 300 months. Age was negatively correlated with tumour size (r = -0.14 [-0.24 to -0.04], p=0.01) and positively correlated with symptom duration (r = 0.16 [0.03-0.29], p=0.02). CONCLUSIONS The incidence of vestibular schwannoma has increased compared to previous studies in the UK and is similar to incidence rates reported in other countries during the past decade. It peaks in the seventh decade of life, mainly because of an increase in the diagnosis of small tumours with a long duration of audio-vestibular symptoms in older patients, compared to earlier studies.
Collapse
Affiliation(s)
- Rocio Fernández-Méndez
- Clinical Neurosciences, University of Cambridge, Addenbrooke's Biomedical Campus, Cambridge, Cambridgshire, CB2 0QQ, UK
| | - Yizhou Wan
- Clinical Neurosciences, University of Cambridge, Addenbrooke's Biomedical Campus, Cambridge, Cambridgshire, CB2 0QQ, UK.
| | - Patrick Axon
- Clinical Neurosciences, University of Cambridge, Addenbrooke's Biomedical Campus, Cambridge, Cambridgshire, CB2 0QQ, UK
| | - Alexis Joannides
- Clinical Neurosciences, University of Cambridge, Addenbrooke's Biomedical Campus, Cambridge, Cambridgshire, CB2 0QQ, UK
| |
Collapse
|
18
|
Marinelli JP, Link MJ, Carlson ML. Size Threshold Surveillance-A Revised Approach to Wait-and-Scan for Vestibular Schwannoma. JAMA Otolaryngol Head Neck Surg 2023; 149:657-658. [PMID: 37410485 DOI: 10.1001/jamaoto.2023.1427] [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: 07/07/2023]
Abstract
This Viewpoint discusses how recent discoveries surrounding the natural history of sporadic vestibular schwannoma provide data to support a shift in current management paradigms.
Collapse
Affiliation(s)
- John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J Link
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
19
|
Marinelli JP, Schnurman Z, Killeen DE, Nassiri AM, Hunter JB, Lees KA, Lohse CM, Roland JT, Golfinos JG, Kondziolka D, Link MJ, Carlson ML. Stratifying Risk of Future Growth Among Sporadic Vestibular Schwannomas. Otol Neurotol 2023; Publish Ahead of Print:00129492-990000000-00318. [PMID: 37367632 DOI: 10.1097/mao.0000000000003934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE In certain cases, clinicians may consider continued observation of a vestibular schwannoma after initial growth is detected. The aim of the current work was to determine if patients with growing sporadic vestibular schwannomas could be stratified by the likelihood of subsequent growth based on initial growth behavior. STUDY DESIGN Slice-by-slice volumetric tumor measurements from 3,505 serial magnetic resonance imaging studies were analyzed from 952 consecutively treated patients. SETTING Three tertiary-referral centers. PATIENTS Adults with sporadic vestibular schwannoma. INTERVENTIONS Wait-and-scan. MAIN OUTCOME MEASURES Composite end point of subsequent growth- or treatment-free survival rates, where growth is defined as an additional increase of at least 20% in tumor volume from the volume at the time of initial growth. RESULTS Among 405 patients who elected continued observation despite documented growth, stratification, of volumetric growth rate into less than 25% (reference: n = 107), 25 to less than 50% (hazard ratio [HR], 1.39; p = 0.06; n = 96), 50 to less than 100% (HR, 1.71; p = 0.002; n = 112), and at least 100% (HR, 2.01; p < 0.001; n = 90) change per year predicted the likelihood of future growth or treatment. Subsequent growth- or treatment-free survival rates (95% confidence interval) at year 5 after detection of initial growth were 31% (21-44%) for those with less than 25% growth per year, 18% (10-32%) for those with 25 to less than 50%, 15% (9-26%) for those with 50 to less than 100%, and 6% (2-16%) for those with at least 100%. Neither patient age (p = 0.15) nor tumor volume at diagnosis (p = 0.95) significantly differed across stratification groups. CONCLUSIONS At the time of diagnosis, clinical features cannot consistently predict which tumors will ultimately display aggressive behavior. Stratification by volumetric growth rate at the time of initial growth results in a stepwise progression of increasing likelihood of subsequent growth. When considering continued observation after initial growth detection, almost 95% of patients who have tumors that double in volume between diagnosis and the first detection of growth demonstrate further tumor growth or undergo treatment if observed to 5 years.
Collapse
Affiliation(s)
- John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Zane Schnurman
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York
| | - Daniel E Killeen
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University Medical School, Cleveland, Ohio
| | - Ashley M Nassiri
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katherine A Lees
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York
| | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York
| | | | | |
Collapse
|
20
|
Durham AR, Tooker EL, Patel NS, Gurgel RK. Epidemiology and Risk Factors for Development of Sporadic Vestibular Schwannoma. Otolaryngol Clin North Am 2023; 56:413-420. [PMID: 37019771 DOI: 10.1016/j.otc.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Vestibular schwannomas (VSs) are benign, slow-growing tumors of the eighth cranial nerve. Sporadic unilateral VSs constitute approximately 95% of all newly diagnosed tumors. There is little known about risk factors for developing sporadic unilateral VS. Potential risk factors that have been reported are familial or genetic risk, noise exposure, cell phone use, and ionizing radiation, whereas protective factors may include smoking and aspirin use. More research is needed to elucidate the risk factors for development of these rare tumors.
Collapse
|
21
|
Marinelli JP, Lohse CM, Carlson ML. Introducing an Evidence-Based Approach to Wait-And-Scan Management of Sporadic Vestibular Schwannoma. Otolaryngol Clin North Am 2023; 56:445-457. [PMID: 37019767 DOI: 10.1016/j.otc.2023.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
The advent of MRI has led to more sporadic vestibular schwannomas diagnosed today than ever before. Despite the average patient being diagnosed in their sixth decade of life with a small tumor and minimal symptoms, population-based data demonstrate that more tumors per capita are treated today than ever before. Emerging natural history data justify either an upfront treatment approach or the "Size Threshold Surveillance" approach. Specifically, if the patient elects to pursue observation, then existing data support the tolerance of some growth during observation in appropriately selected patients up until a specific size threshold range (about 15 mm of CPA extension). The current article discusses the rationale behind a shift in the existing observation management approach, where initial detection of growth typically begets treatment, and outlines the application of a more flexible and nuanced approach based on existing evidence.
Collapse
|
22
|
Marinelli JP, Lohse CM, Link MJ, Carlson ML. Quality of Life in Sporadic Vestibular Schwannoma. Otolaryngol Clin North Am 2023; 56:577-586. [PMID: 37019770 DOI: 10.1016/j.otc.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
The focus of management in sporadic vestibular schwannoma has dramatically evolved over the last 100 years. The centrality of quality of life (QoL) is being underscored by an ongoing epidemiologic shift toward an older patient demographic that is being diagnosed with smaller tumors and often with few associated symptoms. Two disease-specific QoL instruments have been developed for sporadic vestibular schwannoma: the Penn Acoustic Neuroma Quality of Life Scale in 2010, and more recently, the Mayo Clinic Vestibular Schwannoma Quality of Life Index in 2022. The current article examines disease-specific quality-of-life outocmes in the management of ssporadic vestibular schwannoma.
Collapse
|
23
|
Takeda A, Kobayashi M, Hasegawa K, Fujimaki T. Regression of Acoustic Tumor After Chemotherapy for Ovarian Cancer in a Patient With a Breast Cancer Susceptibility Gene 1 (BRCA1) Germline Mutation. Cureus 2023; 15:e35917. [PMID: 36911580 PMCID: PMC9995742 DOI: 10.7759/cureus.35917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
We report the case of an adult woman who developed ovarian cancer during a follow-up for vestibular schwannoma. Volume reduction of the schwannoma was observed after chemotherapy for ovarian cancer. After ovarian cancer had been diagnosed, the patient was found to have a germline mutation of breast cancer susceptibility gene 1 (BRCA1). This is the first reported case of vestibular schwannoma in a patient with a germline mutation of BRCA1 and the first documented example of chemotherapy including olaparib to have shown efficacy for schwannoma.
Collapse
Affiliation(s)
- Anna Takeda
- Neurosurgery, Saitama Medical University Hospital, Saitama, JPN
| | | | - Kosei Hasegawa
- Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, JPN
| | | |
Collapse
|
24
|
Hannan CJ, Lewis D, O'Leary C, Waqar M, Brough D, Couper KN, Dyer DP, Vail A, Heal C, Macarthur J, Cooper C, Hammerbeck-Ward C, Evans DG, Rutherford SA, Lloyd SK, Mackenzie Freeman SR, Coope DJ, King AT, Pathmanaban ON. Increased Circulating Chemokines and Macrophage Recruitment in Growing Vestibular Schwannomas. Neurosurgery 2023; 92:581-589. [PMID: 36729787 DOI: 10.1227/neu.0000000000002252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/20/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is evidence that macrophage infiltration in the tumor microenvironment promotes vestibular schwannoma (VS) growth. Efficacy of bevacizumab in NF2-associated VS demonstrates the value of therapies targeting the microvascular tumor microenvironment, and tumor-associated macrophages (TAMs) may represent another druggable target. OBJECTIVE To characterize the relationship between growth, TAM infiltration, and circulating monocyte chemokines in a large cohort of patients with VS. METHODS Immunostaining for Iba1 (macrophages), CD31 (endothelium), and fibrinogen (permeability) was performed on 101 growing and 19 static sporadic VS. The concentrations of monocyte-specific chemokines were measured in the plasma of 50 patients with growing VS and 25 patients with static VS. RESULTS The Iba1 + cell count was significantly higher in growing as compared with static VS (592 vs 226/×20 HPF, P =<0.001). Similarly, the CD31 + % surface area was higher in growing VS (2.19% vs 1.32%, P = .01). There was a positive correlation between TAM infiltration and VS growth rate, which persisted after controlling for the effect of tumor volume (aR2 = 0.263, P =<0.001). The plasma concentrations of several monocytic chemokines were higher in patients with growing rather than static VS. CONCLUSION There is a strong positive correlation between TAM infiltration and volumetric growth of VS, and this relationship is independent of tumor size. There is a colinear relationship between TAM infiltration and tumor vascularity, implying that inflammation and angiogenesis are interlinked in VS. Chemokines known to induce monocyte chemotaxis are found in higher concentrations in patients with growing VS, suggestive of a potential pathophysiological mechanism.
Collapse
Affiliation(s)
- Cathal John Hannan
- Manchester Centre for Clinical Neurosciences, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester, UK
- Division of Cardiovascular Sciences, University of Manchester, UK
| | - Daniel Lewis
- Manchester Centre for Clinical Neurosciences, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester, UK
- Division of Neuroscience and Experimental Psychology, University of Manchester, UK
| | - Claire O'Leary
- Geoffrey Jefferson Brain Research Centre, Manchester, UK
- Division of Neuroscience and Experimental Psychology, University of Manchester, UK
| | - Mueez Waqar
- Geoffrey Jefferson Brain Research Centre, Manchester, UK
- Division of Neuroscience and Experimental Psychology, University of Manchester, UK
| | - David Brough
- Geoffrey Jefferson Brain Research Centre, Manchester, UK
- Division of Neuroscience and Experimental Psychology, University of Manchester, UK
- Lydia Becker Institute of Inflammation and Immunology, University of Manchester, UK
| | - Kevin N Couper
- Geoffrey Jefferson Brain Research Centre, Manchester, UK
- Lydia Becker Institute of Inflammation and Immunology, University of Manchester, UK
| | - Douglas P Dyer
- Wellcome Centre for Cell-Matrix Research, University of Manchester, UK
| | - Andy Vail
- Centre for Biostatistics, University of Manchester, UK
| | - Calvin Heal
- Centre for Biostatistics, University of Manchester, UK
| | | | | | | | - D Gareth Evans
- St. Mary's Centre for Genomic Medicine
- Division of Evolution and Genomic Sciences, University of Manchester, UK
| | | | - Simon K Lloyd
- Division of Neuroscience and Experimental Psychology, University of Manchester, UK
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Otolaryngology, Salford Royal Hospital, Manchester, UK
| | - Simon Richard Mackenzie Freeman
- Division of Neuroscience and Experimental Psychology, University of Manchester, UK
- Department of Otolaryngology, Salford Royal Hospital, Manchester, UK
| | - David John Coope
- Manchester Centre for Clinical Neurosciences, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester, UK
- Division of Neuroscience and Experimental Psychology, University of Manchester, UK
| | - Andrew T King
- Manchester Centre for Clinical Neurosciences, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester, UK
- Division of Cardiovascular Sciences, University of Manchester, UK
| | - Omar Nathan Pathmanaban
- Manchester Centre for Clinical Neurosciences, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester, UK
- Division of Neuroscience and Experimental Psychology, University of Manchester, UK
| |
Collapse
|
25
|
Kortebein S, Gu S, Dai K, Zhao E, Riska K, Kaylie D, Hoa M. MRI Screening in Vestibular Schwannoma: A Deep Learning-based Analysis of Clinical and Audiometric Data. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e028. [PMID: 38516318 PMCID: PMC10950172 DOI: 10.1097/ono.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/05/2022] [Indexed: 03/23/2024]
Abstract
Objective To find a more objective method of assessing which patients should be screened for a vestibular schwannoma (VS) with magnetic resonance imaging (MRI) using a deep-learning algorithm to assess clinical and audiometric data. Materials and Methods Clinical and audiometric data were collected for 592 patients who received an audiogram between January 2015 and 2020 at Duke University Health Center with and without VS confirmed by MRI. These data were analyzed using a deep learning-based analysis to determine if the need for MRI screening could be assessed more objectively with adequate sensitivity and specificity. Results Patients with VS showed slightly elevated, but not statistically significant, mean thresholds compared to those without. Tinnitus, gradual hearing loss, and aural fullness were more common in patients with VS. Of these, only the presence of tinnitus was statistically significant. Several machine learning algorithms were used to incorporate and model the collected clinical and audiometric data, but none were able to distinguish ears with and without confirmed VS. When tumor size was taken into account the analysis was still unable to distinguish a difference. Conclusions Using audiometric and clinical data, deep learning-based analyses failed to produce an adequately sensitive and specific model for the detection of patients with VS. This suggests that a specific pattern of audiometric asymmetry and clinical symptoms may not necessarily be predictive of the presence/absence of VS to a level that clinicians would be comfortable forgoing an MRI.
Collapse
Affiliation(s)
- Sarah Kortebein
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Shoujun Gu
- Auditory Development and Restoration Program, NIDCD Otolaryngology Surgeon-Scientist Program, Division of Intramural Research, NIDCD/NIH, Bethesda, MD
| | - Kathy Dai
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Elizabeth Zhao
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Kristal Riska
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
| | - David Kaylie
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Michael Hoa
- Auditory Development and Restoration Program, NIDCD Otolaryngology Surgeon-Scientist Program, Division of Intramural Research, NIDCD/NIH, Bethesda, MD
| |
Collapse
|
26
|
How Cochlear Implant Rehabilitation Impacts the Therapeutic Strategy for Vestibular Schwannoma. Audiol Res 2023; 13:116-129. [PMID: 36825950 PMCID: PMC9952590 DOI: 10.3390/audiolres13010012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Since both surgery and more conservative treatments show long-term outcomes in patients with VS, the current challenge in its therapeutic strategy is to offer a cure with lower functional morbidity in terms of facial and hearing preservation or the possibility of hearing rehabilitation with a cochlear implant. METHODS PubMed and Scopus databases were searched from 2017 to November 2022. Fifteen articles met our selection criteria: (1) patients with a diagnosis of VS, either sporadic or NF2-related; (2) simultaneous or sequential cochlear implantation; (3) specified audiological test results and follow-up timing. CONCLUSIONS Although the level of evidence for the presently included studies is low due to either the study design or the lack of treatment consensus, CI rehabilitation is a promising option, especially in small VS with compromised hearing and as a salvage option after a failed attempt at hearing preservation surgery.
Collapse
|
27
|
Huang Z, Dewanjee S, Chakraborty P, Jha NK, Dey A, Gangopadhyay M, Chen XY, Wang J, Jha SK. CAR T cells: engineered immune cells to treat brain cancers and beyond. Mol Cancer 2023; 22:22. [PMID: 36721153 PMCID: PMC9890802 DOI: 10.1186/s12943-022-01712-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/29/2022] [Indexed: 02/01/2023] Open
Abstract
Malignant brain tumors rank among the most challenging type of malignancies to manage. The current treatment protocol commonly entails surgery followed by radiotherapy and/or chemotherapy, however, the median patient survival rate is poor. Recent developments in immunotherapy for a variety of tumor types spark optimism that immunological strategies may help patients with brain cancer. Chimeric antigen receptor (CAR) T cells exploit the tumor-targeting specificity of antibodies or receptor ligands to direct the cytolytic capacity of T cells. Several molecules have been discovered as potential targets for immunotherapy-based targeting, including but not limited to EGFRvIII, IL13Rα2, and HER2. The outstanding clinical responses to CAR T cell-based treatments in patients with hematological malignancies have generated interest in using this approach to treat solid tumors. Research results to date support the astounding clinical response rates of CD19-targeted CAR T cells, early clinical experiences in brain tumors demonstrating safety and evidence for disease-modifying activity, and the promise for further advances to ultimately assist patients clinically. However, several variable factors seem to slow down the progress rate regarding treating brain cancers utilizing CAR T cells. The current study offers a thorough analysis of CAR T cells' promise in treating brain cancer, including design and delivery considerations, current strides in clinical and preclinical research, issues encountered, and potential solutions.
Collapse
Affiliation(s)
- Zoufang Huang
- grid.452437.3Department of Hematology, Ganzhou Key Laboratory of Hematology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Saikat Dewanjee
- grid.216499.10000 0001 0722 3459Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032 India
| | - Pratik Chakraborty
- grid.216499.10000 0001 0722 3459Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032 India
| | - Niraj Kumar Jha
- grid.412552.50000 0004 1764 278XDepartment of Biotechnology, School of Engineering & Technology, Sharda University, Greater Noida, Uttar Pradesh 201310 India
| | - Abhijit Dey
- grid.412537.60000 0004 1768 2925Department of Life Sciences, Presidency University, 86/1 College Street, Kolkata, West Bengal 700032 India
| | - Moumita Gangopadhyay
- grid.502979.00000 0004 6087 8632Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Barasat, Kolkata, West Bengal 700126 India
| | - Xuan-Yu Chen
- grid.264091.80000 0001 1954 7928Institute for Biotechnology, St. John’s University, Queens, New York, 11439 USA
| | - Jian Wang
- Department of Radiotherapy, the Affiliated Jiangyin People’s Hospital of Nantong University, Jiangyin, 214400 China
| | - Saurabh Kumar Jha
- grid.412552.50000 0004 1764 278XDepartment of Biotechnology, School of Engineering & Technology, Sharda University, Greater Noida, Uttar Pradesh 201310 India ,grid.448792.40000 0004 4678 9721Department of Biotechnology Engineering and Food Technology, Chandigarh University, Mohali, 140413 India ,grid.449906.60000 0004 4659 5193Department of Biotechnology, School of Applied & Life Sciences (SALS), Uttaranchal University, Dehradun, 248007 India
| |
Collapse
|
28
|
Colombo F, Maye H, Rutherford S, King A, Hammerbeck-Ward C, Whitfield GA, McBain C, Colaco R, Entwistle H, Wadeson A, Lloyd S, Freeman S, Pathmanaban ON. Surgery versus radiosurgery for vestibular schwannoma: Shared decision making in a multidisciplinary clinic. Neurooncol Adv 2023; 5:vdad089. [PMID: 37547267 PMCID: PMC10403749 DOI: 10.1093/noajnl/vdad089] [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: 08/08/2023] Open
Abstract
Background Our neurosurgical unit adopted a model of shared decision-making (SDM) based on multidisciplinary clinics for vestibular schwannoma (VS). A unique feature of this clinic is the interdisciplinary counseling process with a surgeon presenting the option of surgery, an oncologist radiosurgery or radiotherapy, and a specialist nurse advocating for the patient. Methods This is a retrospective cohort study. All new patients seen in the combined VS clinic and referred from the skull base multidisciplinary team (MDT) from beginning of June 2013 to end of January 2019 were included. Descriptive statistics and frequency analysis were carried out for the full cohort. Results Three hundred and fifty-four patients presenting with new or previously untreated VS were included in the analysis. In our cohort, roughly one-third of patients fall into each of the treatment strategies with slightly smaller numbers of patients undergoing surgery than watch, wait and rescan (WWR) ,and SRS (26.6% vs. 32.8% and 37.9%, respectively). Conclusion In our experience, the combined surgery/oncology/specialist nurse clinic streamlines the patient experience for those with a VS suitable for either microsurgical or SRS/radiotherapy treatment. Decision-making in this population of patients is complex and when presented with all treatment options patients do not necessarily choose the least invasive option as a treatment. The unique feature of our clinic is the multidisciplinary counseling process with a specialist nurse advocating and guiding the patient. Treatment options are likely to become more rather than less complex in future years making combined clinics more valuable than ever in the SDM process.
Collapse
Affiliation(s)
- Francesca Colombo
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Helen Maye
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Scott Rutherford
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrew King
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Charlotte Hammerbeck-Ward
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Gillian A Whitfield
- Department of Neuro-Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Catherine McBain
- Department of Neuro-Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Rovel Colaco
- Department of Neuro-Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Helen Entwistle
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrea Wadeson
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Simon Lloyd
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Simon Freeman
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Omar N Pathmanaban
- Geoffrey Jefferson Brain Research Centre, Manchester Centre for Clinical Neurosciences, Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine, and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| |
Collapse
|
29
|
Gheorghe L, Negru D, Cobzeanu MD, Palade OD, Botnariu EG, Cobzeanu BM, Cobzeanu ML. The Diagnostic Accuracy of Pure-Tone Audiometry Screening Protocols for Vestibular Schwannoma in Patients with Asymmetrical Hearing Loss-A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12112776. [PMID: 36428836 PMCID: PMC9689241 DOI: 10.3390/diagnostics12112776] [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: 10/10/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Magnetic resonance imaging (MRI) is the gold standard investigation for all patients who present with asymmetrical hearing loss (AHL) and a high index of suspicion for vestibular schwannoma (VS). However, pure-tone audiometry (PTA) is an investigation that can be used for the screening of these patients in order to reduce the costs. The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of different PTA protocols for VS in patients with ASHL, when compared with MRI; (2) Methods: Medline, Embase, and Cochrane databases were used to find relevant studies. All prospective and retrospective observational studies that evaluated the accuracy of PTA protocols for the screening of VS were assessed, according to the international guidelines; (3) Results: We analyzed seven studies (4369 patients) of poor-to-moderate quality. Their pooled sensitivity was good (0.73-0.93), but their specificity was low (0.31-0.60). All protocols were located in the right lower quadrant on the likelihood scattergram, and the post-test probabilities for positive and negative diagnosis of these protocols were extremely low; (4) Conclusions: PTA protocols cannot be used for a proper screening or diagnosis of vestibular schwannoma despite their good sensibility, and MRI remains the gold standard for this purpose.
Collapse
Affiliation(s)
- Liliana Gheorghe
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Emergency Clinical Hospital “Sfântul Spiridon” Iasi, 700111 Iasi, Romania
| | - Dragos Negru
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Emergency Clinical Hospital “Sfântul Spiridon” Iasi, 700111 Iasi, Romania
| | - Mihail Dan Cobzeanu
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Emergency Clinical Hospital “Sfântul Spiridon” Iasi, 700111 Iasi, Romania
| | - Octavian Dragos Palade
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Emergency Clinical Hospital “Sfântul Spiridon” Iasi, 700111 Iasi, Romania
- Correspondence: (O.D.P.); (E.G.B.)
| | - Eosefina Gina Botnariu
- Emergency Clinical Hospital “Sfântul Spiridon” Iasi, 700111 Iasi, Romania
- Internal Medicine Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Correspondence: (O.D.P.); (E.G.B.)
| | - Bogdan Mihail Cobzeanu
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Maria-Luiza Cobzeanu
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Emergency Clinical Hospital “Sfântul Spiridon” Iasi, 700111 Iasi, Romania
| |
Collapse
|
30
|
Zhang Z, Zhang D, Shi X, Tao B, Liu Y, Zhang J. A Nomogram to Predict Recurrence-Free Survival Following Surgery for Vestibular Schwannoma. Front Oncol 2022; 12:838112. [PMID: 35574416 PMCID: PMC9097914 DOI: 10.3389/fonc.2022.838112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Vestibular schwannoma (VS) is the most common benign tumor of the posterior fossa. The recurrence of VS has always received widespread attention. This study aimed to develop a nomogram to predict Recurrence-free survival (RFS) following resection of VS. Methods A total of 425 patients with VS who underwent resection at the Department of Neurosurgery in Chinese PLA General Hospital between January 2014 and December 2020 were enrolled in this retrospective study. The medical records and follow-up data were collected. Cox regression analysis was used to screen prognostic factors and construct the nomogram. The predictive accuracy and clinical benefits of the nomogram were validated using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA). Results The Cox regression analysis revealed that age (HR = 0.96; 95% CI 0.94 - 0.99; p < 0.01), EOR (HR = 4.65; 95% CI 2.22 - 9.74; p < 0.001), and Ki-67 (HR = 1.16; 95% CI 1.09 - 1.23; p < 0.001) were all significantly correlated with recurrence, and they were finally included in the nomogram model. The concordance index of the nomogram was 0.86. The areas under the curve (AUCs) of the nomogram model of 3-, 4- and 5-year were 0.912, 0.865, and 0.809, respectively. A well-fitted calibration curve was also generated for the nomogram model. The DCA curves also indicated that the nomogram model had satisfactory clinical utility compared to the single indicators. Conclusions We developed a nomogram that has high accuracy in predicting RFS in patients after resection of VS. All of the included prognostic factors are easy to obtain. The nomogram can improve the postoperative management of patients and assist clinicians in individualized clinical treatment. Furthermore, we generated a web-based calculator to facilitate clinical application: https://abc123-123.shinyapps.io/VS-RFS/.
Collapse
Affiliation(s)
- Zehan Zhang
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China.,Department of Neurosurgery, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ding Zhang
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China.,Department of Neurosurgery, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xudong Shi
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China.,Department of Neurosurgery, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Bingyan Tao
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China.,Department of Neurosurgery, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yuyang Liu
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China.,Department of Neurosurgery, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jun Zhang
- Department of Neurosurgery, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| |
Collapse
|