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Ziegler J, El-Shakankery KH, Hyare H, Flynn M. Synchronous skull base and spinal metastases in a patient with treatment-resistant, high-grade serous adenocarcinoma of tubo-ovarian origin. BMJ Case Rep 2024; 17:e259144. [PMID: 38772871 DOI: 10.1136/bcr-2023-259144] [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] [Indexed: 05/23/2024] Open
Abstract
Brain metastases (BMs) arising from ovarian cancer remain rare. Spinal cord metastases are even rarer, accounting for just 0.4% of total metastatic spinal cord compressions. In this report, we describe a case of a woman in her 70s who developed sequential brain and spinal cord metastases during her treatment for high-grade serous ovarian cancer, without a germline or somatic BRCA mutation. Following completion of neoadjuvant chemotherapy, interval debulking surgery and adjuvant chemotherapy, relapsed disease was ultimately identified as a single BM, curiously mimicking an acoustic neuroma. Subsequently, spinal cord metastases rapidly developed. Throughout, multidisciplinary team meetings guided decisions on patient management. In this report, we highlight the rarity of such a presentation and discuss the possible role of disease pathophysiology, associated systemic anticancer therapy resistance, and treatment possibilities for both cerebral and spinal metastases.
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Affiliation(s)
- Joseph Ziegler
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Harpreet Hyare
- Imaging Department, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Michael Flynn
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
- Clinical Research Facility, NIHR University College London Hospitals Biomedical Research Centre, London, UK
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2
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Vasilijic S, Atai NA, Hyakusoku H, Worthington S, Ren Y, Sagers JE, Sahin MI, Fujita T, Landegger LD, Lewis R, Welling DB, Stankovic KM. Identification of Immune-Related Candidate Biomarkers in Plasma of Patients with Sporadic Vestibular Schwannoma: Candidate Plasma Biomarkers in Vestibular Schwannoma. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.24.525436. [PMID: 36747696 PMCID: PMC9900840 DOI: 10.1101/2023.01.24.525436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Vestibular schwannoma (VS) is intracranial tumor arising from neoplastic Schwann cells, causing hearing loss in about 95% of patients. The traditional belief that hearing deficit is caused by physical expansion of the VS, compressing the auditory nerve, does not explain the common clinical finding that patients with small tumors can have profound hearing loss, suggesting that tumor-secreted factors could influence hearing ability in VS patients. Here, we conducted profiling of patients' plasma for 67 immune-related factors on a large cohort of VS patients (N>120) and identified candidate biomarkers associated with tumor growth (IL-16 and S100B) and hearing (MDC). We identified the 7-biomarker panel composed of MCP-3, BLC, S100B, FGF-2, MMP-14, eotaxin, and TWEAK that showed outstanding discriminatory ability for VS. These findings revealed possible therapeutic targets for VS-induced hearing loss and provided a unique diagnostic tool that may predict hearing change and tumor growth in VS patients and may help inform the ideal timing of tumor resection to preserve hearing.
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Affiliation(s)
- Sasa Vasilijic
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, US
| | - Nadia A. Atai
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Hiroshi Hyakusoku
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
- Department of Otorhinolaryngology, Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - Steven Worthington
- Harvard Institute for Quantitative Social Science, Harvard University, Cambridge, MA, US
| | - Yin Ren
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Jessica E. Sagers
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Mehmet I Sahin
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Takeshi Fujita
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Lukas D. Landegger
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Richard Lewis
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
- Department of Neurology, Harvard Medical School, Boston, MA, US
| | - D. Bradley Welling
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
| | - Konstantina M. Stankovic
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, US
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, US
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, US
- Wu Tsai Neuroscience Institute, Stanford University, Stanford, CA, US
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3
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Grundfast KM, Jamil TL. Evaluation and Management of Tinnitus: Are There Opportunities for Improvement? Otolaryngol Head Neck Surg 2023; 168:45-58. [PMID: 35349391 DOI: 10.1177/01945998221088286] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review current information about diagnosis and management of tinnitus aiming to identify opportunities for achieving a cost-effective, efficient, evidence-based approach that meets the needs of tinnitus sufferers. DATA SOURCES PubMed/MEDLINE. REVIEW METHODS In total, 249 relevant published reports were reviewed. Pertinent keywords and MeSH terms identified reports via PubMed and EMBASE. Acknowledged experts were consulted on ways to improve tinnitus management. CONCLUSIONS There may be opportunities to improve evaluation and management of patients with tinnitus using modern modes of communication and a multidisciplinary therapeutic approach. IMPLICATIONS FOR PRACTICE Tinnitus can adversely affect quality of life while being time-consuming and costly to evaluate and manage. Based on both personal experience and the reports of others, patients with tinnitus who choose to see a physician primarily want to know two things: (1) that the tinnitus that is so distressing will not remain at the same level of severity forever and (2) that something can be done to help cope with the tinnitus that is so annoying. Recent advancements in internet communications, social media, information technology, artificial intelligence, machine learning, holistic medical care, mind-body integrative health care, and multidisciplinary approaches in medical therapeutics may be possibly making new ways of meeting the needs of patients with tinnitus.
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Affiliation(s)
- Kenneth M Grundfast
- Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Otology Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Taylor L Jamil
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
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Gerganov V, Petrov M, Sakelarova T. Schwannomas of Brain and Spinal Cord. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:331-362. [PMID: 37452944 DOI: 10.1007/978-3-031-23705-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Schwannomas are benign tumors originating from the Schwann cells of cranial or spinal nerves. The most common cranial schwannomas originate from the eight cranial nervevestibular schwannomas (VS). VS account for 6-8% of all intracranial tumors, 25-33% of the tumors localized in the posterior cranial fossa, and 80-94% of the tumors in the cerebellopontine angle (CPA). Schwannomas of other cranial nerves/trigeminal, facial, and schwannomas of the lower cranial nerves/are much less frequent. According to the World Health Organization (WHO), intracranial and intraspinal schwannomas are classified as Grade I. Some VS are found incidentally, but most present with hearing loss (95%), tinnitus (63%), disequilibrium (61%), or headache (32%). The neurological symptoms of VSs are mainly due to compression on the surrounding structures, such as the cranial nerves and vessels, or the brainstem. The gold standard for the imaging diagnosis of VS is MRI scan. The optimal management of VSs remains controversial. There are three main management options-conservative treatment or "watch-and-wait" policy, surgical treatment, and radiotherapy in all its variations. Currently, surgery of VS is not merely a life-saving procedure. The functional outcome of surgery and the quality of life become issues of major importance. The most appropriate surgical approach for each patient should be considered according to some criteria including indications, risk-benefit ratio, and prognosis of each patient. The approaches to the CPA and VS removal are generally divided in posterior and lateral. The retrosigmoid suboccipital approach is a safe and simple approach, and it is favored for VS surgery in most neurosurgical centers. Radiosurgery is becoming more and more available nowadays and is established as one of the main treatment modalities in VS management. Radiosurgery (SRS) is performed with either Gamma knife, Cyber knife, or linear accelerator. Larger tumors are being increasingly frequently managed with combined surgery and radiosurgery. The main goal of VS management is preservation of neurological function - facial nerve function, hearing, etc. The reported recurrence rate after microsurgical tumor removal is 0.5-5%. Postoperative follow-up imaging is essential to diagnose any recurrence.
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Affiliation(s)
- Venelin Gerganov
- International Neuroscience Institute, Hannover, Germany
- University Multiprofile Hospital for Active Treatment With Emergency Medicine N. I. Pirogov, Sofia, Bulgaria
| | - Mihail Petrov
- University Multiprofile Hospital for Active Treatment With Emergency Medicine N. I. Pirogov, Sofia, Bulgaria.
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5
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Gu F, Yang X, Wang Z, Tan X, Xue T, Chen Z, Wang Z, Chen G. Diagnostic accuracy of intraoperative brainstem auditory evoked potential for predicting hearing loss after vestibular schwannoma surgery. Front Neurol 2022; 13:1018324. [PMID: 36588877 PMCID: PMC9797509 DOI: 10.3389/fneur.2022.1018324] [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: 08/13/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
Objective This meta-analysis evaluated the diagnostic value of intraoperative brainstem auditory evoked potential (BAEP) for predicting post-operative hearing loss. Methods Research articles in MEDLINE, Embase, and Cochrane Library databases were searched and selected up to 20 January 2022, and data were extracted following a standard procedure. A diagnostic accuracy test meta-analysis was performed using a mixed-effect binary regression model. Results A total of 693 patients from 15 studies were extracted. The change in intraoperative BAEP showed high sensitivity (0.95) but low specificity (0.37), with an area under the curve of 0.83. Diagnostic accuracy of the loss of potentials showed high sensitivity (0.82) and specificity (0.79). The area under the curve was 0.88. No factor was found to account for the heterogeneity of the results according to the meta-regression and subgroup analyses (all P-values > 0.05). Conclusions Our results showed that the loss of BAEP has meaningful value for predicting hearing loss after vestibular schwannoma surgery. The change in BAEP is also important for its high sensitivity during hearing preservation surgery.
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Affiliation(s)
- Feng Gu
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xingyu Yang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zilan Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xin Tan
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Tao Xue
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhouqing Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,Zhouqing Chen
| | - Zhong Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,*Correspondence: Zhong Wang
| | - Gang Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Farag AA, Ibrahim AEKSED, Alaghory IM. Clinical Benefits of Facial Nerve Monitoring during Cerebellopontine Angle Surgery. OPEN JOURNAL OF MODERN NEUROSURGERY 2022; 12:9-27. [DOI: 10.4236/ojmn.2022.121002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Li J, Deng X, Ke D, Cheng J, Zhang S, Hui X. Risk Factors for Progression in Vestibular Schwannomas After Incomplete Resection: A Single Center Retrospective Study. Front Neurol 2021; 12:778590. [PMID: 34899585 PMCID: PMC8660677 DOI: 10.3389/fneur.2021.778590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/27/2021] [Indexed: 02/05/2023] Open
Abstract
Background and Purpose: The risk factors for progression in vestibular schwannomas (VSs) after incomplete resection (IR) remain to be elucidated. The purpose of this study was to investigate the risk factors for progression in remnant VSs after surgery. Methods: From January 2009 to January 2018, 140 consecutive patients who underwent IR of VSs via suboccipital retrosigmoid approach in our institution were retrospectively analyzed. During follow-up, if progression was detected, the patient was classified into Progressive Group (PG); if the residual tumor was stable or shrank, the patient was classified into Stable Group (SG). Univariate analysis and multivariate analysis were used to evaluate the risk factors for progression after IR of VSs. Results: After a mean follow-up of 80.4 months (range, 24–134 months), 35 (25.0%) patients (PG) had a progression, and no progression was detected in 105 (75.0%) patients (SG). The average tumor size was 36.5 ± 8.9 mm in PG and 31.0 ± 9.8 mm in SG, respectively. The residual tumor volume was 304.6 ± 443.3 mm3 in PG and 75.9 ± 60.0 mm3 in SG, respectively. Univariate analysis showed that preoperative tumor size, residual tumor volume, and irregular internal auditory canal (IAC) expansion were significantly different between the two groups, whereas gender, age, cystic component, or Ki-67 labeling index (LI) did not differ significantly between the two groups. Multivariate analysis showed residual tumor volume was the independent risk factor for progression. Conclusions: VSs that underwent IR with larger preoperative size, greater residual tumor volume, or irregular IAC expansion may have a higher progression rate. Strict follow-up with shorter interval in these patients to detect early progression is necessary.
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Affiliation(s)
- Jiuhong Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xueyun Deng
- Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Daibo Ke
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Cheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Si Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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8
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Kouzel Martinez F, Graffeo CS, Carlstrom LP, Link MJ. Growth arrest of a refractory vestibular schwannoma after anti-PD-1 antibody treatment. BMJ Case Rep 2021; 14:14/5/e241834. [PMID: 34045200 DOI: 10.1136/bcr-2021-241834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 25-year-old man presented with left-sided hearing loss, blurred vision and papilloedema. Imaging revealed a large, left-sided, contrast-enhancing cerebellopontine mass causing obstructive hydrocephalus, consistent with vestibular schwannoma (VS). Following an incomplete resection via retrosigmoid craniotomy at an outside facility, he was referred to our department, and cerebrospinal fluid diversion followed by repeat resection was recommended. A subtotal resection was achieved, and the patient was subsequently treated with adjuvant stereotactic radiosurgery (SRS). Progressive interval growth was observed on serial post-SRS MRI studies; correspondingly, at 31 months after treatment, the patient was initiated on antiprogrammed-death receptor 1 (PD-1) antibody treatment with pembrolizumab. Growth arrest was noted on subsequent serial imaging studies, which have been maintained for a total of 30 months since initiation of a 18-month anti-PD-1 course of therapy. Additional case accumulation and translational study is required to better characterise this therapeutic strategy; however, PD-1/programmed death-ligand 1 inhibition may offer a promising salvage therapy for refractory VS.
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9
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Leao MT, Machetanz K, Sandritter J, Liebsch M, Stengel A, Tatagiba M, Naros G. Repetitive Transcranial Magnetic Stimulation for Tinnitus Treatment in Vestibular Schwannoma: A Pilot Study. Front Neurol 2021; 12:646014. [PMID: 33912127 PMCID: PMC8072380 DOI: 10.3389/fneur.2021.646014] [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: 12/24/2020] [Accepted: 02/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Vestibular schwannomas (VS) are brain tumors affecting the vestibulocochlear nerve. Thus, VS patients suffer from tinnitus (TN). While the pathophysiology is mainly unclear, there is an increasing interest in repetitive transcranial magnetic stimulation (rTMS) for TN treatment. However, the results have been divergent. In addition to the methodological aspects, the heterogeneity of the patients might affect the outcome. Yet, there is no study evaluating rTMS exclusively in VS-associated tinnitus. Thus, the present pilot study evaluates low-frequency rTMS to the right dorsolateral pre-frontal cortex (DLPFC) in a VS-associated tinnitus. Methods: This prospective pilot study enrolled nine patients with a monoaural VS-associated tinnitus ipsilateral to the tumor. Patients were treated with a 10-day rTMS regime (1 Hz, 100% RMT, 1,200 pulses, right DLPFC). The primary endpoint of the study was the reduction of TN distress (according to the Tinnitus Handicap Inventory, THI). The secondary endpoint was a reduction of TN intensity (according to the Tinnitus Matching Test, TMT) and the evaluation of factors predicting tinnitus outcome (i.e., hearing impairment, TN duration, type of tinnitus). Results: No complications or side effects occurred. There was one drop-out due to a non-responsiveness of the complaint. There was a significant acute effect of rTMS on the THI and TMT. However, there was no significant long-term effect after 4 weeks. While the THI failed to detect any clinically relevant acute effect of rTMS in 56% of the patients, TMT revealed a reduction of TN intensity for more than 20 in 89% and for more than 50 in 56% of the patients. Notably, the acute effect of rTMS was influenced by the TN type and duration. In general, patients with a tonal TN and shorter TN duration showed a better response to the rTMS therapy. Conclusion: The present pilot study is the first one to exclusively evaluate the effect of low-frequency rTMS to the right DLPFC in a VS-associated tinnitus. Our results prove the feasibility and the efficacy of rTMS in this patient cohort. There is a significant acute but a limited long-term effect. In addition, there is evidence that patients with a tonal tinnitus and shorter tinnitus duration might have the strongest benefit. A larger, randomized controlled study is necessary to prove these initial findings.
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Affiliation(s)
- Maria Teresa Leao
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany.,Section Psychooncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital Tuebingen, Tuebingen, Germany
| | - Kathrin Machetanz
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Joey Sandritter
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Marina Liebsch
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Andreas Stengel
- Section Psychooncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital Tuebingen, Tuebingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Georgios Naros
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
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10
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Ceronie B, Green F, Cockerell OC. Acoustic neuroma presenting as a hypnic headache. BMJ Case Rep 2021; 14:14/3/e235830. [PMID: 33687931 PMCID: PMC7944972 DOI: 10.1136/bcr-2020-235830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hypnic headache (HH) is a rare, primary headache syndrome that invariably occurs during sleep and wakes the patient. Acoustic neuroma (AN) is a benign tumour that uncommonly presents with isolated headache. Here, we describe a patient with AN that presented with an HH-like syndrome. A 40-year-old woman presented with 4 months of generalised, throbbing, nocturnal headaches that woke her from sleep. Neurological examination was unremarkable. Retrospectively, she reported a 4-year history of mild, bilateral tinnitus. Neuroimaging demonstrated a large, left-sided AN in the cerebellopontine angle without obstructive hydrocephalus. Gamma knife radiosurgery controlled tumour growth. One year after radiosurgery, she became nocturnal headache-free. AN has not previously been described as presenting with an HH-like syndrome. There are four previous reports of an HH-like syndrome secondary to intracranial masses. In all cases, patients became headache-free following surgery. This advocates for neuroimaging to exclude structural causes.
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Affiliation(s)
- Bryan Ceronie
- Cardiology, West Middlesex University Hospital, Isleworth, London, UK .,Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Frederick Green
- Ear, Nose and Throat Surgery, Barts Health NHS Trust, London, UK
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11
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Sobieski C, Killeen DE, Barnett SL, Mickey BE, Hunter JB, Isaacson B, Kutz JW. Facial Nerve Outcomes After Vestibular Schwannoma Microsurgical Resection in Neurofibromatosis Type 2. Otolaryngol Head Neck Surg 2020; 164:850-858. [PMID: 32957864 DOI: 10.1177/0194599820954144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study is to investigate facial nerve outcomes after microsurgical resection in neurofibromatosis type 2 (NF2) compared to sporadic tumors. STUDY DESIGN Single institutional retrospective chart review. SETTING Tertiary referral center. METHODS All adult patients with NF2 vestibular schwannoma (VS) or sporadic VS who underwent microsurgical resection from 2008 to 2019 with preoperative magnetic resonance imaging (MRI) and 1 year of postsurgical follow-up were included. The primary outcome measure was postoperative House-Brackmann (HB) facial nerve score measured at first postoperative visit and after at least 10 months. RESULTS In total, 161 sporadic VSs and 14 NF2 VSs met inclusion criteria. Both median tumor diameter (NF2, 33.5 mm vs sporadic, 24 mm, P = .0011) and median tumor volume (NF2, 12.4 cm3 vs sporadic, 2.9 cm3, P = .0005) were significantly greater in patients with NF2. The median follow-up was 24.9 months (range, 12-130.1). Median facial nerve function after 1 year for patients with NF2 was HB 3 (range, 1-6) compared to HB 1 (range, 1-6) for sporadic VS (P = .001). With multivariate logistic regression, NF2 tumors (odds ratio [OR] = 13.9, P = .001) and tumor volume ≥3 cm3 (OR = 3.6, P = .025) were significantly associated with HB ≥3 when controlling for age, sex, extent of tumor resection, translabyrinthine approach, and prior radiation. CONCLUSION Tumor volume >3 cm3 and NF2 tumors are associated with poorer facial nerve outcomes 1 year following microsurgical resection.
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Affiliation(s)
- Catherine Sobieski
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel E Killeen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samuel L Barnett
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bruce E Mickey
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brandon Isaacson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joe Walter Kutz
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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12
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Early S, Rinnooy Kan CE, Eggink M, Frijns JHM, Stankovic KM. Progression of Contralateral Hearing Loss in Patients With Sporadic Vestibular Schwannoma. Front Neurol 2020; 11:796. [PMID: 33013614 PMCID: PMC7461819 DOI: 10.3389/fneur.2020.00796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/25/2020] [Indexed: 12/18/2022] Open
Abstract
Background and Introduction: Vestibular schwannomas (VSs) are the most common tumors of the cerebellopontine angle, typically presenting unilaterally with ipsilateral sensorineural hearing loss (SNHL). The mechanism of tumor-induced hearing loss has recently been shown to be related to secreted tumor factors, in addition to mechanical compression of the adjacent auditory nerve, and these factors may percolate through CSF or blood to affect contralateral hearing as well. Methods: This is a retrospective study of medical records for patients treated for VS at Mass Eye and Ear from January 1994 through October 2018. Included patients had unilateral VS and sequential audiometry allowing for longitudinal assessment of hearing over time. Mass Eye and Ear's audiology database was used to select age- and sex-matched case controls, also with sequential audiometry, from the non-VS population. Subgroup analysis was performed by age, sex, baseline hearing, and tumor size at initial diagnosis. Hearing loss progression was performed using Kaplan-Meier analysis to account for variable follow-up times. Results: A total of 661 patients were identified with VS and sequential audiometry. The population was predominantly female vs. male (368 vs. 293, p = 0.0035), driven primarily by younger patients with Koos 4 tumors (76 female vs. 49 male, p = 0.016). Patients with normal baseline hearing bilaterally (N = 241) demonstrated no significant difference in hearing loss progression in VS-contralateral vs. control ears. Patients with abnormal baseline VS-ipsilateral hearing (N = 190), however, demonstrated significantly higher likelihood of reaching moderate SNHL in VS-contralateral ears. Subgroup analysis by age, sex, and baseline tumor size did not yield any subgroup-specific trends for hearing loss progression. Discussion and Conclusion: This is the largest study to date tracking long-term bilateral hearing outcomes in patients with VS, and demonstrates that, in patients with abnormal hearing in the VS-ipsilateral ear, there exists a long-term risk of progression to moderate hearing loss in the contralateral ear as well. Combined with the absence of significant changes in word understanding in the affected ears, these findings may provide clues to the nature of tumor-secreted factors involved in VS-associated hearing loss. Female predominance within the VS patient population is confirmed, driven mostly by younger female patients with Koos 4 tumors.
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Affiliation(s)
- Samuel Early
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,San Diego School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Charlotte E Rinnooy Kan
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Leiden University Medical Center, Leiden, Netherlands
| | - Maura Eggink
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,University Medical Center Groningen, Groningen, Netherlands
| | - Johan H M Frijns
- Leiden University Medical Center, Leiden, Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden, Netherlands
| | - Konstantina M Stankovic
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, United States.,Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA, United States
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Zhu S, Rotondo R, Mendenhall WM, Dagan R, Lewis D, Huh S, Knox G, Tavaniepour D, Sandhu S, Rutenberg MS. Long-Term Outcomes of Fractionated Stereotactic Proton Therapy for Vestibular Schwannoma: A Case Series. Int J Part Ther 2018; 4:37-46. [PMID: 31773014 DOI: 10.14338/ijpt-17-00032.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 06/05/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose Evaluate clinical outcomes in patients with vestibular schwannoma (VS) treated with fractionated proton therapy (PT) at a single institution. Materials and Methods We retrospectively reviewed the medical records of patients treated with fractionated PT for definitive management of VS between November 2007 and December 2013 at our institution. No patient had received prior treatment for VS. Patients received 50.4 Gy in 28 fractions using passively scattered PT. Pretreatment and posttreatment hearing status, tumor dimensions, and cranial nerve V and VII function were evaluated. Hearing status was graded as nonserviceable or serviceable, defined as Gardner-Robertson grade I or II and the ability to use a telephone with the treated ear. Toxicities were prospectively evaluated using Common Terminology Criteria for Adverse Events, version 4.0. Results Fourteen patients with 14 lesions (8 men, 6 women) were included in the analysis. Median age at treatment was 60 years (range, 24-74 years). Median clinical follow-up for living patients was 68 months (range, 36-106 months). Mean maximal tumor dimension was 2.1 cm (range, 0.5-3.8 cm). Mean tumor volume was 6.4 cm3 (range, 0.3-16.0 cm3). One patient died of unrelated causes 5 months after treatment, and 2 had subsequent surgical resections due to radiographic and/or clinical progression. The actuarial 3-year local control rate was 85%. There were no cranial nerve V or VII injuries. Two of 6 patients (33%) with serviceable hearing at the time of treatment retained serviceable hearing. Three patients (21%) demonstrated radiographic tumor regression on brain magnetic resonance imaging after a median of 26 months (range, 2-113 months). No acute toxicity of grade 3 or above was reported. Conclusion Fractionated PT for VS is well tolerated and provides good local control. Improvements in proton delivery techniques and patient selection may enable improved outcomes.
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Affiliation(s)
- Simeng Zhu
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Ronny Rotondo
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Debbie Lewis
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Soon Huh
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Glenn Knox
- Department of Otolaryngology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Daryoush Tavaniepour
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Sukhwinder Sandhu
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Michael S Rutenberg
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
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14
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Halliday J, Rutherford SA, McCabe MG, Evans DG. An update on the diagnosis and treatment of vestibular schwannoma. Expert Rev Neurother 2017; 18:29-39. [DOI: 10.1080/14737175.2018.1399795] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Jane Halliday
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, UK
| | - Scott A. Rutherford
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, UK
| | - Martin G. McCabe
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Dafydd G. Evans
- Manchester Centre for Genomic Medicine, MAHSC, Division of Evolution and Genomic Science, University of Manchester, Manchester, UK
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15
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Klersy PC, Arlt F, Hofer M, Meixensberger J. Quality of life in patients with unilateral vestibular schwannoma on wait and see - strategy. Neurol Res 2017; 40:34-40. [PMID: 29048255 DOI: 10.1080/01616412.2017.1390184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE A 'wait and see' strategy is an option when managing patients with small vestibular schwannomas (VS). A risk of growth and worsening of hearing may influence a patient's daily quality of life (QOL). Therefore, the present study focused on QOL parameters in patients who are on a 'wait and see' strategy following magnetic resonance imaging (MRI)-based diagnosis of small unilateral VS. PATIENTS AND METHODS Sixty-five patients (mean age 64.4 years; male:female, 32:33) who suffered from a small unilateral VS (9.34 mm, range 1.5-23 mm) between 2013 and 2016 were included in a prospective single center study. During follow-up, in addition to clinical and neurological examinations and MRI imaging, all patients answered the Short Form 36 questionnaire once to characterize QOL. Additionally, the severity of tinnitus was determined by the Mini-TQ-12 from Hiller and Goebel. RESULTS It was found during follow-up that there was no lowering of QOL in patients with small VS who were on 'wait and see' strategy compared with Germany's general population and no tumor growth was detected in 53 patients (81.5%). Patients with a tumor diameter larger than 10 mm did not suffer from stronger tinnitus, vertigo or unsteadiness than the group with an average tumor size, which is smaller than 10 mm. Sixty-two patients (95.4%) showed ipsilateral hearing loss and three of these reported deafness (4.6%). Severe vertigo or tinnitus is connected with lower levels of mental component scale and physical component scale. These findings reduced the QOL (p = 0.05). CONCLUSION In our series, QOL is not influenced in patients with unilateral untreated small VS in comparison to Germany's general population. This is helpful information when advising patients during follow-up and finding out the optimal timing of individual treatment.
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Affiliation(s)
- P C Klersy
- a Department of Neurosurgery , University Hospital Leipzig , Leipzig , Germany
| | - F Arlt
- a Department of Neurosurgery , University Hospital Leipzig , Leipzig , Germany
| | - M Hofer
- b Department of ENT , University Hospital Leipzig , Leipzig , Germany
| | - J Meixensberger
- a Department of Neurosurgery , University Hospital Leipzig , Leipzig , Germany
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16
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Soares VYR, Atai NA, Fujita T, Dilwali S, Sivaraman S, Landegger LD, Hochberg FH, Oliveira CAPC, Bahmad F, Breakefield XO, Stankovic KM. Extracellular vesicles derived from human vestibular schwannomas associated with poor hearing damage cochlear cells. Neuro Oncol 2016; 18:1498-1507. [PMID: 27194145 PMCID: PMC5063517 DOI: 10.1093/neuonc/now099] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 04/13/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Vestibular schwannoma (VS) is a tumor of the vestibular nerve that transmits balance information from the inner ear to the brain. Sensorineural hearing loss occurs in 95% of patients with these tumors, but the cause of this loss is not well understood. We posit a role of VS-secreted extracellular vesicles (EVs) as a major contributing factor in cochlear nerve damage. METHODS Using differential centrifugation, we isolated EVs from VS cell line HEI-193 and primary cultured human VS cells from patients with good hearing or poor hearing. The EVs were characterized using a Nanosight device and transmission electron microscopy and by extracting their RNA content. The EVs' effects on cultured murine spiral ganglion cells and organotypic cochlear cultures were studied using a transwell dual-culture system and by direct labeling of EVs with PKH-67 dye. EV-induced changes in cochlear cells were quantified using confocal immunohistochemistry. Transfection of VS cells with a green fluorescent protein-containing plasmid was confirmed with reverse transcription PCR. RESULTS Human VS cells, from patients with poor hearing, produced EVs that could damage both cultured murine cochlear sensory cells and neurons. In contrast, EVs derived from VS cells from patients with good hearing did not damage the cultured cochlear cells. CONCLUSIONS This is the first report on EVs derived from VSs and on the capacity of EVs from VSs from patients with hearing loss to selectively damage cochlear cells, thereby identifying a potential novel mechanism of VS-associated sensorineural hearing loss.
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Affiliation(s)
- Vitor Y R Soares
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Nadia A Atai
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Takeshi Fujita
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Sonam Dilwali
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Sarada Sivaraman
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Lukas D Landegger
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Fred H Hochberg
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Carlos A P C Oliveira
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Fayez Bahmad
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Xandra O Breakefield
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Konstantina M Stankovic
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
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17
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G RSK, Jagadish J. A STUDY OF THE INCID ENCE OF CEREBELLOPON TINE ANGLE TUMORS AND THEIR MAN AGEMENT IN A TERTIAR Y CARE HOSPITAL. ACTA ACUST UNITED AC 2015. [DOI: 10.18410/jebmh/2015/366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Sakakura K, Akutsu H, Yamamoto T, Masuda Y, Ishikawa E, Matsumura A. Trigeminal neuralgia in a patient with Marfan syndrome: case report. Neurol Med Chir (Tokyo) 2013; 55:101-5. [PMID: 24390183 PMCID: PMC4533392 DOI: 10.2176/nmc.cr.2013-0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Marfan syndrome can demonstrate tortuous and elongated intracranial arteries. However, these arteries rarely cause neurovascular compression resulting in hemifacial spasm or trigeminal neuralgia. The authors report a 33-year-old woman who was diagnosed as Marfan syndrome, suffered from trigeminal neuralgia. Magnetic resonance (MR) angiography showed tortuous and elongated left vertebral artery (VA). The coronal section of three dimensional (3D) MR cisternography with contrast enhancement showed that the left trigeminal nerve was compressed from underneath by the tortuous and elongated left VA. After successful surgery of microvascular decompression, the patient’s symptom resolved and no recurrence was encountered. Neurosurgeons should not only be aware of hemifacial spasm but also of trigeminal neuralgia caused by elongated vessels in a patient with Marfan syndrome, although it is an extremely rare condition. In addition, offending vessel is not atherosclerotic in younger patients unlike usual cases of trigeminal neuralgia. Thus, microvascular decompression can be easier than usual cases. Care should be taken to prevent arterial dissection during transposition by using some technical tips.
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Affiliation(s)
- Kazuki Sakakura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
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19
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Voss NF, Vrionis FD, Heilman CB, Robertson JH. Meningiomas of the cerebellopontine angle. SURGICAL NEUROLOGY 2000; 53:439-46; discussion 446-7. [PMID: 10874142 DOI: 10.1016/s0090-3019(00)00195-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Meningiomas of the cerebellopontine angle (CPA), although uniform in location, are diverse with regard to the site of dural origin and displacement of neurovascular structures. A study of patients with CPA meningiomas was undertaken to gain more information regarding the relationship between site of dural attachment, clinical presentation, operative approach, and outcome. METHODS In this report, we retrospectively review 40 patients with CPA meningiomas managed surgically. RESULTS Common clinical presentations were hearing loss, unsteadiness, and dysequilibrium. Findings upon physical examination included hearing loss (73%), cerebellar signs (32%), trigeminal neuropathy (16%), and facial nerve dysfunction (16%). The most common site of dural origin was the petrous ridge (anterior to the IAC [26%], posterior [21%], superior [18%], and inferior [16%]). Less common sites of dural origin included the tentorium (31%), the clivus (15%), the IAC (10%), and the jugular foramen (8%). Site of dural origin determined the direction of displacement of the facial/vestibulocochlear nerve bundle. The most common microsurgical complication was facial nerve dysfunction (30%). Gross total resection was achieved in 82% of cases, whereas 18% underwent subtotal resection. Two patients died. Follow-up ranged from three months to 13 years with three recurrences. CONCLUSIONS CPA meningiomas displace the seventh and eighth cranial nerves in various directions depending on the site of dural origin. Total surgical excision can be accomplished in the majority of cases with acceptable morbidity.
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Affiliation(s)
- N F Voss
- Department of Neurosurgery, University of Tennessee, Memphis 38163, USA
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