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Wang SSY, Horstmann G, van Eck A, Tatagiba M, Naros G. Likelihood-of-harm/help of microsurgery compared to radiosurgery in large vestibular schwannoma. J Neurooncol 2024; 169:299-308. [PMID: 38951458 PMCID: PMC11341602 DOI: 10.1007/s11060-024-04732-0] [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: 04/30/2024] [Accepted: 05/31/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE It has been shown that in large vestibular schwannomas (VS), radiosurgery (SRS) is inferior with respect to tumor control compared to microsurgical resection (SURGERY). However, SURGERY poses a significantly higher risk of facial-function deterioration (FFD). The aim of this study was to illustrate the effectiveness in terms of number-needed-to-treat/operate (NNO), number-needed-to-harm (NNH), and likelihood-of-harm/help (LHH) by comparing both treatment modalities in large VS. METHODS This was a retrospective, dual-center cohort study. Tumor size was classified by Hannover Classification. Absolute risk reduction and risk increase were used to derive additional estimates of treatment effectiveness, namely NNO and NNH. LHH was then calculated by a quotient of NNH/NNO to illustrate the risk-benefit-ratio of SURGERY. RESULTS Four hundred and forty-nine patients treated met the inclusion criteria. The incidence of tumor recurrence was significantly higher in SRS (14%), compared to SURGERY (3%) resulting in ARR of 11% and NNO of 10. At the same time, SURGERY was related to a significant risk of FFD resulting in an NNH of 12. Overall, the LHH calculated at 1.20 was favored SURGERY, especially in patients under the age of 40 years (LHH = 2.40), cystic VS (LHH = 4.33), and Hannover T3a (LHH = 1.83) and T3b (LHH = 1.80). CONCLUSIONS Due to a poorer response of large VS to SRS, SURGERY is superior with respect to tumor control. One tumor recurrence can be prevented, when 10 patients are treated by SURGERY instead of SRS. Thus, LHH portrays the benefit of SURGERY in large VS even when taking raised FFD into account.
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Affiliation(s)
- Sophie Shih-Yüng Wang
- Department of Neurosurgery, Eberhard Karls University, Hoppe-Seyler-Strasse 3, Tubingen, Germany.
| | | | | | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University, Hoppe-Seyler-Strasse 3, Tubingen, Germany
| | - Georgios Naros
- Department of Neurosurgery, Eberhard Karls University, Hoppe-Seyler-Strasse 3, Tubingen, Germany
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2
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Thomas M, Führes H, Scheer M, Rampp S, Strauss C, Schönfeld R, Leplow B. Perceived Health Benefits in Vestibular Schwannoma Patients with Long-Term Postoperative Headache: Insights from Personality Traits and Pain Coping-A Cross-Sectional Study. J Pers Med 2024; 14:75. [PMID: 38248776 PMCID: PMC10817612 DOI: 10.3390/jpm14010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/28/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
Postoperative headaches (POHs) following retrosigmoid microsurgery for vestibular schwannoma (VS) can significantly impact patients' perceived health benefits (PHBs). In this cross-sectional observational study, 101 VS patients were investigated. For the assessment of pain, the Rostock Headache Compendium (RoKoKo) and the German pain processing questionnaire (FESV) were used. The perceived health benefits (PHBs) were assessed by the Glasgow Benefit Inventory (GBI) and Big Five personality traits were measured using the Ten-Item Personality Inventory (TIPI-G). We showed that 55% of the participants experienced POHs, leading to a marked reduction in overall PHBs compared to those without POHs. The correlation analysis revealed an association between decreased PHBs and elevated levels of pain-related helplessness, depression, anxiety, and anger. Positive correlations were identified between PHBs and action-planning competence, cognitive restructuring, and the experience of competence. Low emotional stability and openness yielded associations with pain-related psychological impairment. Hearing loss and facial paresis did not exert a significant impact on PHBs. The study highlights the influence of pain-related coping strategies on PHBs in long-term POH patients. Thus, coping mechanisms and personality traits should be assessed even before surgery for post-surgery pain prevention. The limitations of this study include a relatively small sample size, potential biases introduced by the overrepresentation of female patients, and the use of an online survey methodology. In conclusion, this research highlights that the interplay between headaches, PHBs, and psychological factors is also relevant in VS patients undergoing microsurgery. Short-term psychological interventions should therefore be taken into account to improve post-surgery adaptive coping strategies.
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Affiliation(s)
- Mareike Thomas
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Hannah Führes
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Maximilian Scheer
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Robby Schönfeld
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Emil-Abderhalden-Straße 26-27, 06108 Halle, Germany
| | - Bernd Leplow
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Emil-Abderhalden-Straße 26-27, 06108 Halle, Germany
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3
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Pruijn IMJ, van Heemskerken P, Kunst HPM, Tummers M, Kievit W. Patient-preferred outcomes in patients with vestibular schwannoma: a qualitative content analysis of symptoms, side effects and their impact on health-related quality of life. Qual Life Res 2023; 32:2887-2897. [PMID: 37258945 PMCID: PMC10474211 DOI: 10.1007/s11136-023-03433-x] [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] [Accepted: 04/28/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE During counseling and management of patients with vestibular schwannoma (VS), the emphasis is shifting from tumour control and nerve preservation towards maintaining or improving health-related quality of life (HRQoL). Understanding the patients' perspective and impact of VS is, therefore, of utmost importance. The current study aimed to identify treatment outcomes preferred by patients and to explore the patient-reported VS symptoms and management-related side effects and their impact on HRQoL. METHODS Patients with VS were contacted through the Dutch VS association Stichting Hoormij and questioned using a semi-structured, cross-sectional online survey. Patients were asked to report and rank symptoms and side effects, with their impact on HRQoL and frequency of occurrence. Results were structured through qualitative content analysis. Coded symptoms, side effects, impacts, frequencies, and patient-preferred outcomes were analysed and summarized with descriptive statistics. RESULTS Of the 231 respondents, 71% were actively treated. Hearing (symptoms vs. side effects: 78.8% vs. 63.6%), balance (62.3%; 48.8%), and energy issues (33.8%; 32.6%) were the most frequently mentioned symptoms and management-related side effects. Fatigue, deafness, headaches, and hearing loss had the highest impact on HRQoL. The majority of patients identified hearing preservation (61%), balance preservation (38.5%), and reduced tinnitus (34.6%) to be the patient-preferred outcomes. CONCLUSION This qualitative study demonstrates that in this population many patients with VS encounter participation difficulties in their daily physical and social activities and value hearing and balance preservation, reduced tinnitus, and restored energy as preferred outcomes as they are hampered by symptoms and side effects related to hearing, balance, and energy. Healthcare professionals should consider these key points and use these and the patient-preferred outcomes in consultation, shared decision making, treatment, and follow-up to optimize patient-centred care.
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Affiliation(s)
- Ineke M J Pruijn
- Department of Otorhinolaryngology, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6525 EX, Nijmegen, The Netherlands.
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center, Nijmegen/Maastricht, The Netherlands.
| | - Phylisha van Heemskerken
- Department of Otorhinolaryngology, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6525 EX, Nijmegen, The Netherlands
- Department of Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6525 EX, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center, Nijmegen/Maastricht, The Netherlands
- Department of Otorhinolaryngology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcia Tummers
- Department of Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Wietske Kievit
- Department of Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Chojak R, Koźba-Gosztyła M, Gaik M, Madej M, Majerska A, Soczyński O, Czapiga B. Meningitis after elective intracranial surgery: a systematic review and meta-analysis of prevalence. Eur J Med Res 2023; 28:184. [PMID: 37291583 DOI: 10.1186/s40001-023-01141-3] [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: 10/03/2022] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
Meningitis is a potential complication of elective intracranial surgery (EIS). The prevalence of meningitis after EIS varies greatly in the literature. The objective of this study was to estimate the overall pooled prevalence of meningitis following EIS. Four databases (PubMed, Scopus, Web of Science, and Embase) were searched to identify relevant studies. Meta-analyses of proportions were used to combine data. Cochran's Q and I2 statistics were used to assess and quantify heterogeneity. Additionally, several subgroup analyses were conducted to investigate the source of heterogeneity and examine differences in the prevalence based on variables such as geographical regions, income level, and meningitis type. The meta-analysis included 83 studies (30 959 patients) from 26 countries. The overall pooled prevalence of meningitis after EIS was 1.6% (95% CI 1.1-2.1), with high heterogeneity present (I2 = 88%). The pooled prevalence in low- to middle-income countries and high-income countries was 2.7% (95% CI 1.6-4.1) and 1.2% (95% CI 0.8-1.7), respectively. Studies that reported only aseptic meningitis had a pooled prevalence of 3.2% (95% CI 1.3-5.8). The pooled prevalence was 2.8% (95% CI 1.5-4.5) in studies that reported only bacterial meningitis. Similar prevalence rates of meningitis were observed in the subgroups of tumor resection, microvascular decompression, and aneurysm clipping. Meningitis is a rare but not exceptional complication following EIS, with an estimated prevalence of 1.6%.
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Affiliation(s)
- Rafał Chojak
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland.
| | | | - Magdalena Gaik
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Marta Madej
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Aleksandra Majerska
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Oskar Soczyński
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Bogdan Czapiga
- Department of Neurosurgery, 4th Military Hospital in Wroclaw, Wrocław, Poland
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
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Foscolo V, de Gennaro L, Murri A, Speranzon L, Signorelli F, Quaranta N, Messina R. Postoperative Impact of Pontocerebellar Angle Surgery on the Quality of Life in Patients with Vestibular Schwannoma. Audiol Res 2022; 12:635-643. [PMID: 36412656 PMCID: PMC9680513 DOI: 10.3390/audiolres12060061] [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: 10/10/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vestibular Schwannomas are benign tumors arising from the VIII CN. Surgical treatment is indicated in case of tumors larger than 2.5 cm in the cerebellopontine angle or in the case of cranial nerve dysfunction. The aim of the present study was to evaluate the QoL by means of the PANQOL questionnaire in a group of surgically treated patients mainly affected by large and giant VS Methods: All patients underwent preoperative and postoperative otoneurological evaluation and gadolinium enhanced MRI and they completed, independently, the PANQOL questionnaire at last follow up. RESULTS 70% of patients presented with large Koos III or IV VS Each domain of PANQOL showed a strong correlation with the total PANQOL score. In relation to the postoperative facial nerve function, patients with poorer function showed significantly lower score in the facial dysfunction and pain, patients with postoperative balance problems showed a significantly lower PANQOL score for domains of balance and pain. CONCLUSIONS This study showed that postoperative QoL of patients was acceptable even if there were some domains that were more affected, such as hearing and balance domains; therefore, the lowest scores suggest the need for vestibular rehabilitation programs and strategies that improve postoperative hearing.
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Affiliation(s)
- Valentina Foscolo
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Luigi de Gennaro
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Alessandra Murri
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Luca Speranzon
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Francesco Signorelli
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Nicola Quaranta
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, 70124 Bari, Italy
- Correspondence:
| | - Raffaella Messina
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University “Aldo Moro” of Bari, 70124 Bari, Italy
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6
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Adegboyega G, Jordan C, Kawka M, Chisvo N, Toescu SM, Hill C. Quality of life reporting in the management of posterior fossa tumours: A systematic review. Front Surg 2022; 9:970889. [PMID: 36303860 PMCID: PMC9594859 DOI: 10.3389/fsurg.2022.970889] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Survival amongst posterior fossa tumour (PFT) patients is improving. Clinical endpoints such as overall survival fail to depict QoL. There is yet to be a review of current QoL instruments used for adult PFTs. Aim of this review is to outline the QoL reporting in the management of PFTs and measure participation level. Methods This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A search strategy to identify adult patients with PFTs who took part in QoL metrics was conducted. Observational and experimental studies published from 1990 to date were included. Studies with a sample size less than 10 and performance measures such as Karnofsky Performance Status were not considered. Results A total of 116 studies were included in the final analysis. Vestibular schwannomas were the most common tumour pathology (n = 23,886, 92.6%) followed by pilocytic astrocytomas (n = 657, 2.5%) and meningiomas (n = 437, 1.7%) Twenty-five different QoL measures were used in the study pool. SF-36 was the most common (n = 55, 17 47.4%) QoL metric in the whole study pool, followed by the Penn Acoustic Neuroma QoL scale (n = 24, 20.7%) and Dizziness Handicap Inventory (n = 16, 13.8%). Seventy-two studies reported less-than 100% participation in QoL evaluation. The commonest reason for non-participation was a lack of response (n = 1,718, 60.8%), incomplete questionnaires (n = 268, 9.4%) and cognitive dysfunction (n = 258, 9.1%). Conclusion Informed clinical decision-making in PFT patients requires the development of specific QoL outcomes. Core outcome sets, and minimal clinically important differences (MCID) are essential for these metrics to show clinically significant improvements in patient QoL.
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Affiliation(s)
- Gideon Adegboyega
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Chloe Jordan
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Michal Kawka
- Imperial College London School of Medicine, London, United Kingdom
| | - Nathan Chisvo
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Ciaran Hill
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
- University College London Cancer Institute, London, United Kingdom
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7
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Bender M, Tatagiba M, Gharabaghi A. Quality of Life After Vestibular Schwannoma Surgery: A Question of Perspective. Front Oncol 2022; 11:770789. [PMID: 35223451 PMCID: PMC8873590 DOI: 10.3389/fonc.2021.770789] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectiveHealth-related quality of life (HRQoL) and self-reported outcome measures have a relevant impact on the medical decision-making process. They capture either the current status and allow for multiple prospective evaluations in the course of a treatment or rely on the retrospective comparison of health of patients before and after an intervention to assess its benefit. Importantly, these patient-assessed measures may be influenced by psychological factors. We compared HRQoL and perceived benefit in the course of surgical vestibular schwannoma (VS) treatment, as assessed by the patients from a prospective and retrospective point-of-view, and evaluated the influence of co-morbid depression.MethodsWithin a prospective observational single-center study, forty-three patients with VS were investigated before and after retrosigmoid tumor resection. SF-36, Beck Depression Inventory and patient-assessed clinical symptoms were acquired before surgery and at follow-up. At follow-up, the Glasgow Benefit Inventory (GBI) was acquired as well.ResultsSF-36 scores were significantly lower than the age and sex matched normative data in six and three out of eight categories before and after surgery, respectively. Three categories improved significantly after vs. before surgery; one of them (global health) reached a minimal clinical important difference. In contrast, patients reported predominantly a deterioration, when asked for a retrospective evaluation of the benefit (i.e., GBI). Depression correlated with both SF-36 and GBI, determined dissatisfaction, improved significantly after surgery and was the measure that had the largest impact on HRQoL.ConclusionProspective and retrospective HRQoL measures may lead to different findings and can be confounded by psychological factors.
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Hephzibah A, Pandey SK, Rupa V, Moorthy RK, Rajshekhar V. Changes in pattern of presentation of patients with unilateral vestibular schwannoma over two decades: Influence of cell phone use in early diagnosis. J Clin Neurosci 2021; 94:102-106. [PMID: 34863422 DOI: 10.1016/j.jocn.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
We aimed to study whether the increased use of cell phone in south Asia over the past two decades has impacted presentation of patients with vestibular schwannoma (VS). In this observational cohort study, data on cell phone use and severity of hearing loss and tumor size was collected using a questionnaire through a patient interview (n = 62) in consecutive patients with VS managed between 2017 and 2020. Association between cell phone use and severity of hearing loss and tumor size were studied and compared with our data published earlier when telephone use was not widely prevalent. 71% of the 62 patients (aged between 15 and 81 years) had large or giant VS. Pure tone audiometry showed moderately severe or profound hearing loss in77.4%. Sixty (96.7%) patients used cell phones. 50% of patients complained of difficulty in using their cell phone because of hearing loss. Compared to the earlier era, a higher proportion consulted an ENT surgeon first for hearing loss (59.7% vs 26%; p = 0.0005) and had small or medium sized tumors (29% vs 8%; p = 0.008) with a smaller mean tumor size (3.3 vs 3.9 cm; p = 0.03). Increased cell phone use has led to earlier diagnosis of VS and smaller tumours in recent years when compared to an earlier era. However, the vast majority of patients continue to present with severe to profound hearing loss and large tumors.
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Affiliation(s)
- Adeline Hephzibah
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | | | - V Rupa
- Department of ENT, Christian Medical College, Vellore, India
| | - Ranjith K Moorthy
- Department of Neurological Sciences, Christian Medical College, Vellore, India.
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, India
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9
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Grigoryan GY, Sitnikov AR, Grigoryan YA. [Trigeminal radiculopathy in vestibular schwannomas]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:29-43. [PMID: 34156205 DOI: 10.17116/neiro202185031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the correlation of trigeminal radiculopathy with anatomical relationships of trigeminal nerve root, brainstem, tumors and vessels in patients with vestibular schwannomas. MATERIAL AND METHODS A retrospective analysis included 153 patients (106 females and 47 males aged 22-82 years) with vestibular schwannomas who underwent surgery via retromastoid approach. Preoperative trigeminal radiculopathy (facial pain and sensory disturbances) was examined after microsurgical resection. Brainstem compression was analyzed by comparison of transverse size of contralateral to vestibular schwannoma half of brainstem and ipsilateral side. RESULTS Tumor-induced brainstem and trigeminal nerve compression was found in 115 cases. Sixty-four of these patients had trigeminal radiculopathy symptoms. Degree of brainstem compression was significantly higher in trigeminal radiculopathy group. Facial hypoesthesia was found in 61patients, trigeminal neuralgia - in 5 cases, neuropathic pain - in 3 patients. Thirty-seven patients without brainstem compression had no trigeminal nerve involvement. One patient had trigeminal neuralgia following compression by superior cerebellar artery. Total resection with brainstem and trigeminal nerve decompression were performed in all cases. Isolated or combined compression of trigeminal nerve root was noted in 9 patients with trigeminal neuralgia and neuropathic pain, in 2 with facial numbness and in 2 patients without trigeminal symptoms. In case of trigeminal neuralgia following compression by superior cerebellar artery, vascular decompression was performed only in patients with facial pain and numbness. Facial pain completely resolved in all patients. Complete or partial sensory restoration was noted in 25 cases. No facial sensory disorders were noted in 26 cases, transient sensory deterioration - in 10 patients. CONCLUSION Trigeminal radiculopathy is caused by severe brainstem compression following vestibular schwannomas and usually results sensory disturbances and rarely facial pain. The impact of tumor on trigeminal nerve root and brainstem trigeminal pathways can be accompanied by vascular compression by superior cerebellar artery. Regression of trigeminal radiculopathy symptoms after resection of vestibular schwannoma is caused by decompression of trigeminal nerve root and brainstem. In case of concomitant neurovascular syndrome, vascular decompression is indicated.
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Affiliation(s)
| | - A R Sitnikov
- Treatment and Rehabilitation Center, Moscow, Russia
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10
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Hostettler IC, Jayashankar N, Bikis C, Wanderer S, Nevzati E, Karuppiah R, Waran V, Kalbermatten D, Mariani L, Marbacher S, Guzman R, Madduri S, Roethlisberger M. Clinical Studies and Pre-clinical Animal Models on Facial Nerve Preservation, Reconstruction, and Regeneration Following Cerebellopontine Angle Tumor Surgery-A Systematic Review and Future Perspectives. Front Bioeng Biotechnol 2021; 9:659413. [PMID: 34239858 PMCID: PMC8259738 DOI: 10.3389/fbioe.2021.659413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background and purpose: Tumorous lesions developing in the cerebellopontine angle (CPA) get into close contact with the 1st (cisternal) and 2nd (meatal) intra-arachnoidal portion of the facial nerve (FN). When surgical damage occurs, commonly known reconstruction strategies are often associated with poor functional recovery. This article aims to provide a systematic overview for translational research by establishing the current evidence on available clinical studies and experimental models reporting on intracranial FN injury. Methods: A systematic literature search of several databases (PubMed, EMBASE, Medline) was performed prior to July 2020. Suitable articles were selected based on predefined eligibility criteria following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Included clinical studies were reviewed and categorized according to the pathology and surgical resection strategy, and experimental studies according to the animal. For anatomical study purposes, perfusion-fixed adult New Zealand white rabbits were used for radiological high-resolution imaging and anatomical dissection of the CPA and periotic skull base. Results: One hundred forty four out of 166 included publications were clinical studies reporting on FN outcomes after CPA-tumor surgery in 19,136 patients. During CPA-tumor surgery, the specific vulnerability of the intracranial FN to stretching and compression more likely leads to neurapraxia or axonotmesis than neurotmesis. Severe FN palsy was reported in 7 to 15 % after vestibular schwannoma surgery, and 6% following the resection of CPA-meningioma. Twenty-two papers reported on experimental studies, out of which only 6 specifically used intracranial FN injury in a rodent (n = 4) or non-rodent model (n = 2). Rats and rabbits offer a feasible model for manipulation of the FN in the CPA, the latter was further confirmed in our study covering the radiological and anatomical analysis of perfusion fixed periotic bones. Conclusion: The particular anatomical and physiological features of the intracranial FN warrant a distinguishment of experimental models for intracranial FN injuries. New Zealand White rabbits might be a very cost-effective and valuable option to test new experimental approaches for intracranial FN regeneration. Flexible and bioactive biomaterials, commonly used in skull base surgery, endowed with trophic and topographical functions, should address the specific needs of intracranial FN injuries.
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Affiliation(s)
- Isabel C Hostettler
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Narayan Jayashankar
- Department of Oto-Rhino-Laryngology, Nanavati Super Speciality Hospital, Mumbai, India
| | - Christos Bikis
- Department of Biomedical Engineering, Biomaterials Science Center, University of Basel, Allschwil, Switzerland.,Integrierte Psychiatrie Winterthur - Zürcher Unterland, Winterthur, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Edin Nevzati
- Department of Neurosurgery, Kantonsspital Luzern, Lucerne, Switzerland
| | - Ravindran Karuppiah
- Department of Neurosurgery, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Vicknes Waran
- Department of Neurosurgery, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Daniel Kalbermatten
- Department of Plastic Surgery, University Hospital Geneva, Geneva, Switzerland.,Department of Surgery, Biomaterials and Neuro Tissue Bioengineering, University of Geneva, Geneva, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, University of Basel, Basel, Switzerland.,Department of Biomedicine, Brain Ischemia and Regeneration, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, Center for Bioengineering and Regenerative Medicine, University of Basel, Basel, Switzerland
| | - Srinivas Madduri
- Department of Surgery, Biomaterials and Neuro Tissue Bioengineering, University of Geneva, Geneva, Switzerland.,Department of Biomedicine, Brain Ischemia and Regeneration, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, Center for Bioengineering and Regenerative Medicine, University of Basel, Basel, Switzerland
| | - Michel Roethlisberger
- Department of Neurosurgery, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia.,Department of Neurosurgery, University Hospital of Basel, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, Center for Bioengineering and Regenerative Medicine, University of Basel, Basel, Switzerland
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11
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Quality of life in patients of unilateral vestibular schwannoma treated with microsurgery: A South-Asian tertiary care Hospital experience. J Clin Neurosci 2021; 89:264-270. [PMID: 34119279 DOI: 10.1016/j.jocn.2021.04.034] [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: 10/18/2020] [Revised: 04/09/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022]
Abstract
Majority of the published literature on the impact of microsurgery over quality-of-life (QOL) in vestibular schwannoma (VS) patients is retrospective in nature, with variable results, and there has been very little contribution from South-Asia. The authors designed this study to investigate the role of microsurgery in QOL alterations in VS patients, and to compare obtained QOL scores with that of control population. Between February 2017 and March 2018, a prospective/retrospective study was done at our institute. Prospective and retrospective cohorts included, 30 and 34 consecutive patients, respectively, of unilateral VS undergoing microsurgery. QOL assessment was done using Short Form-36 (SF-36), and the Penn Acoustic Neuroma Quality-Of-Life (PANQOL) questionnaires. Prospective cohort underwent QOL assessment at 3 junctures - pre-surgery, 3-months & 1-year post-surgery; while retrospective cohort was assessed only once, at 1-year post-surgery. Age- & sex- matched normal population and diabetic patients were used as controls. In the prospective cohort, patients showed drop in all PANQOL domain/ SF-36 dimension scores at 3-month post-surgery, exception being vitality and general health in SF-36; showed improvement at 1-year follow-up, with majority either levelling or improving their respective pre-surgery scores. Gross total resection, tumors ≤ 3 cm, and age ≤ 45 years had better PANQOL scores at 1-year post-surgery across all the domains. Patients in both the cohorts showed worse QOL compared to normal population, but the gap got narrower at 1-year post-surgery. Our study adds a South-Asian perspective to the pool of prospective knowledge available on QOL following microsurgery in VS patients.
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12
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Teng KX, Price B, Joshi S, Alukaidey L, Shehab A, Mansour K, Toor GS, Angliss R, Drummond K. Life after surgical resection of a low-grade glioma: A prospective cross-sectional study evaluating health-related quality of life. J Clin Neurosci 2021; 88:259-267. [PMID: 33992194 DOI: 10.1016/j.jocn.2021.03.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Abstract
Health related quality of life (HRQoL) has become an important consideration in LGG patients. We report the largest prospective, longitudinal, cross-sectional cohort study of HRQoL in LGG patients, aiming to identify actionable determinants of HRQoL. Post-operative LGG adults at a large tertiary center underwent HRQoL assessment using the EORTC QLQ-C30 questionnaire administered at follow-up visits and by mail. Scores at 12 month intervals were compared with those from a normative reference population. Spearman's Rho was used to evaluate correlation of subdomain and symptom scores with global HRQoL and change over time. There were 167 participants and 366 questionnaires analysed. Patients reported reduced global HRQoL at nearly every 12 month interval with significant impairments at 12, 72, 108, and 120+ months postoperative. They also reported a significant impairment in each functional subdomain at 12 months, which persisted to varying degrees over 120 months, as did significant fatigue and insomnia. Role, emotional, and social subdomains, as well as fatigue, were significantly associated with global HRQoL at the first 12 month interval. Overall, there was no significant correlation between time from surgery and global HRQoL or the subdomain functional or symptom sections of the QLQ-C30. LGG patients report considerable, sustained impairments in HRQoL after surgery, particularly in cognitive, emotional, and social function, as well as suffering significant fatigue and insomnia. These are strongly associated with global HRQoL and thus can be considered determinants of global HRQoL that with intervention, may improve HRQoL for our LGG patients. This is the largest prospective longitudinal study of HRQoL in postoperative LGG patients yet reported and is ongoing. It identifies several determinants of impaired HRQoL with available management options and interventions that have the potential to significantly improve HRQoL in these patients.
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Affiliation(s)
- Ken X Teng
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia; Department of Surgery, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Benjamin Price
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia; Department of Surgery, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Shubhum Joshi
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia; Department of Surgery, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Lobna Alukaidey
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia; Department of Surgery, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Ameer Shehab
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia; Department of Surgery, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Kristy Mansour
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia; Department of Surgery, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Gurvinder S Toor
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia; Department of Surgery, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Rosemary Angliss
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia; Department of Surgery, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Katharine Drummond
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia; The Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, VIC, 3050, Australia; Department of Surgery, University of Melbourne, Parkville, VIC, 3052, Australia.
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13
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Chartrand B, Al-Tamami N, Carriere JS, Moumdjian R, Saliba I, Saliba J. Outcome Measures and Quality of Life in Vestibular Schwannomas. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00342-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Mastronardi L, Campione A, Boccacci F, Scavo CG, Carpineta E, Cacciotti G, Roperto R, Sufianov A, Zomorodi A. Koos grade IV vestibular schwannomas: considerations on a consecutive series of 60 cases-searching for the balance between preservation of function and maximal tumor removal. Neurosurg Rev 2021; 44:3349-3358. [PMID: 33598820 DOI: 10.1007/s10143-021-01501-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/24/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
Koos grade IV vestibular schwannomas (VS) (maximum diameter > 3 cm) compress the brainstem and displace the fourth ventricle. Microsurgical resection with attention to the right balance between preservation of function and maximal tumor removal is the treatment of choice. Our series consists of 60 consecutive patients with unilateral VS, operated on from December 2010 to July 2019. All patients underwent microsurgical removal via the retrosigmoid approach. The adherence of VS' capsule to the surrounding nervous structures and the excessive tendency of tumor to bleed during debulking, because of a redundant vascular architecture, was evaluated by reviewing video records. Microsurgical removal of tumor was classified as total (T), near-total (NT: residue < 5%), subtotal (ST: residue 5-10%), or partial (P: residue > 10%). Maximal mean tumor diameter was 3,97 cm (SD ± 1,13; range 3,1-5,8 cm). Preoperative severely impaired hearing or deafness (AAO-HNS classes C-D) was present in 52 cases (86,7%). Total or NT resection was accomplished in 46 cases (76,7%), 65,8% in cases with, and 95,4% without tight adhesion of capsule to nervous structures (p < 0,001). Endoscopic-assisted microsurgical removal of VS in the IAC was performed in 23 patients: in these cases, a T resection was obtained in 78,3% versus 45,9% of microsurgery only (p < 0,001). The capsule of VS was tightly adherent to nervous structures in 63,3% of patients, whereas hypervascular high-bleeding tumors represented 56,7%. Hearing preservation was possible in 2 out of 8 patients with preoperative class B hearing. At last follow-up, 34 (56,7%) patients had a normal postoperative FN outcome (HBI), 9 (15,0%) were HBII, 8 (13,3%) HBIII, and 9 (15,0%) HBIV. The total NT resection of solid and low-bleeding VS, without tight capsule adhesion, was associated with better FN outcome. Mortality was zero; permanent complications were observed in 2 cases (diplopia, hydrocephalus), transient in 9. Microsurgery of Koos grade IV VS seems to be associated with more than acceptable functional results, with high rate of T and NT removal of tumor. Long-term FN results seem to be worse in patients with cystic Koos grade IV VS, in cases with tight capsule adherences to nervous structures and in high-bleeding tumors.
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Affiliation(s)
- Luciano Mastronardi
- Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy. .,Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University under Ministry of Health, Moscow, Russian Federation.
| | - Alberto Campione
- Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy
| | - Fabio Boccacci
- Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy
| | | | - Ettore Carpineta
- Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy
| | | | - Raffaelino Roperto
- Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy
| | - Albert Sufianov
- Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University under Ministry of Health, Moscow, Russian Federation.,Federal Centre of Neurosurgery, Tyumen, Russian Federation
| | - Ali Zomorodi
- Vascular Neurosurgery Medical Director, Co-Director of Skull Base Surgery Center, Duke University Medical Center, Durham, NC, USA
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15
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Bălaşa AF, Hurghiş CI, Tămaş F, Şerban GM, Kövecsi A, Florian IA, Chinezu R. Gross-total versus near-total resection of large vestibular schwannomas. An institutional experience. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:485-492. [PMID: 33544800 PMCID: PMC7864290 DOI: 10.47162/rjme.61.2.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We will report our experience of the surgical treatment of large vestibular schwannomas (VSs). PATIENTS, MATERIALS AND METHODS We conducted a retrospective study of patients operated on for Koos grade IV VS between 2007 and 2015 at the Department of Neurosurgery, Emergency County Hospital, Târgu Mureş, Romania. We studied the general preoperatory clinical data, the preoperative and postoperative facial nerve status, preoperative hearing on the affected side, and any postoperative complications, including death. RESULTS Sixty-six cases were included in our study. The mean age was 52.95 years and 66.7% (n=44) of the sample were female. All patients had suffered from tinnitus and this had been followed by loss of serviceable hearing on the affected side in 89.4% (n=59) of cases. Preoperative facial palsy was found in 53% (n=35) of patients. The mean tumor size was 40.35 mm. Gross-total resection (GTR) was achieved in 24 (36.36%) cases, while near-total resection (NTR) was obtained in 42 (63.64%) cases. New-onset facial palsy or degradation of the preoperative facial deficit occurred in 12 (18.18%) cases, most of whom were patients with a GTR (n=9, 37.5%). This was statistically significant. There were no significant postoperative differences between the GTR and NTR groups. There was one death in the GTR group. CONCLUSIONS We conclude that near-total tumor removal provides good surgical results and better postsurgical quality of life for patients when compared to gross-total tumor resection. Therefore, this should be the end goal of the resection of large VSs.
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Affiliation(s)
- Adrian Florian Bălaşa
- Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Romania;
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16
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Starnoni D, Giammattei L, Cossu G, Link MJ, Roche PH, Chacko AG, Ohata K, Samii M, Suri A, Bruneau M, Cornelius JF, Cavallo L, Meling TR, Froelich S, Tatagiba M, Sufianov A, Paraskevopoulos D, Zazpe I, Berhouma M, Jouanneau E, Verheul JB, Tuleasca C, George M, Levivier M, Messerer M, Daniel RT. Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section. Acta Neurochir (Wien) 2020; 162:2595-2617. [PMID: 32728903 PMCID: PMC7550309 DOI: 10.1007/s00701-020-04491-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective. MATERIAL AND METHODS A systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. A subgroup analysis screening all surgical series published within the last 20 years (January 2000 to March 2020) was performed. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using meta-analysis models. This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management. RESULTS Tumor classification grades should be systematically used in the perioperative management of patients, with large vestibular schwannomas (VS) defined as > 30 mm in the largest extrameatal diameter. Grading scales for pre- and postoperative hearing (AAO-HNS or GR) and facial nerve function (HB) are to be used for reporting functional outcome. There is a lack of consensus to support the superiority of any surgical strategy with respect to extent of resection and use of adjuvant radiosurgery. Intraoperative neuromonitoring needs to be routinely used to preserve neural function. Recommendations for postoperative clinico-radiological evaluations have been elucidated based on the surgical strategy employed. CONCLUSION The main goal of management of large vestibular schwannomas should focus on maintaining/improving quality of life (QoL), making every attempt at facial/cochlear nerve functional preservation while ensuring optimal oncological control, thereby allowing to meet patient expectations. Despite the fact that this analysis yielded only a few Class B evidences and mostly expert opinions, it will guide practitioners to manage these patients and form the basis for future clinical trials.
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Affiliation(s)
- Daniele Starnoni
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | | | - Giulia Cossu
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Michael J Link
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Pierre-Hugues Roche
- Department of Neurosurgery, CHU North Hospital, Aix-Marseille University, Marseille, France
| | - Ari G Chacko
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Majid Samii
- Neurosurgery, International Neuroscience Institute, Hannover, Germany
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Michael Bruneau
- Department of Neurosurgery, Erasme Hospital, Brussels, Belgium
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Luigi Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Naples, NA, Italy
| | - Torstein R Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | | | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Albert Sufianov
- Federal Centre of Neurosurgery, Tyumen, Russian Federation; Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University under Ministry of Health, Tyumen, Russian Federation
| | - Dimitrios Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - Idoya Zazpe
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, Spain
- Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Moncef Berhouma
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - Jeroen B Verheul
- Department of Neurosurgery and Gamma knife Centre, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Constantin Tuleasca
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5) Ecole Polytechnique Fédérale de Lausanne (EPFL) Lausanne, Lausanne, Switzerland
| | - Mercy George
- ENT Service, Centre Hospitalier Universitaire Vaudois (CHUV); Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marc Levivier
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
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Electrophysiological predictors of hearing deterioration based on AEP monitoring during petroclival meningioma resection. Neurosurg Rev 2020; 44:1601-1609. [PMID: 32671694 DOI: 10.1007/s10143-020-01350-y] [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: 04/08/2020] [Revised: 06/09/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
The objective of this study was to calculate the risk of postsurgical hearing deterioration as a function of changes in the amplitude and latency of the most stable components (waves III and V) of the auditory evoked potential (AEP) during petroclival meningioma resection surgery. We retrospectively analyzed intraoperative AEP monitoring results and pre- and postsurgical hearing status in 40 consecutive patients who were surgically treated for petroclival meningiomas. Statistical analyses were conducted to identify the most sensitive and specific way to predict hearing dysfunction after surgery. Patients' mean age was 59 ± 10 years, and 31 (77.5%) were women. Twelve (30%) patients presented with clinically detectable hearing impairment preoperatively. At the first postoperative assessment, four of those 12 patients reported subjective improvement, and eight reported hearing deterioration. Of those eight, four remained stable and four recovered hearing by the last assessment. Wave III latency reached its highest specificity (100%) and sensitivity (71.43%) at x = 143%. Wave V latency, on the other hand, reached its highest sensitivity (71%) and specificity (93%) at x = 124%. Finally, wave V amplitude reached its highest sensitivity (100%) and specificity (79%) at x = 74%. Intraoperative alterations of wave III latency and wave V amplitude seem to be highly sensitive and specific at predicting the risk of auditory dysfunction in patients undergoing petroclival meningioma resection and should be used to determine maximum resection with preservation of function.
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18
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Saad M, Shata H, Younis M, Taha ANM. Microsurgical Management of Vestibular Schwannomas with Brainstem Compression: Surgical Challenges and Outcome. ACTA ACUST UNITED AC 2020. [DOI: 10.4236/ojmn.2020.101013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Abstract
Technological breakthroughs along with modern application of awake craniotomy and new neuroanesthesia protocols have led to a progressive development in outpatient brain tumor surgery and improved surgical outcomes. As a result, outpatient neurosurgery has become a standard of care at the authors' center due to its clinical benefits and impact on patient recovery and overall satisfaction. On the other hand, the financial savings derived from its application is also another favorable factor exerting influence on patients, health care systems, and society. Although validated several years ago and with recent data supporting its application, outpatient brain tumor surgery has not gained the traction that it deserves, based on scientific skepticism and perceived potential for medicolegal issues. The goal of this review, based on the available literature and the senior author's experience in outpatient brain tumor surgery, was to evaluate the most important aspects regarding indications, clinical outcomes, economic burden, and patient perceptions.
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Self-Evaluated Quality of Life and Functional Outcomes After Microsurgery, Stereotactic Radiation or Observation-Only for Vestibular Schwannoma of the Adult Patient: A Systematic Review. Otol Neurotol 2019; 39:232-241. [PMID: 29315189 DOI: 10.1097/mao.0000000000001664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the impact of different management options on health-related quality of life (HRQoL) in vestibular schwannoma patients. DATA SOURCES A systematic search of the Cochrane Database, Database of Abstracts of Reviews of Effectiveness, and the Ovid Medline & EMBASE was performed. English and German language studies published between 1980 and 2015 were considered. STUDY SELECTION This is a systematic review of HRQoL of patients managed for vestibular schwannoma. Studies in which HRQoL after one management option were evaluated or compared with other managements or with control populations using validated or reliable questionnaires, were included. DATA EXTRACTION The included studies were independently evaluated by two reviewers. The quality of studies was assessed and graded as per Oxford Centre of Evidence Based Medicine System. RESULTS Ten prospective and 29 retrospective studies were identified: microsurgery initially exerted a negative effect on HRQoL but this tended to improve with follow up. Radiotherapy had a less negative effect but with minimal change over follow up. A significant limitation was that studies did not present results stratified by tumor size. Many patients will need active treatment despite the potential for negative effects on their QoL. The concept of a minimal clinically important difference has been introduced into this field and was compared with five studies. CONCLUSION A number of prospective studies are available but none yet with a disease-specific questionnaire. Heterogeneity and the methodological weaknesses of the included studies constitute the principle limitation of this review. The introduction of the minimal clinically important difference should improve the relevance of studies and allow a sensitive comparison of treatments.
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21
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Protein profiling of cerebrospinal fluid from patients undergoing vestibular schwannoma surgery and clinical significance. Biomed Pharmacother 2019; 116:108985. [PMID: 31146115 DOI: 10.1016/j.biopha.2019.108985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/24/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022] Open
Abstract
Vestibular schwannoma (VS) is a common disease in the region of the cerebellopontine angle in the posterior cranial fossa. Large VS and its surgical management usually lead to severe cranial nerve dysfunction and affect the patient's quality of life. We aimed to find some possible progression markers of VS. Here, we sought to characterize the cerebrospinal fluid (CSF) proteome of patients with different VS grades and recurrence to identify biomarkers predictive of VS growth or recurrence. CSF was collected intraoperatively prior to removal of untreated VS, including grade I-V and recurrence. Isobaric tags for relative and absolute quantitation-based proteomic analysis of CSF from 43 VS patients and 3 control patients was used to identify candidate proteins. Ninety-three overlapping proteins were found to display differential expression in grade I, II, III, IV, and V VS patients compared with the control group. Nine proteins were chosen for validation with enzyme-linked immunosorbent assay. VS was distinguished from control patients based on the expression patterns of six proteins (ATP-binding cassette subfamily A member 3 [ABCA3], secretogranin-1 [SCG1], Krueppel-like factor 11 [KLF11], voltage-dependent calcium channel subunit alpha-2/delta-1 [CA2D1], brain acid soluble protein 1 [BASP1], and peroxiredoxin-2 [PRDX2]. ABCA3 and KLF11 were positively correlated with the size of early-phase of VS, while BASP1 and PRDX2 showed a negative correlation. ABCA3, CA2D1, and KLF11 were upregulated, while BASP1 and PRDX2 were downregulated in the CSF from VS recurrence. But SCG1 was increased only at early-phase. These data suggest that increased ABCA3 and KLF11 and decreased BASP1 and PRDX2 in CSF are associated with VS growth at the early phase or recurrence.
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22
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Scholte M, Hentschel MA, Hannink G, Kunst HPM, Steens SC, Rovers MM, Grutters JPC. In search of the most cost-effective monitoring strategy for vestibular schwannoma: A decision analytical modelling study. Clin Otolaryngol 2019; 44:525-533. [PMID: 30864276 PMCID: PMC6850121 DOI: 10.1111/coa.13326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/19/2019] [Accepted: 03/08/2019] [Indexed: 01/22/2023]
Abstract
Objectives To assess the cost‐effectiveness of frequently used monitoring strategies for vestibular schwannoma (VS). Design A state transition model was developed to compare six monitoring strategies for patients with VS: lifelong annual monitoring; annual monitoring for the first 10 years after diagnosis; scanning at 1‐5, 7, 9, 12, 15 years after diagnosis and subsequently every 5 years; a personalised monitoring strategy for small and large tumours; scanning at 1, 2 and 5 years after diagnosis and no monitoring. Input data were derived from literature and expert opinion. Quality‐adjusted life years (QALYs) and healthcare costs of each strategy were modelled over lifetime. Net monetary benefits (NMBs) were calculated to determine which strategy provided most value for money. Sensitivity analyses were performed to address uncertainty. Results Omitting monitoring is least effective with 18.23 (95% CI 16.84‐19.37) QALYs per patient, and lifelong annual monitoring is most effective with 18.66 (95% CI 17.42‐19.65) QALYs. Corresponding costs were €6526 (95% CI 5923‐7058) and €9429 (95% CI 9197‐9643) per patient, respectively. Lifelong annual monitoring provided the best value with a NMB of €363 765 (339 040‐383 697), but the overall probability of being most cost‐effective compared to the other strategies was still only 23%. Sensitivity analysis shows that there is large uncertainty in the effectiveness of all strategies, with largely overlapping 95% confidence intervals for all strategies. Conclusions Due to the largely overlapping 95% confidence intervals of all monitoring strategies for VS, it is unclear which monitoring strategy provides most value for money at this moment.
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Affiliation(s)
- Mirre Scholte
- Department of Operating Rooms, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mayke A Hentschel
- Department of Otolaryngology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henricus P M Kunst
- Department of Otolaryngology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Otolaryngology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stefan C Steens
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department for Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janneke P C Grutters
- Department of Operating Rooms, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department for Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Long-term Quality of Life Following Vestibular Schwannoma Excision Via the Translabyrinthine Approach. Otol Neurotol 2018; 38:1165-1173. [PMID: 28806327 DOI: 10.1097/mao.0000000000001507] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess postoperative quality of life (QOL) and other patient-reported outcomes following surgery for vestibular schwannoma. STUDY DESIGN Cross-sectional retrospective case review using postal questionnaires. SETTING Tertiary referral center. PATIENTS Five hundred consecutive patients undergoing surgery for vestibular schwannoma. INTERVENTION(S) Patients undergoing surgery via the translabyrinthine approach (excluding neurofibromatosis type 2) under the senior author, with a minimum of 5 years follow-up, were included. MAIN OUTCOME MEASURE(S) QOL was assessed using the Short Form 36 (SF-36) questionnaire and a disease-specific survey to assess patients' subjective outcomes. RESULTS The SF-36 scores in this group were significantly lower than the general UK population, though 24% of respondents reported a subjective improvement in overall QOL. Tumors larger than 4 cm were related to a reduced SF-36 total mental component score (p = 0.037). Increased age at time of surgery correlated with a reduced physical component of QOL (correlation coefficient = -0.26) and an improved mental component (correlation coefficient = 0.26). Subjective reports of postoperative symptoms and return to work, driving and social activities were similar to other published studies. 35% of patients reported vivid dreams or nightmares following surgery; the first reported incidence of this phenomenon in a large group of vestibular schwannoma patients. CONCLUSIONS Generic measures of QOL in patients following translabyrinthine surgery for vestibular schwannoma do not always match subjective reports, reflecting the complexity of QOL assessment and the range of outcomes in this group. Increased time since surgery appears to be associated with an improvement in mental health.
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Kronzer VL, Jerry MR, Ben Abdallah A, Wildes TS, McKinnon SL, Sharma A, Avidan MS. Changes in quality of life after elective surgery: an observational study comparing two measures. Qual Life Res 2017; 26:2093-2102. [PMID: 28357679 PMCID: PMC6309881 DOI: 10.1007/s11136-017-1560-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Our main objective was to compare the change in a validated quality of life measure to a global assessment measure. The secondary objectives were to estimate the minimum clinically important difference (MCID) and to describe the change in quality of life by surgical specialty. METHODS This prospective cohort study included 7902 adult patients undergoing elective surgery. Changes in the Veterans RAND 12-Item Health Survey (VR-12), composed of a physical component summary (PCS) and a mental component summary (MCS), were calculated using preoperative and postoperative questionnaires. The latter also contained a global assessment question for quality of life. We compared PCS and MCS to the global assessment using descriptive statistics and weighted kappa. MCID was calculated using an anchor-based approach. Analyses were pre-specified and registered (NCT02771964). RESULTS By the change in VR-12 scores, an equal proportion of patients experienced improvement and deterioration in quality of life (28% for PCS, 25% for MCS). In contrast, by the global assessment measure, 61% reported improvement, while only 10% reported deterioration. Agreement with the global assessment was slight for both PCS (kappa = 0.20, 57% matched) and MCS (kappa = 0.10, 54% matched). The MCID for the overall VR-12 score was approximately 2.5 points. Patients undergoing orthopedic surgery showed the most improvement in quality of life measures, while patients undergoing gastrointestinal/hepatobiliary or urologic surgery showed the most deterioration. CONCLUSIONS Subjective global quality of life report does not agree well with a validated quality of life instrument, perhaps due to patient over-optimism.
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Affiliation(s)
- Vanessa L Kronzer
- Department of Anesthesia, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO, 63110, USA
| | - Michelle R Jerry
- Department of Biostatistics, University of Michigan, 534 Canton Street, Canton, MI, 48188, USA
| | - Arbi Ben Abdallah
- Department of Anesthesia, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO, 63110, USA
| | - Troy S Wildes
- Department of Anesthesia, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO, 63110, USA
| | - Sherry L McKinnon
- Department of Anesthesia, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO, 63110, USA
| | - Anshuman Sharma
- Department of Anesthesia, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO, 63110, USA
| | - Michael S Avidan
- Department of Anesthesia, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO, 63110, USA.
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25
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Grahnke K, Garst JR, Martin B, Leonetti JP, Anderson DE. Prognostic Indices for Predicting Facial Nerve Outcome following the Resection of Large Acoustic Neuromas. J Neurol Surg B Skull Base 2017; 78:454-460. [PMID: 29134163 DOI: 10.1055/s-0037-1604077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022] Open
Abstract
This study analyzes the simple ratio of anterior-to-posterior extension of large (>2.5 cm) acoustic neuromas relative to the internal auditory canal (ICA; anterior-posterior [A/P] index) as a tool for predicting risk of facial nerve (FN) injury. In total, 105 patients who underwent microsurgical resection for large acoustic neuromas were analyzed retrospectively. House-Brackmann (HB) scores were assessed immediately postoperatively, at 1 month, and at 1 year. Lateral-medial, inferior-superior, A/P, and maximum diameters were measured from preoperative magnetic resonance images. These measurements and the A/P index were analyzed using univariable and multivariable statistical models to assess relationship to FN outcomes. The retrosigmoid, translabyrinthine, and combined approaches were used, and the extent of resection was evaluated. For every 1 standard deviation increase in the A/P index, a patient was 3.87 times more likely have a higher postoperative HB score ( p < 0.0001). Accordingly, for every 1-mm increase anterior to the IAC, a patient was 16% more likely have a higher postoperative HB score ( p < 0.001). After controlling for tumor size, a patient was still 3.82 times more likely have a higher postoperative HB score for every 1 standard deviation increase in the A/P index ( p < 0.0001). While larger tumor size trended toward worse postoperative HB scores, it was not statistically significant. Our prognostic index may be useful to assess the risk of FN injury preoperatively for large acoustic neuromas, while also providing information about the tumor-nerve relationship.
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Affiliation(s)
- Kurt Grahnke
- Department of Neurological Surgery and Otolaryngology, Head and Neck Surgery, Loyola University Chicago, Maywood, Illinois, United States
| | - Jonathan R Garst
- Department of Neurological Surgery and Otolaryngology, Head and Neck Surgery, Loyola University Chicago, Maywood, Illinois, United States
| | - Brendan Martin
- Department of Neurological Surgery and Otolaryngology, Head and Neck Surgery, Loyola University Chicago, Maywood, Illinois, United States
| | - John P Leonetti
- Department of Neurological Surgery and Otolaryngology, Head and Neck Surgery, Loyola University Chicago, Maywood, Illinois, United States
| | - Douglas E Anderson
- Department of Neurological Surgery and Otolaryngology, Head and Neck Surgery, Loyola University Chicago, Maywood, Illinois, United States
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Abstract
BACKGROUND Vestibular schwannoma (VS) is a disease which might affect health-related quality of life (HR-QOL) in a negative manner. For many years, only generic quality of life instruments such as SF-36 were available to measure HR-QOL. However, some years ago, the Penn Acoustic Neuroma Quality Of Life (PANQOL) tool, a disease-specific instrument, was developed and validated. It is expected that the application of this instrument will be able to better assess relevant aspects of the HR-QOL of VS patients in the future. A validated German version of the instrument does not exist yet. The disease-specific symptoms most frequently named by patients are headache and dizziness. RESULTS AND DISCUSSION The available literature shows that the therapeutic approaches affect HR-QOL differently. In particular, radiation therapy of small and medium-sized tumors has no pronounced negative effects on HR-QOL. However, restrictions after surgery become similar to those after radiotherapy over the course of several years. For large VS with a diameter >3 cm, no guiding data on this aspect are currently available. To clarify the outstanding issues, future prospective studies with long-term follow-up of 10 years and more are desirable.
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Affiliation(s)
- I Baumann
- Hals-Nasen-Ohren-Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - P K Plinkert
- Hals-Nasen-Ohren-Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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27
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Abstract
Technological advances in neurosurgery, aided by improvements in anesthesia have resulted in surgery that is faster, simpler and safer with excellent perioperative recovery. As a result of improved outcomes, several centers are performing certain neurosurgical procedures on an outpatient basis; where patients arrive at the hospital the morning of their procedure and leave the hospital the same evening, thus avoiding an overnight stay in the hospital. Apart from the medical benefits of the outpatient procedure, its impact on patient satisfaction is substantial. The economic benefits are extremely favorable for the patient, physician, as well as the hospital. However, due to skepticism surrounding medico-legal aspects, and how radical the concept at first sounds, these procedures have not gained widespread popularity. We provide an overview of outpatient neurosurgery discussing results, outcomes related to patients' quality of life, and impact on the economic burden on currently burgeoning health care costs.
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Affiliation(s)
- Mazda K Turel
- a Division of Neurosurgery , Toronto Western Hospital , Toronto , Ontario , Canada
| | - Mark Bernstein
- b Department of Surgery , University of Toronto Neurosurgeon, Toronto Western Hospital, University Health Network , Toronto , Ontario , Canada
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28
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van Leeuwen BM, Herruer JM, Putter H, van der Mey AGL, Kaptein AA. The art of perception: Patients drawing their vestibular schwannoma. Laryngoscope 2015; 125:2660-7. [DOI: 10.1002/lary.25386] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Bibian M. van Leeuwen
- Department of Otorhinolaryngology-Head and Neck Surgery; Leiden University Medical Center; Leiden the Netherlands
| | - Jasmijn M. Herruer
- Department of Otorhinolaryngology-Head and Neck Surgery; Leiden University Medical Center; Leiden the Netherlands
| | - Hein Putter
- Department of Medical Statistics; Leiden University Medical Center; Leiden the Netherlands
| | - Andel G. L. van der Mey
- Department of Otorhinolaryngology-Head and Neck Surgery; Leiden University Medical Center; Leiden the Netherlands
| | - Adrian A. Kaptein
- Department of Medical Psychology; Leiden University Medical Center; Leiden the Netherlands
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29
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Carlson ML, Tveiten ØV, Yost KJ, Lohse CM, Lund-Johansen M, Link MJ. The Minimal Clinically Important Difference in Vestibular Schwannoma Quality-of-Life Assessment. Otolaryngol Head Neck Surg 2015; 153:202-8. [DOI: 10.1177/0194599815585508] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/15/2015] [Indexed: 01/23/2023]
Abstract
Objective Several studies have demonstrated small but statistically significant differences in quality-of-life (QOL) scores among vestibular schwannoma (VS) treatment modalities. However, does a several-point difference on a 100-point scale really matter? The minimal clinically important difference (MCID)—defined as the smallest difference in scores that patients perceive as important and that could lead to a change in management—was developed to answer this important question. While the MCID has been determined for QOL measures used in other diseases, it remains undefined in the VS literature. Study Design Distribution- and anchor-based techniques were utilized to define the MCID for the Penn Acoustic Neuroma Quality of Life (PANQOL) and 36-Item Short Form Health Survey (SF-36). Setting Two academic referral centers. Patients Patients with VS (N = 538). Intervention Cross-sectional postal survey. Main Outcome Measures MCID for PANQOL domains and total score and SF-36 Physical and Mental Health Component Summary scores. Results The MCID (median, interquartile range) for the PANQOL total score was 11 points (10-12); the MCIDs for individual domains were as follows: hearing, 6 (5-8); balance, 16 (14-19); facial, 10 (no interquartile range); pain, 11 (10-13); energy, 13 (10-17); anxiety, 11 (5-22); and general, 15 (11-19). The MCID was 7 points (6-11) for the SF-36 Mental Health Component Summary score and 8 points (6-10) for the Physical Health Component Summary score. Conclusions The MCIDs determined in the current study generally exceed differences reported in previous prospective studies, in which conclusions about QOL benefit (or harm) among VS treatment modalities were based on statistical significance alone. Moving forward, these MCIDs should be considered when interpreting results of VS QOL studies.
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Affiliation(s)
- Matthew L. Carlson
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | | | - Kathleen J. Yost
- Department of Epidemiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Christine M. Lohse
- Department of Health Sciences Research, Biomedical Statistics and Informatics, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Morten Lund-Johansen
- Department of Neurosurgery, Bergen University Hospital, Bergen, Norway
- Institute of Surgical Sciences, University of Bergen, Bergen, Norway
| | - Michael J. Link
- Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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