1
|
Pruijn IMJ, Parmaksiz M, Verheul JB, Mulder JJS, Kievit W, Kunst HPM. Health-Related Quality of Life in Patients With a Stable or Growing Vestibular Schwannoma Managed by Wait and Scan or Stereotactic Radiosurgery. Otolaryngol Head Neck Surg 2024; 171:823-832. [PMID: 38769852 DOI: 10.1002/ohn.814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/17/2024] [Accepted: 04/06/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To assess the effect of wait and scan (W&S) and stereotactic radiosurgery (SRS) on health-related quality of life (HRQoL) over time in patients with a stable vestibular schwannoma (VS) and growing VS. STUDY DESIGN Longitudinal, multicenter, observational study. SETTING Tertiary expert center for VS (Radboudumc Nijmegen) and Gamma-Knife center ETZ Hospital Tilburg. METHODS Changes in HRQoL, measured with the Penn Acoustic Neuroma Quality-of-Life (PANQOL), and the physical and mental component summary scores (PCS and MCS, respectively) derived from the 36-Item Short Form Health Survey (SF-36), were compared among patients managed by W&S and SRS between 2017 and 2022. Second, HRQoL over time in patients with a growing VS was compared between W&S and SRS. RESULTS Differences in PANQOL total and subdomain scores, PCS and MCS scores over time in the W&S (n = 73) and SRS (n = 170) groups were nonsignificant and on average did not exceed the minimal clinically important differences (mean difference of -2.56 [PANQOL total], 1.22 [PCS], and -1.76 [MCS]; all P > .05). In growing VS, comparison of W&S (n = 29) and SRS (n = 154) also revealed no significant difference (mean difference of 1.19 (PANQOL total), 1.83 (PCS) and -0.12 (MCS); all P > .05). CONCLUSION Differences in HRQoL in patients with VS are minor and not significantly different or clinically relevant between patients managed with W&S or SRS. Similarly, patients with a growing VS managed with W&S or SRS exhibit no significant or clinical relevant difference in HRQoL during follow-up. This can aid clinicians in the counseling of patients regarding HRQoL when deciding on a management strategy after diagnosis or documented growth.
Collapse
Affiliation(s)
- Ineke M J Pruijn
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, The Netherlands
| | - Merve Parmaksiz
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen B Verheul
- Department of Neurosurgery, Gamma Knife Center, ETZ Hospital, Tilburg, The Netherlands
| | - Jef J S Mulder
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, The Netherlands
| | - Wietske Kievit
- Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, 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
| |
Collapse
|
2
|
Rutenkröger M, Wandke S, Gempt J, Dührsen L, Scheer M, Strauss C, Führes H. German translation and cross-cultural adaptation of the Vestibular Schwannoma Quality of Life Index (VSQOL). J Patient Rep Outcomes 2024; 8:95. [PMID: 39136861 PMCID: PMC11322465 DOI: 10.1186/s41687-024-00778-w] [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: 04/19/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Vestibular schwannomas (VSs) are benign tumors of the vestibulocochlear nerve that often cause significant neurological and functional impairment. Patient-reported outcomes, including quality of life (QoL), are essential for understanding the overall impact of VS and its treatment. This study aimed to translate and culturally adapt the Vestibular Schwannoma Quality of Life (VSQOL) Index into German to expand its relevance to German-speaking populations. METHODS We used a qualitative approach including translation and cognitive interviews with 10 patients who underwent VS surgery. The translation process followed the TRAPD protocol to ensure linguistic and conceptual accuracy. Cognitive interviews assessed the comprehensibility and relevance of the translated questionnaire. RESULTS The translation showed remarkable consistency between translators, with minor discrepancies resolved by consensus. Cognitive interviews provided valuable insights that led to refinements in item wording. Participants emphasized the importance of an additional item on physician referrals, reflecting differences in health care systems between the United States and Germany. CONCLUSIONS The German VSQOL provides a comprehensive tool for assessing QoL in patients with VS that integrates patient-centered dimensions. A Validation study is underway to establish its reliability and validity.
Collapse
Affiliation(s)
- Mareike Rutenkröger
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Svenja Wandke
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Gempt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lasse Dührsen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Scheer
- Department of Neurosurgery, University Hospital Halle, Halle (Saale), Germany
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle, Halle (Saale), Germany
| | - Hannah Führes
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
3
|
Jiramongkolchai P, Vacaru A, La Monte O, Lee J, Schwartz MS, Friedman RA. Quality of Life for Patients with Sporadic Small Vestibular Schwannomas Following Middle Fossa Craniotomy. Otol Neurotol 2024; 45:684-689. [PMID: 38769097 DOI: 10.1097/mao.0000000000004202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To evaluate quality-of-life outcomes for patients with vestibular schwannomas (VS) undergoing a middle cranial fossa (MCF) approach. STUDY DESIGN Prospective study from 2018 to 2023. SETTING Tertiary academic institution. PATIENTS Adults with sporadic VS. INTERVENTIONS MCF. MAIN OUTCOME MEASURES The primary outcome measure was the change in preoperative and 1-year postoperative Penn Acoustic Neuroma Quality-of-life (PANQOL) scores. Secondary outcome measures included hearing preservation and facial nerve function. RESULTS Of the 164 patients who underwent MCF for sporadic VS, 78 patients elected to voluntarily complete preoperative PANQOL assessments prior to surgery. Seventy-one (91%) of those 78 patients completed postoperative PANQOL surveys. Fifty (70%) of the respondents were female and the median age was 48 years (range, 27-71 years). Overall, at 1-year postsurgery, a minimal clinically important difference (MCID) was obtained in the hearing (mean difference, 10.5; 95% confidence interval [CI], 4.3-16.7) and anxiety (mean difference, 18.8; 95% CI, 11.7-25.9) domains. For patients with hearing preservation (n = 48, 68%), MCIDs were reached in the hearing (mean difference, 13.4; 95% CI, 6.3-20.6), anxiety (mean difference, 20.8; 95% CI, 11.8-29.9), energy (mean difference, 13.7; 95% CI, 3.6-23.8), pain (mean difference, 13.7; 95% CI, 3.6-23.8) domains, and overall PANQOL scores (mean difference, 12.7; 95% CI, 7.1-18.3). Postoperatively, 64 (90%) patients maintained a House-Brackmann I. CONCLUSIONS To our knowledge, this is the largest study examining disease-specific QOL for VS patients undergoing MCF. Based on our institution's experience, MCF approach for small VS is associated with clinically meaningful improvements in QOL, hearing preservation, and excellent facial nerve outcomes.
Collapse
Affiliation(s)
| | | | | | - Joshua Lee
- Department of Otolaryngology-Head and Neck Surgery
| | - Marc S Schwartz
- Department of Neurosurgical Surgery, University of California, San Diego, La Jolla, California
| | | |
Collapse
|
4
|
Riedy LN, Shanker RM, Sloane DC, Heiferman DM, Rezaii EG, Finucane SE, Veras P, Leonetti JP, Anderson DE. Long-term quality of life outcomes in patients undergoing microsurgical resection of vestibular schwannoma. World Neurosurg X 2024; 22:100294. [PMID: 38450247 PMCID: PMC10914591 DOI: 10.1016/j.wnsx.2024.100294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
Background While previous studies have assessed patient reported quality of life (QOL) of various vestibular schwannoma (VS) treatment modalities, few studies have assessed QOL as related to the amount of residual tumor and need for retreatment in a large series of patients. Objective: To assess patient reported QOL outcomes following VS resection with a focus on extent of resection and retreatment. Methods A retrospective chart review was performed using single-center institutional data of adult patients who underwent VS resection by the senior authors between 1989-2018 at Loyola University Medical Center. The Penn Acoustic Neuroma Quality of Life (PANQOL) survey was sent to all patients via postal mail. Results Fifty-five percent of 367 total patients were female with a mean age of 61.6 years (SD 12.63). The mean period between surgery and PANQOL response was 11.4 years (IQR: 4.74-7.37). The median tumor size was 2 cm (IQR: 1.5-2.8). The mean total PANQOL score was 70 (SD 19). Patients who required retreatment reported lower overall scores (μdiff = -10.11, 95% CI: -19.48 to -0.74; p = 0.03) and face domain scores (μdiff = -20.34, 95% CI: -29.78 to -10.91; p < .001). There was no association between extent of resection and PANQOL scores in any domain. Conclusion In an analysis of 367 patients who underwent microsurgical resection of VS, extent of resection did not affect PANQOL scores in contrast to previous reports in the literature, while the need for retreatment and facial function had a significant impact on patient-reported outcomes.
Collapse
Affiliation(s)
- Loren N. Riedy
- Committee Neurobiology, University of Chicago, Hyde Park, IL, USA
| | - Rachyl M. Shanker
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Dayna C. Sloane
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Daniel M. Heiferman
- Department of Neurological Surgery, Edward-Elmhurst Health, Naperville, IL, USA
| | - Elhaum G. Rezaii
- Department of Neurological Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sarah E. Finucane
- Department of Otolaryngology, Loyola University Medical Center, Maywood, IL, USA
| | - Perry Veras
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - John P. Leonetti
- Department of Otolaryngology, Loyola University Medical Center, Maywood, IL, USA
| | - Douglas E. Anderson
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, USA
| |
Collapse
|
5
|
Teo KAC, Agrwal R, Kei PL, Lim SL, Sun SI, Low SW. Spontaneous Regression of a Large Vestibular Schwannoma: Is Nonoperative Management Reasonable? Brain Tumor Res Treat 2024; 12:125-131. [PMID: 38742262 PMCID: PMC11096635 DOI: 10.14791/btrt.2024.0008] [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: 02/21/2024] [Accepted: 03/25/2024] [Indexed: 05/16/2024] Open
Abstract
Vestibular schwannomas (VSs) are the most common cerebellopontine tumors. The natural history of smaller-sized VSs (<30 mm) has been well-studied, leading to the recommendation of a "watch and wait" approach. However, large VSs (>30 mm) have not been extensively studied, mainly because of their rarity. As such, most patients are conventionally offered surgery which carries a significant risk of neurological morbidity. Here, we report a case of a giant VS (>40 mm) in a 30-year-old man who regressed spontaneously. He was lost to follow-up for 18 years and, upon re-presentation, the symptomatology drastically improved and repeat imaging demonstrated a marked reduction in tumor size. Referring to similar cases in other studies, we postulate that most large and giant VSs undergo a phase of growth and stasis, followed by regression due to shifts in the balance between tumorigenic and regressive factors. Taken together with emerging molecular data, further studies are required to better understand the history of large and giant VSs to shape more personalized treatment options. This potentially includes non-operative management as a tenable option.
Collapse
Affiliation(s)
| | - Rachit Agrwal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Pin Lin Kei
- Division of Neurosurgery, Ng Teng Fong General Hospital, Singapore
| | - Su Lone Lim
- Division of Neurosurgery, Ng Teng Fong General Hospital, Singapore
| | - Siyang Ira Sun
- Division of Neurosurgery, Ng Teng Fong General Hospital, Singapore
| | - Shiong Wen Low
- Division of Neurosurgery, Ng Teng Fong General Hospital, Singapore
| |
Collapse
|
6
|
Esser J, Walger M, Pollet N, Klußmann JP, Ruge M, Goldbrunner R, Lüers JC. [Vestibular Schwannoma: Factors in Therapy Decision-Making]. Laryngorhinootologie 2024; 103:176-186. [PMID: 38128578 DOI: 10.1055/a-2222-0878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The treatment of vestibular schwannomas (VS) has always posed a challenge for physicians. Three essential treatment principles are available: wait-and-scan, surgery, and stereotactic radiotherapy. In addition to the type of treatment, decisions must be made regarding the optimal timing of therapy, the combination of different treatment modalities, the potential surgical approach, and the type and intensity of radiation. Factors influencing the therapy decision include tumor location and size or stage, patient age, comorbidities, symptoms, postoperative hearing rehabilitation options, patient preferences, and, not least, the experience of the surgeons and the personnel and technical capabilities of the clinical site. This article begins with a brief overview of vestibular schwannomas, then outlines the fundamental interdisciplinary treatment options, and finally discusses the ENT (ear, nose, and throat)-relevant factors in the therapy decision.
Collapse
Affiliation(s)
- Julia Esser
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, DE 50937, Germany
| | - Martin Walger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, DE 50937, Germany
| | - Naomi Pollet
- Universität zu Köln, Medizinische Fakultät, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf und Hals-Chirurgie, Uniklinik Köln, Köln, DE 50937, Germany
| | - Jens Peter Klußmann
- Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, DE 50937, Germany
| | - Maximilian Ruge
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Universität zu Köln Medizinische Fakultät, Köln, Germany
| | - Roland Goldbrunner
- Universität zu Köln, Medizinische Fakultät, Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Universität zu Köln Medizinische Fakultät, Köln, Germany
| | - Jan Christoffer Lüers
- Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln Medizinische Fakultät, Köln, Germany
| |
Collapse
|
7
|
Carretta A, Voglis S, Röösli C, Mazzatenta D, Krayenbühl N, Huber A, Regli L, Serra C. Intraoperative ultrasonography in microsurgical resection of vestibular schwannomas via retrosigmoid approach: surgical technique and proof-of-concept illustrative case series. Acta Neurochir (Wien) 2024; 166:55. [PMID: 38289396 DOI: 10.1007/s00701-024-05962-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] [Received: 09/02/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE Intraoperative ultrasonography (ioUS) is an established tool for the real-time intraoperative orientation and resection control in intra-axial oncological neurosurgery. Conversely, reports about its implementation in the resection of vestibular schwannomas (VS) are scarce. The aim of this study is to describe the role of ioUS in microsurgical resection of VS. METHODS ioUS (Craniotomy Transducer N13C5, BK5000, B Freq 8 MHz, BK Medical, Burlington, MA, USA) is integrated into the surgical workflow according to a 4-step protocol (transdural preresection, intradural debulking control, intradural resection control, transdural postclosure). Illustrative cases of patients undergoing VS resection through a retrosigmoid approach with the use of ioUS are showed to illustrate advantages and pitfalls of the technique. RESULTS ioUS allows clear transdural identification of the VS and its relationships with surgically relevant structures of the posterior fossa and of the cerebellopontine cistern prior to dural opening. Intradural ioUS reliably estimates the extent of tumor debulking, thereby helping in the choice of the right moment to start peripheral preparation and in the optimization of the extent of resection in those cases where subtotal resection is the ultimate goal of surgery. Transdural postclosure ioUS accurately depicts surgical situs. CONCLUSION ioUS is a cost-effective, safe, and easy-to-use intraoperative adjunctive tool that can provide a significant assistance during VS surgery. It can potentially improve patient safety and reduce complication rates. Its efficacy on clinical outcomes, operative time, and complication rate should be validated in further studies.
Collapse
Affiliation(s)
- Alessandro Carretta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
| | - Stefanos Voglis
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christof Röösli
- Department of Otorhinolaryngology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Diego Mazzatenta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Via Altura 3, 40139, Bologna, Italy
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Niklaus Krayenbühl
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Division of Pediatric Neurosurgery, University Children's Hospital, Zurich, Switzerland
| | - Alexander Huber
- Department of Otorhinolaryngology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| |
Collapse
|
8
|
Quimby AE, Salmon MK, Zhao CH, Y K Lee J, Bigelow DC, Ruckenstein MJ, Brant JA. Socioeconomic determinants impact quality of life at vestibular schwannoma diagnosis. J Clin Neurosci 2024; 119:122-128. [PMID: 38007900 DOI: 10.1016/j.jocn.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Socioeconomic variables including race, education, and income have been shown to affect vestibular schwannoma incidence, treatment, and outcomes. We sought to determine the impact of socioeconomic factors on quality of life at the time of vestibular schwannoma diagnosis. METHODS Retrospective cohort study conducted at a tertiary academic center. All patients evaluated for vestibular schwannoma from March 1, 2010 to December 31, 2021 who completed at least one Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire at presentation or prior to any intervention were included. PANQOL scores were compared across income quintiles, racial groups, and health insurance categories. RESULTS Two-hundred and ninety-six patients who had non-missing information on variables of interest were included. Compared to White/Caucasian patients (84.5 %), Black/African American patients (4.7 %) had significantly lower PANQOL total scores (b = -12.8[-21.7, -4.0], p = 0.005). Compared to patients with Commercial insurance (53 %), patients who were Uninsured/ Self-pay (1.7 %) had significantly lower PANQOL total scores (b = -16.7[-31.4, -1.9], p = 0.027). Patients in higher income quintiles had significantly higher PANQOL total scores (b = 11.7[3.9, 19.5], p = 0.004 comparing highest income quintile to lowest). After controlling for potential confounders, income quintile (b = 9.6[1.3, 17.9], p = 0.023 comparing highest quintile to lowest) and insurance (b = -17.0[-31.9, -21], p = 0.025 comparing Uninsured/Self-pay to Commercial insurance) remained predictors of total PANQOL score. CONCLUSIONS Socioeconomic factors including race, health insurance, and income appear to contribute to quality of life at the time of vestibular schwannoma diagnosis. These variables are interrelated and the effects of race may be mediated in part by differences in income and health insurance coverage.
Collapse
Affiliation(s)
- Alexandra E Quimby
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA; Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Mandy K Salmon
- Department of Otolaryngology, Oregon Health & Science University, Portland, OR, USA
| | | | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas C Bigelow
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael J Ruckenstein
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| |
Collapse
|
9
|
Ben-Harosh L, Barker-Collo S, Nowacka A, Garrett J, Miles A. Quality of life and broader experiences of those with acoustic neuroma: a mixed methods approach. BRAIN IMPAIR 2024; 25:IB23072. [PMID: 38566292 DOI: 10.1071/ib23072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 04/04/2024]
Abstract
Background Acoustic neuromas (ANs) are consistently associated with decreased quality of life (QOL) related to the physical and psychosocial impacts of symptoms experienced from the tumour and its treatment. This study explored patient-reported experiences of ANs in New Zealand, with a focus on the impact on QOL and the provision of information, support and services. Methods A mixed methods approach was taken, conducting an online community survey that included the Penn Acoustic Neuroma Quality of Life Scale (N = 52). Those who indicated interest were offered semi-structured interviews after the survey (N = 17), which were analysed using content analysis. Results A negative impact on QOL was found, highlighting five key themes in the experiences of people: (1) ongoing physical, social and psychological impacts; (2) information and support from the medical system; (3) autonomy and decision-making; (4) the importance of peer support; and (5) remaining positive - life goes on. Conclusions Our findings indicate areas for improvement that may benefit people's healthcare experience and QOL. Both quantitative and qualitative results identified gaps associated with person-centred care and the need for information, education, emotional support and access to services. Recommendations include a need for more information (verbal and written) during all stages of diagnosis and treatment, shared decision-making and increased access to allied health, including psychological services and support groups.
Collapse
Affiliation(s)
- Lior Ben-Harosh
- School of Psychology, The University of Auckland, New Zealand
| | | | - Alicja Nowacka
- School of Psychology, The University of Auckland, New Zealand
| | - Joanne Garrett
- School of Psychology, The University of Auckland, New Zealand
| | - Anna Miles
- School of Psychology, The University of Auckland, New Zealand
| |
Collapse
|
10
|
Suresh K, Elkahwagi MA, Garcia A, Naples JG, Corrales CE, Crowson MG. Development of a Predictive Model for Persistent Dizziness Following Vestibular Schwannoma Surgery. Laryngoscope 2023; 133:3534-3539. [PMID: 37092316 PMCID: PMC10593906 DOI: 10.1002/lary.30708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE In an era of vestibular schwannoma (VS) surgery where functional preservation is increasingly emphasized, persistent postoperative dizziness is a relatively understudied functional outcome. The primary objective was to develop a predictive model to identify patients at risk for developing persistent postoperative dizziness after VS resection. METHODS Retrospective review of patients who underwent VS surgery at our institution with a minimum of 12 months of postoperative follow-up. Demographic, tumor-specific, preoperative, and immediate postoperative features were collected as predictors. The primary outcome was self-reported dizziness at 3-, 6-, and 12-month follow-up. Binary and multiclass machine learning classification models were developed using these features. RESULTS A total of 1,137 cases were used for modeling. The median age was 67 years, and 54% were female. Median tumor size was 2 cm, and the most common approach was suboccipital (85%). Overall, 63% of patients did not report postoperative dizziness at any timepoint; 11% at 3-month follow-up; 9% at 6-months; and 17% at 12-months. Both binary and multiclass models achieved high performance with AUCs of 0.89 and 0.86 respectively. Features important to model predictions were preoperative headache, need for physical therapy on discharge, vitamin D deficiency, and systemic comorbidities. CONCLUSION We demonstrate the feasibility of a machine learning approach to predict persistent dizziness following vestibular schwannoma surgery with high accuracy. These models could be used to provide quantitative estimates of risk, helping counsel patients on what to expect after surgery and manage patients proactively in the postoperative setting. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3534-3539, 2023.
Collapse
Affiliation(s)
- Krish Suresh
- Department of Otolaryngology–Head & Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed A. Elkahwagi
- Department of Otolaryngology–Head & Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Otolaryngology–Head & Neck Surgery, Mansoura University, Egypt
| | - Alejandro Garcia
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - James G. Naples
- Department of Otolaryngology–Head & Neck Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - C. Eduardo Corrales
- Department of Otolaryngology–Head & Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew G. Crowson
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
11
|
Shah F, Hamilton LOW, Yiannakis CP, Slim MAM, Kontorinis G. A systematic review and meta-analysis of stereotactic radiosurgery as a primary treatment in fast-growing vestibular schwannomas. J Laryngol Otol 2023; 137:1193-1199. [PMID: 37194631 DOI: 10.1017/s0022215123000786] [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: 05/18/2023]
Abstract
BACKGROUND Stereotactic radiosurgery has been shown to be an effective method of managing vestibular schwannomas. The primary aim here is to establish the impact of pre-treatment fast-growing vestibular schwannomas on the efficacy of stereotactic radiosurgery. METHODS PubMed, Medline and Embase databases were used. The ROBINS-I ('Risk Of Bias In Non-randomised Studies - of Interventions') tool was utilised to assess for risk of bias. Proportionate meta-analysis and sub-analysis for fast-growing tumours were performed to explore the success rate of stereotactic radiosurgery in stabilising or decreasing the tumour burden in vestibular schwannomas. RESULTS Four moderate risk studies were included in the analysis. Overall, 91 per cent (95 per cent confidence interval = 0.83-0.97, p < 0.01, I2 = 80 per cent) of the tumours demonstrated successful size reduction or stabilisation following stereotactic radiosurgery. Nevertheless, the efficacy of stereotactic radiosurgery in reducing or stabilising fast-growing vestibular schwannomas decreased by 79 per cent (95 per cent confidence interval = 0.64-0.91, p = 0.11, I2 = 62 per cent). CONCLUSION Stereotactic radiosurgery has a statistically significant success rate in stabilising or decreasing the vestibular schwannoma size. This success rate is diminished in fast-growing vestibular schwannomas.
Collapse
Affiliation(s)
- Faizan Shah
- ENT Department, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | | | | | | | | |
Collapse
|
12
|
Silva VAR, Lavinsky J, Pauna HF, Vianna MF, Santos VM, Ikino CMY, Sampaio ALL, Tardim Lopes P, Lamounier P, Maranhão ASDA, Soares VYR, Polanski JF, Denaro MMDC, Chone CT, Bento RF, Castilho AM. Brazilian Society of Otology task force - Vestibular Schwannoma ‒ evaluation and treatment. Braz J Otorhinolaryngol 2023; 89:101313. [PMID: 37813009 PMCID: PMC10563065 DOI: 10.1016/j.bjorl.2023.101313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE To review the literature on the diagnosis and treatment of vestibular schwannoma. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. CONCLUSIONS Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.
Collapse
Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO
| | - Joel Lavinsky
- Sociedade Brasileira de Otologia - SBO; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Ciências Morfológicas, Porto Alegre, RS, Brazil
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Melissa Ferreira Vianna
- Sociedade Brasileira de Otologia - SBO; Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Vanessa Mazanek Santos
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Cláudio Márcio Yudi Ikino
- Universidade Federal de Santa Catarina, Hospital Universitário, Departamento de Cirurgia, Florianópolis, SC, Brazil
| | - André Luiz Lopes Sampaio
- Sociedade Brasileira de Otologia - SBO; Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Paula Tardim Lopes
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Pauliana Lamounier
- Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), Departamento de Otorrinolaringologia, Goiânia, GO, Brazil
| | - André Souza de Albuquerque Maranhão
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Vitor Yamashiro Rocha Soares
- Hospital Flavio Santos e Hospital Getúlio Vargas, Grupo de Otologia e Base Lateral do Crânio, Teresina, PI, Brazil
| | - José Fernando Polanski
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil; Faculdade Evangélica Mackenzie do Paraná, Faculdade de Medicina, Curitiba, PR, Brazil
| | | | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Ricardo Ferreira Bento
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO.
| |
Collapse
|
13
|
Zhang L, Ouyang S, Chen L, Huang H, Ou Y, Tang X. Evaluation of subjective visual vertical and horizontal in patients with acoustic neuroma based on virtual reality. Front Neurosci 2023; 17:1264585. [PMID: 37954872 PMCID: PMC10639117 DOI: 10.3389/fnins.2023.1264585] [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: 07/21/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
Objective To investigate potential differences in absolute deviation values of subjective visual vertical and horizontal between unilateral acoustic neuroma patients and healthy young adults under varying degrees of static head tilt, as well as the impact of proprioception on these values, with the aim of determining the effect of acoustic neuroma on gravity sensory pathway function in patients. Methods We recruited 22 patients diagnosed with unilateral acoustic neuroma and 25 healthy young adults and employed virtual reality technology to assess the absolute deviation values of subjective visual vertical (SVV) and subjective visual horizontal (SVH) under eight different static tilted head positions (Head centered (0° tilt), PdP, Head tilt 15°, 30°, 45° to the left and right), then compare and analyze intergroup differences. Results In the Head-centered position, both SVV and SVH absolute deviated values were significantly higher in the AN group compared to healthy young adults. The AN group exhibited significantly higher absolute deviation values of SVV compared to the healthy group when tilting their head 30° left and right. Additionally, when tilting their heads to the right at 15° and 45° the AN group showed significant increases in SVH absolute deviated values compared to healthy adults. The SVV and SVH absolute deviation values of LAN and SAN groups did not reach statistical significance. The results of the SVV test for PDP position did not show any significant differences among all groups. However, the SVH test revealed that the absolute deviation values of the LAN group was significantly higher than that of healthy individuals. Conclusion Our study shows that the gravity sensing function of patients with unilateral acoustic neuroma is affected to different degrees, however, the degree of gravity sensing function damage of patients has little relationship with tumor size. When acoustic neuroma is larger than 2 cm, the effect of proprioception on patients' SVH outcome is noteworthy. So, we should pay attention to the postoperative follow-up of patients with acoustic neuroma and the evaluation of vestibular rehabilitation effect. Meanwhile, for patients opting for conservative treatment, it is imperative to monitor the dynamic changes in vestibular function and seize timely opportunities for intervention.
Collapse
Affiliation(s)
- Lin Zhang
- Department of Otorhinolaryngology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shunlin Ouyang
- Department of Otorhinolaryngology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ling Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
| | - Hemei Huang
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yongkang Ou
- Department of Otorhinolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
| | - Xiaowu Tang
- Department of Otorhinolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Huerter BG, Johnson KC, Coutu BG, Thedinger B, Bennion NR, Zheng C, Zhang C. COX inhibitor use during definitive radiotherapy is associated with worse hearing preservation in patients with vestibular schwannoma. J Neurooncol 2023; 165:139-148. [PMID: 37889440 DOI: 10.1007/s11060-023-04462-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Patients with vestibular schwannoma undergoing definitive radiotherapy commonly experience hearing loss due to tumor and treatment effects; however, there is limited data evaluating concurrent medication use and other clinicopathologic factors associated with hearing preservation during and after radiotherapy. We performed a retrospective cohort study reviewing consecutive patients from 2004 to 2019 treated with radiotherapy for vestibular schwannoma at our institution. METHODS Ninety four patients with concurrent medications, baseline audiograms, and post-radiotherapy audiograms available were evaluable. We performed chi-squared analyses of the frequency of various clinicopathologic factors and t-tests evaluating the degree of hearing loss based on audiograms. RESULTS At a median follow-up of 35.7 months (mean: 46.5 months), the baseline pure-tone average (PTA) of the ipsilateral ear worsened from 38.4 to 59.5 dB following completion of radiotherapy (difference: 21.1, 95% CI 17.8-24.4 dB, p < 0.001). 36 patients (38.3%) reported regular use of cyclooxygenase (COX) inhibitors (including acetaminophen and NSAIDs) during radiotherapy. The mean increase in PTA was significantly higher for patients taking COX inhibitors (25.8 dB vs 18.1 dB, p = 0.024) in the ipsilateral ear but not for the contralateral side. COX inhibitor use remained independently associated with worse PTA in the multivariate analysis. CONCLUSION COX inhibitor use during definitive radiotherapy is associated with worse hearing loss in the affected ear but not for the contralateral side. This suggests the ototoxic effects of COX inhibitors may influence the effects of radiotherapy. These results could have clinical implications and warrant further investigation.
Collapse
Affiliation(s)
- Benjamin G Huerter
- Department of Radiation Oncology, College of Medicine, University of Nebraska Medical Center, 987521 Nebraska Medical Center, Omaha, NE, 68198-7521, USA
| | - Kurtis C Johnson
- Department of Radiation Oncology, College of Medicine, University of Nebraska Medical Center, 987521 Nebraska Medical Center, Omaha, NE, 68198-7521, USA
| | - Brendan G Coutu
- Department of Radiation Oncology, College of Medicine, University of Nebraska Medical Center, 987521 Nebraska Medical Center, Omaha, NE, 68198-7521, USA
| | | | - Nathan R Bennion
- Department of Radiation Oncology, College of Medicine, University of Nebraska Medical Center, 987521 Nebraska Medical Center, Omaha, NE, 68198-7521, USA
| | - Cheng Zheng
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4375, USA
| | - Chi Zhang
- Department of Radiation Oncology, College of Medicine, University of Nebraska Medical Center, 987521 Nebraska Medical Center, Omaha, NE, 68198-7521, USA.
| |
Collapse
|
16
|
Żurek M, Wojciechowski T, Niemczyk K. Nationwide clinico-epidemiological treatment analysis of adult patients with tumors of cerebellopontine angle and internal acoustic meatus in Poland during 2011-2020. BMC Public Health 2023; 23:1735. [PMID: 37674102 PMCID: PMC10481480 DOI: 10.1186/s12889-023-16551-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE The aim of this study is to report the epidemiologic characteristics of tumors of the cerebellopontine angle (CPAT) and internal acoustic meatus in adult Polish population throughout the second decade of XXI century and to analyze their treatment. MATERIAL AND METHODS A retrospective analysis of patients with cerebellopontine angle (CPA) and internal acoustic meatus tumors diagnosed in Poland in 2011-2020 was performed. Data recorded in the National Health Fund (NHF) database were analyzed. International Classification of Diseases codes (ICD-9 and ICD-10) were used to identify study group patients and treatment procedures. RESULTS From 2011 to 2020 6,173 Polish adult patients were diagnosed with cerebellopontine angle and internal acoustic meatus tumors. The average incidence in Poland is 1.99 per 100,000 residents/year. It mostly affects women (61.64%), and the average age of patients is 53.78 years. The incidence has steadily increased over the past decade. Treatment has changed significantly over the years, with a definite increase in the number of patients treated with radiotherapy (from 0.54 to 19.34%), and a decrease in surgical therapies (from 41.67 to 6.8%). The most common symptoms were vertigo and/or dizziness (43.48%) and sensorineural hearing loss (39.58%). 4.65% of patients suffered from sudden deafness, in this group of patients the risk of CPAT detection was the highest (6.25 / 1000 patients). CONCLUSIONS The total incidence of CPAT and demographic characteristics of patients were comparable to other studies. Our study demonstrated the increased number of patients are being treated with radiotherapy and fewer with microsurgery. Sudden sensorineural hearing loss (SSNHL) is an uncommon manifestation of CPAT but proper diagnosis should be undertaken because the risk of diagnosis such tumors is greater in this group.
Collapse
Affiliation(s)
- Michał Żurek
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 1a Banacha St., 02097, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 61 Zwirki and Wigury Str, 02091, Warsaw, Poland
- Department of Analyses and Strategies, Ministry of Health, 15 Miodowa Str, 00952, Warsaw, Poland
| | - Tomasz Wojciechowski
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 1a Banacha St., 02097, Warsaw, Poland.
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 1a Banacha St., 02097, Warsaw, Poland
| |
Collapse
|
17
|
Machetanz K, Wang SS, Oberle L, Tatagiba M, Naros G. Sex Differences in Vestibular Schwannoma. Cancers (Basel) 2023; 15:4365. [PMID: 37686642 PMCID: PMC10486905 DOI: 10.3390/cancers15174365] [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: 08/08/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Vestibular schwannoma (VS) are equally common in men and woman. A number of epidemiological studies have reported on sex-specific aspects of incidence, tumor size, tinnitus and hearing loss. However, data on sex-specific, pre- and post-surgically quality of life (QoL) are rare. The objective of the present study was to determine sex-specific aspects on QoL in VS. Health-related QoL was analyzed in 260 patients (112 male/148 female) with unilateral sporadic VS using general (SF-36: general Short-Form Health Survey), disease-specific (PANQOL: Penn Acoustic Neuroma Quality-of-Life Scale, PANQOL) and symptom-specific (DHI: Dizziness Handicap Inventory; HHI: Hearing Handicap Inventory; THI: Tinnitus Handicap Inventory; FDI: Facial Disability Index) QoL questionnaires. Sex differences were evaluated pre- and postoperative by multi- and univariate analyses based on 200 preoperative and 88 postoperative questionnaires. Female patients were significantly more affected by dizziness, headaches, reduced energy and anxiety. Energy and balance changed similarly in both sexes after surgery. However, postoperative women tended to be more affected by facial palsy and headaches than men. Despite the greater physical impairment, general health improved equivalently or even more in female patients than in males. In conclusion, self-rated QoL in VS is significantly affected by sex and surgery. This should be taken into account when counseling VS patients regarding observation, radiotherapy, and surgery.
Collapse
Affiliation(s)
- Kathrin Machetanz
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, 72074 Tuebingen, Germany
| | | | | | | | | |
Collapse
|
18
|
Yu S, Gao Z, Sun H, Tian X, Zhao Y, Feng G. Quality of Life in Patients With Benign Lateral Skull Base Neoplasms Following Infratemporal Fossa Approaches. EAR, NOSE & THROAT JOURNAL 2023:1455613231186049. [PMID: 37458127 DOI: 10.1177/01455613231186049] [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: 07/18/2023] Open
Abstract
Objectives: Infratemporal fossa approaches (IFAs) allow the total resection of certain lateral skull base neoplasms. To date, no studies have explored the change of patient-reported quality of life (QoL) after total resection of benign lateral skull base neoplasms through IFA. The present study aimed to give a comprehensive understanding of QoL among patients after IFA through general and disease-specific QoL questionnaires. Methods: Forty-seven patients with benign lateral skull base neoplasms were enrolled. The Short Form 36 (SF-36), World Health Organization Quality of Life-BREF (WHOQOL-BREF), and the University of Washington Head and Neck Quality of Life (UW-QOL) were chosen as tools to assess QoL before and after surgeries through IFA. Results: Patients had significantly lower scores in appearance, chewing, and speech after surgeries through IFA. However, change in health from SF-36 and physical health from WHOQOL-BREF scored higher after surgery. In multivariate linear regression analysis, age, gender, mood, speech, appearance, swallowing, and chewing contributed independently to general QoL. Conclusion: Patients were shown to benefit with regard to overall QoL after gross tumor resection from IFA, despite the impact of appearance, speech, and chewing. Function preservation and restoration are critical since their correlation with postoperative QoL.
Collapse
Affiliation(s)
- Shuting Yu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiqiang Gao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Huiying Sun
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xu Tian
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Zhao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Guodong Feng
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
19
|
Machetanz K, Lee L, Wang SS, Tatagiba M, Naros G. Trading mental and physical health in vestibular schwannoma treatment decision. Front Oncol 2023; 13:1152833. [PMID: 37434979 PMCID: PMC10332305 DOI: 10.3389/fonc.2023.1152833] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/08/2023] [Indexed: 07/13/2023] Open
Abstract
Objective Observation, radiotherapy and surgery are treatment options in vestibular schwannomas (VS). Decision making differs between centers and is usually based on tumor characteristics (e.g., size) and the expected physical health (PH) outcome (i.e., hearing and facial function). However, mental health (MH) is often under-reported. The objective of the present study was to ascertain the impact of VS treatment on PH and MH. Methods PH and MH were assessed in a prospective cross-sectional study including 226 patients with unilateral sporadic VS before and after surgical removal (SURG). Quality-of-life (QoL) was estimated by self-rating questionnaires: general Short-Form Health Survey (SF-36), Penn Acoustic Neuroma Quality-of-Life Scale (PANQOL), Dizziness Handicap Inventory (DHI), Hearing Handicap Inventory (HHI), Tinnitus Handicap Inventory (THI), and Facial Disability Index (FDI). QoL changes over time as well as predictive factors were accessed by multivariate analyses of covariance (MANCOVA). Results In total, 173 preoperative and 80 postoperative questionnaires were analyzed. There was a significant PH deterioration related to facial function (FDI, PANQOL-face) after surgery. In line with facial rehabilitation, however, FDI improved within the first five years after surgery and did not differ compared to the preoperative patient cohort, eventually. In contrast, MH (i.e., PANQOL-anxiety) and general health (i.e., PANQOL-GH) improved with surgery and correlated with the extent-of-resection. Conclusion Physical and mental health is significantly influenced by VS surgery. While PH might decrease after surgery, MH potentially increases when patient is cured. Practitioners should take MH into account before advising an incompletely VS treatment (e.g., subtotal resection, observation or radiosurgery).
Collapse
Affiliation(s)
- Kathrin Machetanz
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Larissa Lee
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Sophie S Wang
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Marcos Tatagiba
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Georgios Naros
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| |
Collapse
|
20
|
Wu Y, Cai Q, Zheng M, Li J, Xue Y, Qu Y, Zhao T. Clinical outcomes and safety of large or giant vestibular schwannoma in older patients undergoing microsurgery: a matched cohort study. J Neurooncol 2023; 163:429-437. [PMID: 37222918 DOI: 10.1007/s11060-023-04330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To compare the clinical outcomes of large or giant vestibular schwannomas (VSs) between older patients and younger patients who underwent microsurgery and to explore whether the incidence of postoperative complications increased and whether the postoperative hospital stay was prolonged. METHODS We conducted a retrospective matched cohort study based on the surgical approach, maximum tumor diameter and extent of resection. Older patients (≥ 60 years) and a matched group (<60 years) who had undergone microsurgery for VSs between January 2015 and December 2021 were included. Clinical data, surgical outcomes and postoperative complications were analyzed statistically. RESULTS Forty-two older patients (≥ 60 years, 66.0 ± 3.8 years) were identified and matched to younger patients (<60 years, 43.9 ± 11.2 years), and they all underwent microsurgery through a retrosigmoid approach. There were twenty-nine patients with 3-4 cm VSs and thirteen patients with > 4 cm VSs in both groups. The older patients had a higher proportion of imbalance (P = 0.016) and lower American Society of Anesthesiology scores (P = 0.003) before surgery than the younger patients. There was no significant difference in facial nerve function one week (p = 0.851) and one year (p = 0.756) after surgery and no difference in the postoperative complication incidence (40.5% vs. 23.8%, p = 0.102) between the older patients and controls. Furthermore, the older patients had longer postoperative hospital stays than the younger patients (p = 0.043). In the older group, six patients with near total resection and five with subtotal resection were administered stereotactic radiotherapy, and one had recurrence three years after surgery and received conservative treatment. The postoperative follow-up time ranged from 1 to 83 months, with an average of 33.5 ± 21.1 months. CONCLUSIONS For older patients (≥ 60 years) with symptomatic, large or giant -VSs, microsurgery is the only effective method to prolong lifespan, alleviate clinical symptoms and cure the tumor. However, radical resection of VSs may result in a decreased preservation rate of facial-acoustic nerve function and an increased postoperative complication incidence. Therefore, subtotal resection followed by stereotactic radiotherapy should be recommended.
Collapse
Affiliation(s)
- Yingxi Wu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No.1 Xin Si Road, 710038, Xi'an, Shaanxi Province, China
| | - Qing Cai
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No.1 Xin Si Road, 710038, Xi'an, Shaanxi Province, China
| | - Min Zheng
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No.1 Xin Si Road, 710038, Xi'an, Shaanxi Province, China
| | - Junting Li
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Yafei Xue
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No.1 Xin Si Road, 710038, Xi'an, Shaanxi Province, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No.1 Xin Si Road, 710038, Xi'an, Shaanxi Province, China.
| | - Tianzhi Zhao
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No.1 Xin Si Road, 710038, Xi'an, Shaanxi Province, China.
| |
Collapse
|
21
|
Strickland BA, Rennert R, Zada G, Shahrestani S, Russin JJ, Friedman RA, Giannotta SL. Surgical Outcomes Following Vestibular Schwannoma Resection in Patients over the Age of Sixty-five. J Neurol Surg B Skull Base 2023; 84:129-135. [PMID: 36911086 PMCID: PMC9991522 DOI: 10.1055/a-1771-0504] [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: 06/14/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022] Open
Abstract
Objective Vestibular schwannoma (VS) are benign, often slow growing neoplasms. Some institutions opt for radiosurgery in symptomatic patients of advanced age versus surgical resection. The aim of the study is to analyze surgical outcomes of VS in patients over the age of 65 who were either not candidates for or refused radiosurgery. Methods This includes retrospective analysis of VS patients between 1988 and 2020. Demographics, tumor characteristics, surgical records, and clinical outcomes were recorded. Patient preference for surgery over radiosurgery was recorded in the event that patients were offered both. Facial nerve outcomes were quantified using House-Brackmann (HB) scores. Tumor growth was defined by increase in size of >2 mm. Results In total, 64 patients were included of average age 72.4 years (65-84 years). Average maximum tumor diameter was 29 mm (13-55 mm). Forty-five patients were offered surgery or GKRS, and chose surgery commonly due to radiation aversion (48.4%). Gross total resection was achieved in 39.1% ( n = 25), near total 32.8% ( n = 21), and subtotal 28.1% ( n = 18). Average hospitalization was 5 days [2-17] with 75% ( n = 48) discharged home. Postoperative HB scores were good (HB1-2) in 43.8%, moderate (HB3-4) in 32.8%, and poor (HB5-6) in 23.4%. HB scores improved to good in 51.6%, moderate in 31.3%, and remained poor in 17.1%, marking a rate of facial nerve improvement of 10.9%. Tumor control was achieved in 95.3% of cases at an average follow-up time of 37.8 months. Conclusion VS resection can be safely performed in patients over the age of 65. Advanced age should not preclude a symptomatic VS patient from being considered for surgical resection.
Collapse
Affiliation(s)
- Ben A Strickland
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Rob Rennert
- Department of Neuro Otology, University of California San Diego, San Diego, California, United States
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Shane Shahrestani
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Jonathan J Russin
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Rick A Friedman
- Department of Neuro Otology, University of California San Diego, San Diego, California, United States
| | - Steven L Giannotta
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| |
Collapse
|
22
|
Pruijn IM, Waterval JJ, ter Laan M, Temel Y, Pegge SA, Postma AA, Verheul JB, Eekers DB, Kievit W, Kunst HP. Subclassification of the Koos grade 2 vestibular schwannoma into 2a and 2b for individualized patient care: a validity and reliability study. Eur J Radiol 2023; 162:110799. [PMID: 37001257 DOI: 10.1016/j.ejrad.2023.110799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/06/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Vestibular schwannoma (VS) growth of ≥2 mm during serial MRI observation, irrespective of size, is the benchmark for treatment initiation in almost all centers. Although the probability of less optimal outcomes significantly increases in VS closer to the brainstem, early intervention does not improve long-term quality of life. Moving beyond the recommendation of definitive treatment for all VS after detected growth, we subclassified Koos 2 tumors based on extrameatal extension and relation to the brainstem. The aim of the current study was to evaluate the Koos 2 subclassification's validity and the inter-and intra-rater reliability of the entire Koos classification. METHODS Six experts, including neurosurgeons, otorhinolaryngologists and radiologists from two tertiary referral centers, classified 43 VS MRI scans. Validity of the Koos 2 subclassification was evaluated by the percentage agreement against the multidisciplinary skull base tumor board management advice. Inter- and intra-rater reliability were calculated using the intraclass correlation coefficient (ICC). RESULTS Validity was almost perfect in Koos 2a VSs with a 100% agreement and 87.5% agreement for Koos 2b. Inter-rater reliability for all Koos grades was significantly excellent (ICC 0.91; 95%CI 0.866 to 0.944, p= <0.001). Five raters had an excellent intra-rater reliability (ICC > 0.90; p= <0.01) and one rater had a good intra-rater reliability (ICC 0.88; 95% CI 0.742 to 0.949). CONCLUSIONS Although multiple factors influence decision-making, the classification of Koos 2a and 2b with excellent inter- and intra-rater reliability, can aid in recommending treatment initiation, moving beyond detected tumor growth, aiming to optimize patient centered care.
Collapse
|
23
|
Neve OM, Jansen JC, Koot RW, Ridder MD, Paul G van Benthem P, Stiggelbout AM, Hensen EF. Long-Term Quality of Life of Vestibular Schwannoma Patients: A Longitudinal Analysis. Otolaryngol Head Neck Surg 2023; 168:210-217. [PMID: 35349360 DOI: 10.1177/01945998221088565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/03/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Vestibular schwannoma management aims to maintain optimal quality of life (QoL) while preventing severe sequelae of the tumor or its treatment. This study assessed long-term QoL of patients with vestibular schwannoma in relation to treatment modality and decisional regret. STUDY DESIGN A longitudinal study, in which clinical and QoL data were used that were cross-sectionally acquired in 2014 and again in 2020 from the same patient group. SETTING A tertiary expert center for vestibular schwannoma care in the Netherlands. METHODS QoL was measured by the Penn Acoustic Quality of Life (PANQOL) scale. Changes in time were assed using a linear mixed model. In addition, the Decision Regret Scale was analyzed. RESULTS Of 867 patients, 536 responded (62%), with a median follow-up of 11 years. All PANQOL subdomain scores remained stable over time and did not exceed minimal clinically important difference (MCID) levels. Time since treatment did not affect QoL. Patients had comparable average QoL scores and proportions of patients with changing QoL scores (ie, exceeding the MCID) over time, irrespective of the received initial treatment. Female patients and those who required salvage therapy (either by radiotherapy or surgery) reported a lower QoL. The latter patient group reported the highest decisional regret. CONCLUSION On average, the long-term QoL of patients with vestibular schwannoma is comparable for patients under active surveillance and those who have received active treatment, and it remains stable over time. This suggests that, on average, preservation of QoL of patients with vestibular schwannoma is feasible when adequately managed.
Collapse
Affiliation(s)
- Olaf M Neve
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Jeroen C Jansen
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Radboud W Koot
- Department of Neurosurgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Mischa de Ridder
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| |
Collapse
|
24
|
Doerfer KW, Fritz CG, Porps SL, Hong RS, Jacob JT, Babu SC. Twelve-Month Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation. Otolaryngol Head Neck Surg 2023. [PMID: 36939583 DOI: 10.1002/ohn.261] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/15/2022] [Accepted: 12/24/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Audiometric outcomes at 12 months following simultaneous translabyrinthine (TL) resection of vestibular schwannoma (VS) and cochlear implantation (CI). STUDY DESIGN Prospective cohort study. SETTING Tertiary referral center. METHODS Adult patients undergoing TL resection of sporadic, unilateral VS ≤ 2 cm were prospectively enrolled. Preoperative testing included binaural AZBio in noise and quiet and unilateral Consonant-Nucleus-Consonant (CNC). Tinnitus Handicap Index (THI) and Speech, Spatial, and Qualities of Hearing (SSQ) questionnaires were also completed. Patients underwent TL resection with simultaneous CI. The preoperative test battery was repeated at 1, 3, 6, and 12 months after activation. Statistical analysis was performed to characterize short-term outcomes (preoperative to 3 months), longer-term outcomes (3-12 months), and overall changes during the preoperative to 12-month period. RESULTS AZBio, CNC, and THI improved at 3 months with no significant changes thereafter and showed durable improvement at 12 months compared to preoperative testing. While SSQ did not improve at 12 months, a subset of patients showed either recovery or improvement of SSQ-spatial subscores. Patients with cerebellopontine angle tumors had poorer performance, although the impact of tumor size and location could not be deduced based on the small sample size. CONCLUSION Patients undergoing simultaneous CI and TL resection of VS had durable improvements in speech perception and tinnitus severity 12 months following surgery. Subjective improvements in localization were not observed. Additional studies are needed to determine which VS patients are optimal candidates for CI.
Collapse
Affiliation(s)
- Karl W Doerfer
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christian G Fritz
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Sandra L Porps
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Robert S Hong
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Jeffrey T Jacob
- Division of Skull Base Surgery, Michigan Head and Spine Institute, Southfield, Michigan, USA
| | - Seilesh C Babu
- Division of Neurotologic and Lateral Skull Base Surgery, Michigan Ear Institute, Farmington Hills, Michigan, USA
| |
Collapse
|
25
|
Tatagiba M, Wang SS, Rizk A, Ebner F, van Eck ATCJ, Naros G, Horstmann G. A comparative study of microsurgery and gamma knife radiosurgery in vestibular schwannoma evaluating tumor control and functional outcome. Neurooncol Adv 2023; 5:vdad146. [PMID: 38024239 PMCID: PMC10681278 DOI: 10.1093/noajnl/vdad146] [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] [Indexed: 12/01/2023] Open
Abstract
Background Both stereotactic radiosurgery (SRS) and microsurgical resection (SURGERY) are available as treatment options for sporadic vestibular schwannoma (VS). There are very few direct comparative studies comparing both treatment modalities in large cohorts allowing detailed subgroup analysis. This present study aimed to compare the nuances in the treatment of VS by SURGERY and SRS in 2 highly specialized neurosurgical centers. Methods This is a retrospective bicentric cohort study. Data from patients treated between 2005 and 2011 were collected retrospectively. Recurrence-free survival (RFS) was assessed radiographically by contrast-enhanced magnetic resonance imaging. Results The study population included N = 901 patients with a mean follow-up of 7 years. Overall, the incidence of recurrence was 7% after SURGERY, and 11% after SRS with superior tumor control in SURGERY in the Kaplan-Meier-analysis (P = 0.031). In small tumors (Koos I and II), tumor control was equivalent in both treatment arms. In large VS (Koos III and IV), however, RFS was superior in SURGERY. The extent of resection correlated with RFS (P < .001). Facial and hearing deterioration was similar in both treatment arms in small VS, but more pronounced in SURGERY of large VS. Tinnitus, vertigo, imbalance, and trigeminal symptoms were more often improved by SURGERY than SRS. Conclusions SRS can achieve similar tumor control compared to SURGERY in smaller VS (Koos I and II)-with similar postinterventional morbidities. In large VS (Koos III and IV), long-term tumor control of SRS is inferior to SURGERY. Based on these results, we suggest that if combination therapy is chosen, the residual tumor should not exceed the size of Koos II.
Collapse
Affiliation(s)
- Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University, Tubingen, Germany
| | - Sophie S Wang
- Department of Neurosurgery, Eberhard Karls University, Tubingen, Germany
| | - Ahmed Rizk
- Department of Neurosurgery, Eberhard Karls University, Tubingen, Germany
| | - Florian Ebner
- Department of Neurosurgery, Eberhard Karls University, Tubingen, Germany
| | | | - Georgios Naros
- Department of Neurosurgery, Eberhard Karls University, Tubingen, Germany
| | | |
Collapse
|
26
|
Nassiri AM, Lohse CM, Tombers NM, Link MJ, Carlson ML. Comparing Patient Satisfaction After Upfront Treatment Versus Wait-and-Scan for Small Sporadic Vestibular Schwannoma. Otol Neurotol 2023; 44:e42-e47. [PMID: 36240733 DOI: 10.1097/mao.0000000000003728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Management of small vestibular schwannoma (VS) remains controversial, as patients are typically candidates for all three management options including microsurgery, stereotactic radiosurgery, or wait-and-scan. This study compares patient satisfaction across treatment modalities in patients with small VS. STUDY DESIGN Cross-sectional study. SETTING Survey distributed to members of the Acoustic Neuroma Association and Mayo Clinic patients. METHODS Patients with small (<1 cm in any location) sporadic VS who completed at least one survey regarding treatment history and patient satisfaction were included. RESULTS Among 346 patients with small VS, 106 (31%) underwent microsurgery, 78 (23%) radiosurgery, 152 (44%) wait-and-scan, and 10 (3%) multimodal treatment. Collectively, 307 (89%) patients indicated "Yes, I am happy with my treatment type and in hindsight I would not change anything," and 39 (11%) indicated "No, in hindsight I would have chosen a different treatment type." Satisfaction differed significantly by treatment group with 85, 86, 96, and 40% of patients in the microsurgery, radiosurgery, wait-and-scan, and multimodal groups reporting that they were satisfied with treatment, respectively ( p < 0.001). Satisfaction also differed significantly among those undergoing upfront treatment with microsurgery or radiosurgery (81%), initial wait-and-scan followed by treatment (88%), and wait-and-scan only groups (96%; p = 0.001). Specifically, the wait-and-scan only group demonstrated greater satisfaction compared with the other two treatment strategies ( p < 0.05 for both). CONCLUSIONS Patient satisfaction with the management of small VS is generally high. Management with wait-and-scan, even if treatment is eventually pursued, may offer higher patient satisfaction compared with upfront treatment.
Collapse
|
27
|
Quality of life outcomes in incidental and operated meningiomas (QUALMS): a cross-sectional cohort study. J Neurooncol 2023; 161:317-327. [PMID: 36525165 PMCID: PMC9756745 DOI: 10.1007/s11060-022-04198-y] [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: 09/12/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Few studies have evaluated meningioma patients' longer-term health-related quality of life (HRQoL) following diagnosis and treatment, particularly in those with incidental, actively monitored tumours. METHODS A single-center, cross-sectional study was completed. Adult patients with surgically managed or actively monitored meningioma with more than five years of follow-up were included. The patient-reported outcome measures RAND SF-36, EORTC QLQ-C30 and QLQ-BN20 were used to evaluate HRQoL. HRQoL scores were compared to normative population data. Outcome determinants were evaluated using multivariate linear regression analysis. RESULTS 243 patient responses were analyzed, and the mean time from diagnosis was 9.8 years (range 5.0-40.3 years). Clinically relevant, statistically significant HRQoL impairments were identified across several SF-36 and QLQ-C30 domains. Increasing education level (β = 2.9, 95% CI 0.9 to 4.9), P = .004), employment (β = 7.7, 95% CI 2.2 to 13.1, P = .006) and absence of postoperative complications (β=-6.7, 95% CI -13.2 to (-)0.3, P = .041) were associated with a better QLQ-C30 summary score. Other tumour and treatment variables were not. CONCLUSION This study highlights the longer-term disease burden of patients with meningioma nearly one decade after diagnosis or surgery. Patients with actively monitored meningioma have similar HRQoL to operated meningioma patients. Healthcare professionals should be mindful of HRQoL impairments and direct patients to sources of support as needed.
Collapse
|
28
|
Lubelski D, Pennington Z, Ochuba A, Azad TD, Mansouri A, Blakeley J, Belzberg AJ. Natural History of Brachial Plexus, Peripheral Nerve, and Spinal Schwannomas. Neurosurgery 2022; 91:883-891. [PMID: 36069570 DOI: 10.1227/neu.0000000000002118] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 06/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Management of sporadic schwannomas is often dictated by a patient's clinical presentation and the tumor's behavior. For patients who are managed nonsurgically, there are little data available about the expected natural history. OBJECTIVE To evaluate the natural history and growth patterns of extracranial schwannomas including tumors of the distal peripheral nerves, spine, and brachial plexus. METHODS A retrospective review was performed to identify patients with nonsyndromic extracranial schwannomas at a single tertiary care institution diagnosed between 2002 and 2019. Patient data and tumor characteristics including volume were recorded. RESULTS Two hundred twenty-seven patients were identified (mean age 51 years, 42% male, average of 27.8-month follow-up). Tumor location was distal peripheral nerve in 82, brachial plexus in 36, and paraspinal in 109. At the time of diagnosis, peripheral lesions were significantly larger than spinal (59 m 3 vs 13 cm 3 ) and brachial plexus lesions (15 cm 3 ). Distinct growth patterns were seen with both distal peripheral nerve and spinal lesions; 34/82 peripheral nerve lesions had fast growth (β = 0.176%/day), and 48 had slow growth (β = 0.021%/day; P < .01). Spinal schwannomas similarly had 30 fast-growing (β = 0.229%/day), 16 moderate-growing (β = 0.071%/day), and 63 slow-growing (β = 0.022%/day; P = .03) subtypes. The brachial plexus had relatively homogeneous growth patterns (β = 0.065%/day). Females had 2.9 times greater odds of having the fast-growing subtype. CONCLUSION Distinct growth patterns were seen in extracranial sporadic schwannomas based on tumor location and patient demographics. Fast (>80% volume change per year) vs slow (5%-10% per year) tumor growth can often be ascertained within 2 follow-up images. Awareness of these patterns might have implications for patient counseling and therapeutic decision-making.
Collapse
Affiliation(s)
- Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zach Pennington
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arinze Ochuba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tej D Azad
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania, USA
| | - Jaishri Blakeley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allan J Belzberg
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Kumar S, Sahana D, Jain A, Rathore L, Tawari M, Mittal J, Sahu R. Preoperative Visual Impairment in Vestibular Schwannoma Patients: An Overlooked Entity of Developing World. Asian J Neurosurg 2022; 17:448-454. [DOI: 10.1055/s-0042-1756633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Objective Visual impairment in vestibular schwannomas is an underreported entity. The plethora of literature focuses primarily on facial and hearing preservation. This study aims to describe our experience and find the possible reasons for visual impairment.
Materials and Methods This is a retrospective observational study. We evaluated 114 patients with vestibular schwannoma, operated during 2015 to 2020. Eight parameters were studied—age, gender, maximum tumor size, hydrocephalus, economic status, duration of symptoms, visual loss, and ease of access to the tertiary neurosurgical facility. JASP software (version 0.14.1, Amsterdam) was used for statistical analysis.
Results A total of 42/114 (36.84%) patients had a varying degree of impairment. Patients with impaired vision had significantly larger tumors (4.31 vs. 4.12 cm, p = 0.02), longer duration of symptoms (19.14 vs. 16.45 months, p = 0.02), hydrocephalus (p = 0.03), and were from remote areas (p = 0.009). In stepwise logistic regression analysis, longer duration of symptoms and difficult access to neurosurgical facility stand out as decisive factors for visual impairment. The follow-up data were available for 35/42 (83.33%) cases of visual impairment. Vision improved in 14/35 (40%) of cases. Vision improved in a significantly higher number of patients when a preoperative ventriculoperitoneal shunt was placed (p = 0.03).
Conclusion The visual handicap occurs in a significant number of patients with vestibular schwannoma. Delayed arrival at the neurosurgical facility due to difficult access appears to be the primary factor leading to blindness. Strengthening our healthcare systems in rural areas would go a long way in the timely detection and prevention of blindness in such cases.
Collapse
Affiliation(s)
- Sanjeev Kumar
- Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Debabrata Sahana
- Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Amit Jain
- Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Lavlesh Rathore
- Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Manish Tawari
- Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Jatinder Mittal
- Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Rajiv Sahu
- Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| |
Collapse
|
31
|
Impact of Demographics and Clinical Features on Initial Treatment Pathway for Vestibular Schwannoma. Otol Neurotol 2022; 43:1078-1084. [PMID: 35960883 PMCID: PMC9878333 DOI: 10.1097/mao.0000000000003652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To identify demographic and clinical features impacting initial treatment pathway for vestibular schwannoma. STUDY DESIGN Retrospective chart review. SETTING Tertiary care academic medical center. PATIENTS Patients diagnosed with vestibular schwannoma between 2009 and 2019. INTERVENTIONS Observation, stereotactic radiosurgery, or microsurgical resection. MAIN OUTCOME MEASURES χ 2 Test, one-way analysis of variance, and multivariate logistic regression were used to correlate demographic and clinical factors with initial treatment pathway for 197 newly diagnosed vestibular schwannoma patients. RESULTS Among 197 patients, 93 (47%) were initially treated with observation, 60 (30%) with stereotactic radiation (Gamma Knife) and 44 (22%) with surgical resection. Age univariately had no statistically significant impact on initial pathway, but those undergoing surgery trended toward a younger demographic (49.1 yr [surgery] versus 57.2 yr [observation] versus 59.0 yr [Gamma Knife]). Men were more likely to be initially observed than women ( p = 0.04). Patients initially observed were more likely to have a lower Koos classification ( p < 0.001) and have better tumor-ear hearing ( p = 0.03). Only 34.4% of patients living outside the local geographic region were initially observed compared with 53.0% living locally ( p = 0.055). Surgeon correlated with initial treatment ( p = 0.04) but did not maintain significance when adjusting for hearing level or tumor size. A multiple linear regression model found age, maximum tumor diameter, and Koos class to correlate with initial treatment pathway ( p < 0.0001, r2 = 0.42). CONCLUSION Initial treatment pathway for newly diagnosed vestibular schwannoma is impacted by demographic factors such as age, sex, and geographic proximity to the medical center. Clinical features including hearing level and tumor size also correlated with initial treatment modality.
Collapse
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
Albano L, Deng H, Wei Z, Vodovotz L, Niranjan A, Lunsford LD. The longitudinal volumetric response of vestibular schwannomas after Gamma Knife radiosurgery. J Neurosurg 2022; 138:1273-1280. [PMID: 36087328 DOI: 10.3171/2022.7.jns22812] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gamma Knife radiosurgery (GKRS) is an effective treatment for vestibular schwannomas (VSs) and has been used in > 100,000 cases worldwide. In the present study the authors sought to define the serial volumetric tumor response of Koos grade I-IV VS after radiosurgery. METHODS A total of 201 consecutive VS patients underwent GKRS at a single institution between 2015 and 2019. All patients had a minimum follow-up of 18 months and at least 2 interval postprocedure MRI scans. The contrast-enhanced tumor volumes were contoured manually and compared between pre- and post-GKRS imaging. The percentages of tumor volume change at 18 months (short-term follow-up) and up to 5 years after GKRS (long-term follow-up) were compared with the baseline tumor volume. An increase of 20% was considered a significant increase of tumor volume. Trends of tumor volume over time were assessed with linear models using time as a continuous variable. A test for linear trend was evaluated according to the initial Koos tumor classification. RESULTS Koos grade II VS was the most frequently occurring tumor (n = 74, 36.8%), followed by grade III (n = 57, 28.4%), grade I (n = 41, 20.4%), and grade IV (n = 29, 14.4%). The mean tumor volume at the time of GKRS was 2.12 ± 2.82 cm3 (range 0.12-18.77 cm3) and the median margin dose was 12 Gy. Short-term follow-up revealed that tumor volumes transiently increased in 34.2% and 28.4% of patients at 6 and 18 months, respectively, regardless of Koos grade. Linear regression analysis of Koos grade II, III, and IV tumors showed a significant longitudinal volume decrease on long-term follow-up. At last follow-up (median 30 months, range 18-54 months), 19 patients (9.4%) showed a persistent increase of tumor volume. Five patients received additional management after GKRS. CONCLUSIONS Although selected VS patients demonstrate an early and measurable transient volumetric increase after GKRS, > 90% have stable or reduced tumor volumes over an observed period of up to 5 years. Volumetric regression is most pronounced in Koos grade II, III, and IV tumors and may not be fully detectable until 3 years after GKRS.
Collapse
Affiliation(s)
- Luigi Albano
- 1Department of Neurological Surgery and.,2Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hansen Deng
- 1Department of Neurological Surgery and.,2Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Zhishuo Wei
- 1Department of Neurological Surgery and.,2Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lena Vodovotz
- 1Department of Neurological Surgery and.,2Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- 1Department of Neurological Surgery and.,2Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- 1Department of Neurological Surgery and.,2Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
34
|
Carlson ML, Lohse CM, Link MJ, Tombers NM, McCaslin DL, Saoji AA, Hutchins M, Yost KJ. Development and validation of a new disease-specific quality of life instrument for sporadic vestibular schwannoma: the Mayo Clinic Vestibular Schwannoma Quality of Life Index. J Neurosurg 2022; 138:981-991. [PMID: 36057121 DOI: 10.3171/2022.7.jns221104] [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: 05/10/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Facial nerve function, hearing preservation, and tumor control have been the primary benchmarks used to assess vestibular schwannoma (VS) outcomes. Acknowledging the frequent discrepancy between what physicians prioritize and what patients value, there has been increasing prioritization of patient-reported outcome measures when evaluating the impact of VS diagnosis and its treatment. Motivated by reported limitations of prior instruments used to assess quality of life (QOL) in patients with VS, the authors describe the development and validation of a new disease-specific QOL measure: the Vestibular Schwannoma Quality of Life (VSQOL) Index. METHODS The content development phase comprised identification of clinically important domains and prioritization of feelings or concerns individuals with VS may have. The validation phase encompassed determining how items were grouped into domains and eliminating redundant items. Both phases leveraged data from cross-sectional and longitudinal surveys, expertise from a multidisciplinary working group, and patients with a broad range of experiences with VS (n = 42 during content development and n = 263 during validation). Domain scores from the new instrument were assessed for reliability and correlation with other measures of similar constructs. RESULTS The VSQOL Index consists of 40 items that evaluate the impact of VS diagnosis and its management on QOL, treatment satisfaction, and employment and is estimated to take 8-10 minutes to complete. Domain scores range from 0 (worst) to 100 (best) and demonstrate excellent psychometric properties, including content, construct, and convergent validity and both internal consistency (Cronbach's alphas 0.83 to 0.91) and test-retest reliability (reliability coefficients 0.86 to 0.96). CONCLUSIONS The VSQOL Index is a valid and reliable measure that overcomes several limitations of prior instruments, including omission or underrepresentation of domains that frequently impact well-being, such as pain, cognition, satisfaction or regret surrounding treatment decisions, and occupational limitations, to comprehensively evaluate the impact of VS diagnosis or its treatment on QOL.
Collapse
Affiliation(s)
- Matthew L Carlson
- Departments of1Otolaryngology-Head and Neck Surgery.,2Neurosurgery, and
| | | | | | | | - Devin L McCaslin
- 4Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | | | | | - Kathleen J Yost
- 3Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
35
|
Abstract
OBJECTIVE To characterize the natural history of hearing loss for patients presenting with serviceable hearing (SH) who undergo a wait-and-scan approach for sporadic vestibular schwannoma (VS) using aggregate time-to-event survival analysis. STUDY DESIGN Systematic review. SETTING Published international English literature, January 1, 2000 to May 31, 2020. PATIENTS Patients with sporadic VS entering a wait-and-scan approach with SH at diagnosis. INTERVENTIONS Observation with serial MRI and audiometry. RESULTS In total, 3,652 patients from 26 studies were included for analysis. Mean age at diagnosis was 58.8 years (SD, 4.1). Mean follow-up was 49.2 months (SD, 26.5). In total, 755 patients (21%) failed conservative treatment and underwent radiosurgery or microsurgery at the time of last follow-up. The average loss to follow-up was 6.9% (SD, 11.1). A total of 1,674 patients had SH at the time of diagnosis. Survival rates for maintaining SH were 96% at 1 year, 77% at 3 years, 62% at 5 years, and 42% at 10 years following diagnosis. CONCLUSION In this systematic review, aggregate data from 3,652 patients across 26 studies show consistent patterns in progression of hearing loss during observation for patients with sporadic VS as a function of time. As an easy-toremember conservative benchmark for those presenting with SH at diagnosis: approximately 75% retain SH at 3 years, 60% at 5 years, and 40% at 10 years.
Collapse
|
36
|
Kemper M, Paliege K, Zahnert T. [Vestibular schwannomas - baseline and progress diagnostics]. Laryngorhinootologie 2022; 101:518-538. [PMID: 35724922 DOI: 10.1055/a-1739-6662] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Vestibular (vestibulocochlear) schwannomas are rare, benign schwannomas of the cerebellopontine angle, the internal auditory canal, or the inner ear. They can occur with or without clinical symptoms. The most common symptoms are unilateral or side-differentiated hearing loss with or without tinnitus and balance disorders. Initial symptomatology is nonspecific in the basic functional diagnosis, raising the question of when a hearing or balance disorder should be thought of as a differential diagnosis of vestibular schwannoma and what diagnostic pathway is appropriate. This concerns not only the confirmation of the diagnosis and the recording of all dysfunctions of the involved cranial nerves in the initial basic diagnostics, but also the procedure in the course and follow-up diagnostics - especially in patients who are subject to an observation strategy. Today, imaging alone is no longer sufficient for differentiated and individualized patient counseling. Due to the increasing detection of smaller tumors on MRI and the growing proportion of nearly asymptomatic patients, a shift in thinking from pure imaging monitoring to a detailed analysis of auditory and vestibular function is timely. In this educational article, diagnostic pathways for a sufficient patient consultation will be compiled. Ultimately, functional examination techniques from follow-up and progression diagnostics will also be included.
Collapse
Affiliation(s)
- Max Kemper
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | |
Collapse
|
37
|
Vergara Olmos G, Dabiri S, Rutka J. Editorial. Decision-making in the surgical management of a vestibular schwannoma: when timing is everything (cum sincere omnia). J Neurosurg 2022; 136:1285-1286. [PMID: 34653982 DOI: 10.3171/2021.5.jns21981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gabriela Vergara Olmos
- 1Division of Otology/Neurotology, Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Ontario, Canada
| | - Sasan Dabiri
- 1Division of Otology/Neurotology, Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Ontario, Canada
| | - John Rutka
- 1Division of Otology/Neurotology, Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Ontario, Canada
| |
Collapse
|
38
|
Macielak RJ, Wallerius KP, Lawlor SK, Lohse CM, Marinelli JP, Neff BA, Van Gompel JJ, Driscoll CLW, Link MJ, Carlson ML. Defining clinically significant tumor size in vestibular schwannoma to inform timing of microsurgery during wait-and-scan management: moving beyond minimum detectable growth. J Neurosurg 2022; 136:1289-1297. [PMID: 34653971 DOI: 10.3171/2021.4.jns21465] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Detection of vestibular schwannoma (VS) growth during observation leads to definitive treatment at most centers globally. Although ≥ 2 mm represents an established benchmark of tumor growth on serial MRI studies, 2 mm of linear tumor growth is unlikely to significantly alter microsurgical outcomes. The objective of the current work was to ascertain where the magnitude of change in clinical outcome is the greatest based on size. METHODS A single-institution retrospective review of a consecutive series of patients with sporadic VS who underwent microsurgical resection between January 2000 and May 2020 was performed. Preoperative tumor size cutpoints were defined in 1-mm increments and used to identify optimal size thresholds for three primary outcomes: 1) the ability to achieve gross-total resection (GTR); 2) maintenance of normal House-Brackmann (HB) grade I facial nerve function; and 3) preservation of serviceable hearing (American Academy of Otolaryngology-Head and Neck Surgery class A/B). Optimal size thresholds were obtained by maximizing c-indices from logistic regression models. RESULTS Of 603 patients meeting inclusion criteria, 502 (83%) had tumors with cerebellopontine angle (CPA) extension. CPA tumor size was significantly associated with achieving GTR, postoperative HB grade I facial nerve function, and maintenance of serviceable hearing (all p < 0.001). The optimal tumor size threshold to distinguish between GTR and less than GTR was 17 mm of CPA extension (c-index 0.73). In the immediate postoperative period, the size threshold between HB grade I and HB grade > I was 17 mm of CPA extension (c-index 0.65). At the most recent evaluation, the size threshold between HB grade I and HB grade > I was 23 mm (c-index 0.68) and between class A/B and C/D hearing was 18 mm (c-index 0.68). Tumors within 3 mm of the 17-mm CPA threshold displayed similarly strong c-indices. Among purely intracanalicular tumors, linear size was not found to portend worse outcomes for all measures. CONCLUSIONS The probability of incurring less optimal microsurgical outcomes begins to significantly increase at 14-20 mm of CPA extension. Although many factors ultimately influence decision-making, when considering timing of microsurgical resection, using a size threshold range as depicted in this study offers an evidence-based approach that moves beyond reflexively recommending treatment for all tumors after detecting ≥ 2 mm of tumor growth on serial MRI studies.
Collapse
Affiliation(s)
| | | | | | | | | | - Brian A Neff
- 1Department of Otolaryngology-Head and Neck Surgery
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jamie J Van Gompel
- 1Department of Otolaryngology-Head and Neck Surgery
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Colin L W Driscoll
- 1Department of Otolaryngology-Head and Neck Surgery
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J Link
- 1Department of Otolaryngology-Head and Neck Surgery
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew L Carlson
- 1Department of Otolaryngology-Head and Neck Surgery
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
39
|
La Monte OA, Tawfik KO, Khan U, Schwartz M, Friedman R. Analysis of Hearing Preservation in Middle Cranial Fossa Resection of Vestibular Schwannoma. Otol Neurotol 2022; 43:395-399. [PMID: 34999621 DOI: 10.1097/mao.0000000000003445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Describe the effect of preoperative hearing on the likelihood of hearing preservation after middle cranial fossa (MCF) approach for resection of vestibular schwannoma (VS) and the effect of hearing preservation on disease-specific quality of life (QOL). STUDY DESIGN Retrospective chart review. SETTING Academic tertiary care skull base surgery program. PATIENTS Sixty three adult patients with preoperative word recognition score (WRS) ≥50% who underwent MCF resection of VS between 2017 and 2020. INTERVENTIONS All patients underwent MCF VS resection with attempted hearing preservation. MAIN OUTCOME MEASURES Hearing preservation (postoperative WRS ≥50%), hearing-related Penn Acoustic Neuroma Quality of Life (PANQOL) score. RESULTS Sixty three patients with mean age 47.4 (±9.6) years and tumor size 11.5 (±0.5) mm were analyzed. Hearing was preserved (+HP) and lost (-HP) in 37 (58.7%) and 26 (41.3%) patients, respectively. Preoperatively, pure tone average audiometry was significantly lower among the +HP group (20.0 dB) versus -HP (31.0 dB, p < 0.003). WRS was higher among +HP versus -HP (94% vs. 84%, respectively; p < 0.002). Linear regression showed that intra- versus extra-canalicular tumor location, sudden hearing loss history, fundal fluid cap thickness, and tumor size had no relationship to hearing preservation outcomes. When evaluating postoperative QOL data (n = 37) hearing-related PANQOL score differed between +HP and -HP (t35 = 2.458, p = 0.0191) groups. CONCLUSIONS In this cohort of patients undergoing MCF resection of VS, rates of HP were higher for patients with excellent preoperative hearing. Postoperatively, +HP patients reported improved hearing-related PANQOL scores compared to -HP patients.
Collapse
Affiliation(s)
- Olivia A La Monte
- Acoustic Neuroma Program, University of California, San Diego, La Jolla, California, and Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | |
Collapse
|
40
|
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.
Collapse
|
41
|
Ganz JC. Vestibular Schwannomas. PROGRESS IN BRAIN RESEARCH 2022; 268:133-162. [PMID: 35074078 DOI: 10.1016/bs.pbr.2021.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vestibular Schwannomas are well treated by GKNS. This can be used alone for tumors up to 20cm3. For larger tumors subtotal, intracapsular resection followed by GKNS a few months later would seem to give the best results. While there remain disagreements relating to optimal treatment for VSs among colleagues using different techniques, there are indications that these are becoming less confrontational. The evidence in this chapter suggests that early GKNS intervention results in better hearing preservation and tumor control in small tumors. The evidence in favor of "wait and see" depends on series reporting on changes in tumor size using suboptimal measurements. It is more important to record the fate of hearing, and this would seem to be better preserved following early GKNS. The results of GKNS for NF2 are by no means as good as could be wished but would seem to be superior to those of microsurgery. The importance of screening of family members cannot be over emphasized.
Collapse
Affiliation(s)
- Jeremy C Ganz
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
| |
Collapse
|
42
|
Ren Y, McDonald MA, Manning P, MacDonald BV, Schwartz MS, Friedman RA, Harris JP. Dispersed Bone Spicules as a Cause of Postoperative Headache after Retrosigmoid Vestibular Schwannoma Surgery: A Myth? J Neurol Surg B Skull Base 2021; 83:374-382. [PMID: 35903655 PMCID: PMC9324304 DOI: 10.1055/s-0041-1741112] [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: 05/18/2020] [Accepted: 11/05/2021] [Indexed: 01/02/2023] Open
Abstract
Objectives Dispersion of bone dust in the posterior fossa during retrosigmoid craniectomy for vestibular schwannoma (VS) resection could be a source of meningeal irritation and lead to development of persistent postoperative headaches (POH). We aim to determine risk factors, including whether the presence of bone spicules that influence POH after retrosigmoid VS resection. Design Present study is a retrospective case series. Setting The study was conducted at a tertiary skull-base referral center. Participants Adult patients undergoing VS resection via a retrosigmoid approach between November 2017 and February 2020 were included for this study. Main Outcome Measures Development of POH lasting ≥ 3 months is the primary outcome of this study. Results Of 64 patients undergoing surgery, 49 had complete data (mean age, 49 years; 53% female). Mean follow-up time was 2.4 years. At latest follow up, 16 (33%) had no headaches, 14 (29%) experienced headaches lasting <3 months, 19 (39%) reported POH lasting ≥3 months. Twenty-seven (55%) patients had posterior fossa bone spicules detectable on postoperative computed tomography (CT). Age, gender, body mass index, length of stay, tumor diameter, size of craniectomy, the presence of bone spicules, or the amount of posterior petrous temporal bone removed from drilling did not differ significantly between patients with POH and those without. On multivariate logistic regression, patients with POH were less likely to have preoperative brainstem compression by the tumor (odds ratio [OR] = 0.21, p = 0.028) and more likely to have higher opioid requirements during hospitalization (OR = 1.023, p = 0.045). Conclusion The presence of bone spicules in the posterior fossa on postoperative CT did not contribute to headaches following retrosigmoid craniectomy approach for VS resection.
Collapse
Affiliation(s)
- Yin Ren
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States,Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, United States,Address for correspondence Yin Ren, MD, PhD Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology Head and Neck Surgery, The Ohio State University Wexner Medical Center915 Olentangy River Road, Suite 4000, Columbus, OH 43212United States
| | - Marin A. McDonald
- Department of Radiology, University of California San Diego, La Jolla, California, United States
| | - Paul Manning
- Department of Radiology, University of California San Diego, La Jolla, California, United States
| | - Bridget V. MacDonald
- Department of Otolaryngology Head and Neck Surgery, University of California Davis, Sacramento, California, United States
| | - Marc S. Schwartz
- Department of Neurosurgery, University of California San Diego, La Jolla, California, United States
| | - Rick A. Friedman
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, United States
| | - Jeffrey P. Harris
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, United States
| |
Collapse
|
43
|
Brownlee N, Wilson C, Curran DB, Wright G, Flannery T, Caldwell SB. Cognitive and psychosocial outcomes following stereotactic radiosurgery for acoustic neuroma. NeuroRehabilitation 2021; 50:151-159. [PMID: 34957955 DOI: 10.3233/nre-210106] [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: 11/15/2022]
Abstract
BACKGROUND Acoustic Neuroma (AN) is a benign tumour of the eighth cranial nerve. Stereotactic Radiosurgery (SRS) is a common treatment approach. Studies have explored the primary effects of SRS and documented equivalent efficacy for tumour control compared to neurosurgery. OBJECTIVE Examine the longer term cognitive and psychosocial outcomes of SRS in non-Neurofibromatosis Type II patients utilising both objective and subjective cognitive outcomes associated with quality of life and health related distress. METHODS Nineteen individuals treated via SRS were assessed using a battery of standardised psychometric tests as well as measures of quality of life and psychological distress. RESULTS Participants had largely preserved cognitive function except for processing speed, aspects of attention and visual memory relative to age norms. Self-reported quality of life was better than in other AN population studies. Level of psychological distress was equivalent to general population norms. More than half of participants reported subjective cognitive decline though this was not fully supported by objective testing. Subjective cognitive complaints may be associated with lower reported quality of life. CONCLUSIONS Results are largely consistent with previous findings on the effects of SRS in other clinical groups, which supports SRS as a targeted radiation treatment for AN.
Collapse
Affiliation(s)
| | - Colin Wilson
- Regional Acquired Brain Injury Unit (RABIU), Musgrave Park Hospital, Belfast, Northern Ireland
| | - David B Curran
- Clinical Psychology Department, David KeirBuilding, Queen's University Belfast, Belfast, Northern Ireland
| | - Gavin Wright
- Medical Physics and Engineering Department, St.James's University Hospital, Leeds, UK
| | - Tom Flannery
- Departmentof Neurosurgery, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Sheena B Caldwell
- Regional Acquired Brain Injury Unit (RABIU), Belfast, Northern Ireland
| |
Collapse
|
44
|
Wallerius KP, Macielak RJ, Lawlor SK, Lohse CM, Neff BA, Van Gompel JJ, Driscoll CLW, Link MJ, Carlson ML. Hearing Preservation Microsurgery in Vestibular Schwannomas: Worth Attempting in "Larger" Tumors? Laryngoscope 2021; 132:1657-1664. [PMID: 34854492 DOI: 10.1002/lary.29968] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES/HYPOTHESIS To review hearing preservation after microsurgical resection of sporadic vestibular schwannomas according to tumor size. STUDY DESIGN Retrospective cohort. METHODS Baseline, intraoperative, and postoperative patient and tumor characteristics were retrospectively collected for a cohort who underwent hearing preservation microsurgery. Serviceable hearing was defined by a pure tone average ≤50 dB and word recognition score ≥50%. RESULTS A total of 243 patients had serviceable hearing preoperatively. Fifty (21%) tumors were confined to the internal auditory canal, and the median tumor size was 16.2 mm (interquartile range [IQR] 11.3-23.2) for tumors with cerebellopontine angle extension. Serviceable hearing was maintained in 64% of patients with tumors confined to the internal auditory canal, 28% with cerebellopontine angle extension <15 mm, and 9% with cerebellopontine angle extension ≥15 mm. On multivariable analysis, the odds ratios of acquiring nonserviceable hearing postoperatively for tumors extending <15 mm and ≥15 mm into the cerebellopontine angle were 5.75 (95% confidence interval [CI] 2.13-15.53; P < .001) and 22.11 (95% CI 7.04-69.42; P < .001), respectively, compared with intracanalicular tumors. CONCLUSIONS The strongest predictor of hearing preservation with microsurgery after multivariable adjustment is tumor size. Approximately 10% of patients with tumors ≥15 mm of cerebellopontine angle extension will retain serviceable hearing after microsurgery. Furthermore, hearing preservation techniques offer cochlear nerve preservation and cochlear patency allowing for possible future cochlear implantation. An attempt at hearing preservation, including avoiding surgical approaches that necessarily sacrifice hearing, is worthwhile even in larger tumors if serviceable hearing is present preoperatively. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
Collapse
Affiliation(s)
- Katherine P Wallerius
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Robert J Macielak
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Skye K Lawlor
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Brian A Neff
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jamie J Van Gompel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Colin L W Driscoll
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michael J Link
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| |
Collapse
|
45
|
Landry AP, Yang K, Wang JZ, Gao AF, Zadeh G. Outcomes in vestibular schwannoma treated with primary microsurgery: Clinical landscape. J Clin Neurosci 2021; 96:138-146. [PMID: 34802892 DOI: 10.1016/j.jocn.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/30/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Vestibular schwannoma (VS) is the most common tumour of the cerebellopontine angle. Owing to complex anatomy and high rates of morbidity, surgical management of large tumours is challenging. We seek to explore the clinical landscape of VS to identify predictors of outcome and help guide surgical decision making. METHODS We retrospectively reviewed charts of patients who underwent primary surgery for VS between 2005 and 2020 at a quaternary referral center in Toronto, Canada. Mined data includes patient demographics, clinical presentation, radiological features, and treatment details. Regression modelling was used to identify predictors of tumour control, postoperative morbidity, and correlates of progression free survival (PFS). RESULTS Two hundred and five tumours with sufficient data were included in our study. Syndromic NF2, large tumours (>3cm), subtotal resection (vs gross total resection), presence of edema on preoperative MRI, and preoperative trigeminal symptoms were all predictors of postoperative progression/need for further treatment; the latter four were also associated with shorter progression free survival. Extent of resection (EOR), tumour size, and Koos grade were independently predictive of postoperative progression/secondary intervention in multivariate models; however, only EOR was independently predictive of progression-free survival. EOR, tumour size, and patient age are each independently predictive of facial nerve outcome. CONCLUSIONS We comprehensively explore the clinical landscape of surgically treated vestibular schwannoma and highlight important outcome predictors and disease subgroups. This may have important implications in risk stratifying these challenging cases.
Collapse
Affiliation(s)
- Alexander P Landry
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Kaiyun Yang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Justin Z Wang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andrew F Gao
- Division of Neuropathology, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
46
|
Wijn SRW, Hentschel MA, Beynon AJ, Kunst HPM, Rovers MM. Auditory brainstem response prior to MRI compared to standalone MRI in the detection of vestibular schwannoma: A modelling study. Clin Otolaryngol 2021; 47:295-303. [PMID: 34784107 PMCID: PMC9298692 DOI: 10.1111/coa.13894] [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: 06/25/2021] [Revised: 10/25/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022]
Abstract
Objectives To determine the cost‐effectiveness of auditory brainstem response prior to MRI (ABR‐MRI) compared to standalone MRI to diagnose vestibular schwannoma. Design A state transition model was developed to simulate costs and effects (quality‐adjusted life years [QALY]) for both diagnostic strategies for patients suspected of a vestibular schwannoma. Model input was derived from literature, hospital databases and expert opinions. Scenario and sensitivity analyses addressed model uncertainty. Results Over a lifetime horizon, ABR‐MRI resulted in a limited cost‐saving of €68 or €98 per patient (dependent on MRI sequence) and a health loss of 0.005 QALYs over standalone MRI. ABR‐MRI, however, did miss patients with other important pathology (2% of the population) that would have been detected when using standalone MRI. In total, €14 203 or €19 550 could be saved per lost QALY if ABR‐MRI was used instead of standalone MRI. The results were sensitive to the detection rate of vestibular schwannoma and health‐related quality of life of missed patients. Conclusion The cost‐saving with ABR‐MRI does not seem to outweigh the number of missed patients with VS and other important pathologies that would have been detected when using standalone MRI.
Collapse
Affiliation(s)
- Stan R W Wijn
- Department of Operating Rooms, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mayke A Hentschel
- Department of Otolaryngology, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.,Academic Alliance Skull Base Pathology, Radboud University Medical Centre & Maastricht University Medical Centre, Nijmegen & Maastricht, The Netherlands
| | - Andy J Beynon
- Department of Otolaryngology, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.,Academic Alliance Skull Base Pathology, Radboud University Medical Centre & Maastricht University Medical Centre, Nijmegen & Maastricht, The Netherlands
| | - Henricus P M Kunst
- Department of Otolaryngology, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.,Academic Alliance Skull Base Pathology, Radboud University Medical Centre & Maastricht University Medical Centre, Nijmegen & Maastricht, The Netherlands.,Department of Otorhinolaryngology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
47
|
Macielak RJ, Thao V, Borah BJ, Moriarty JP, Marinelli JP, Van Gompel JJ, Carlson ML. Lifetime Cost and Quality-Adjusted Life-Years Across Management Options for Small- and Medium-Sized Sporadic Vestibular Schwannoma. Otol Neurotol 2021; 42:e1369-e1375. [PMID: 34282100 DOI: 10.1097/mao.0000000000003266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite the growing emphasis on healthcare costs, limited data address this aspect of care within the vestibular schwannoma (VS) literature. We sought to determine which strategy confers the lowest lifetime cost and greatest quality-adjusted life-years (QALYs) for patients with small- to medium-sized sporadic VS tumors. STUDY DESIGN A Markov model was created to determine the most cost-effective management algorithm. Tumor characteristics, magnetic resonance imaging surveillance schedule, treatment outcomes, and health-related quality of life values were derived from previously published data. Cost estimates were based on CMS Fee Schedule reimbursement rates. SETTING Economic Evaluation Service within the Kern Center for the Science of Healthcare Delivery. PATIENTS Patients diagnosed with small- to medium-sized sporadic VS. INTERVENTIONS Upfront microsurgery following diagnosis, upfront radiosurgery following diagnosis, observation with microsurgery reserved for observed tumor growth, and observation with radiosurgery reserved for observed tumor growth. RESULTS Across patient ages at time of diagnosis ranging from 18 to 70 years, observation with subsequent radiosurgery used for tumor growth was the most cost-effective management algorithm while upfront microsurgery was the least. When presented with a hypothetical 50-year-old patient, the strategy with the lowest lifetime cost and highest QALYs was observation with subsequent radiosurgery reserved for tumor growth ($32,161, 14.11 QALY), followed by observation with microsurgery reserved for tumor growth ($34,503, 13.94 QALY), upfront radiosurgery ($43,456, 14.02 QALY), and lastly, upfront microsurgery ($47,252, 13.60 QALY). Sensitivity analyses varying mortality rates, estimated costs, health-related quality of life, and progression to nonserviceable hearing demonstrated consistent ranking among treatments. CONCLUSIONS When considering initial management of small- and medium-sized sporadic VSs, neither lifetime cost nor QALYs support upfront microsurgery or radiosurgery, even for younger patients. Initial observation with serial imaging, reserving radiosurgery or microsurgery for patients exhibiting tumor growth, confers the greatest potential for optimized lifetime healthcare cost and QALY outcomes.
Collapse
Affiliation(s)
| | - Viengneesee Thao
- Division of Health Care Policy Research, Department of Health Sciences Research
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
| | - Bijan J Borah
- Division of Health Care Policy Research, Department of Health Sciences Research
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
| | - James P Moriarty
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
| | | | - Jamie J Van Gompel
- Department of Otolaryngology-Head and Neck Surgery
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
48
|
Patro A, Totten DJ, Sherry AD, Manzoor NF, Cass ND, Tawfik K, Bennett ML, O'Malley MR, Haynes DS, Perkins EL. Outcomes of Initial Observation Versus Upfront Microsurgical Resection for Small to Medium-sized Vestibular Schwannomas. Otol Neurotol 2021; 42:1408-1413. [PMID: 34149031 DOI: 10.1097/mao.0000000000003243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess postoperative outcomes and predictive factors of patients observed prior to microsurgery and those undergoing upfront resection for small and medium-sized VS. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS VS patients who had microsurgery from 2003 to 2018 for tumors up to 2.5 cm. MAIN OUTCOME MEASURES Postoperative outcomes including facial nerve function and interventions, complications, extent of resection, and salvage therapy. RESULTS Of 220 patients, 120 were initially observed, and 100 pursued upfront microsurgery. There was no significant association between initial observation and upfront microsurgery for postoperative facial nerve function at 2 to 3 weeks (p = 0.18) or 12 months (p = 0.5), facial nerve intervention (p = 0.5), major/minor complications (p = 0.48/0.63), recurrence (p = 0.8), subtotal resection (p = 0.6), or salvage therapy (p = 0.9). Time from initial consultation to surgery did not significantly impact outcomes. Intrameatal tumors were more likely to be observed (odds ratios [OR] 2.93; 95% CI 1.53-5.63; p = 0.001). Patients with larger tumor volume (OR 0.52; 95% CI 0.37-0.72; p < 0.0001), brainstem compression (OR 0.28; 95% CI 0.09-0.91; p = 0.03), or higher PTA were less likely to undergo observation (OR 0.99; 95% CI 0.97-0.997; p = 0.02). On multivariable analysis, predictive factors for observation were smaller tumor volume (OR 0.53; 95% CI 0.38-0.75; p < 0.001), lower PTA (OR 0.99; 95% CI 0.98-0.999; p = 0.04), and diabetes (OR 2.54; 95% CI 0.95-6.83; p = 0.06). CONCLUSIONS Patients with worse hearing, larger tumor volume, and brainstem compression were more likely to pursue upfront microsurgery. A watchful waiting period does not appear to worsen outcomes and can be considered for patients with better hearing and smaller tumors without brainstem compression.
Collapse
Affiliation(s)
- Ankita Patro
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | | | | | - Nauman F Manzoor
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals, ENT Institute, Case Western Reserve University, Cleveland, Ohio
| | - Nathan D Cass
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Kareem Tawfik
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Marc L Bennett
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Matthew R O'Malley
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - David S Haynes
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Elizabeth L Perkins
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| |
Collapse
|
49
|
Raymond M, Ghanouni A, Brooks K, Clark SM, Mattox DE. Adherence to Long-Term Follow-up in Patients With Sporadic Vestibular Schwannomas Managed With Serial Observation. OTO Open 2021; 5:2473974X211036653. [PMID: 34396030 PMCID: PMC8358519 DOI: 10.1177/2473974x211036653] [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: 04/29/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives To examine the long-term adherence to serial imaging of patients with sporadic vestibular schwannoma and analyze factors associated with being lost to follow-up. Study Design Retrospective chart review with telephone interview. Setting Single tertiary care center. Methods Patients with a sporadic vestibular schwannoma and started on observational surveillance management between January 2005 and December 2010 were included. Demographic data, tumor size, hearing and vestibular changes, and follow-up length were recorded. Patient factors were analyzed for association with being lost to follow-up. Results In total, 122 patients were included with a median length of follow-up of 5 months (range, 0-146). After initial surveillance, 22.1% (n = 27) of patients had a change in management to either microsurgery or radiosurgery. Of the remaining 77.9% (n = 95), nearly half (44.2%, n = 42) never returned for a second visit, and all but 3 were eventually lost to follow-up. There was no association between sex, race, age at diagnosis, initial tumor size, insurance status, household income, or driving distance to hospital and being lost to follow-up. Of 26 interviewed patients initially lost to follow-up, 11 (42.3%) sought care at another institution, 5 (19.2%) chose to no longer receive care, 1 (3.8%) had transportation difficulties, and 9 (36.4%) had poor understanding of their diagnosis or instructions. Conclusions The length of follow-up for patients undergoing surveillance of sporadic vestibular schwannoma varies widely, and patients are commonly lost to follow-up. Further efforts should be made to identify at-risk patients and provide adequate education to improve long-term surveillance.
Collapse
Affiliation(s)
- Mallory Raymond
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Arian Ghanouni
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kaitlyn Brooks
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sarah M. Clark
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Douglas E. Mattox
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Douglas E. Mattox, MD, Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, 550 Peachtree Street NE 11th Floor, Atlanta, GA 30308, USA.
| |
Collapse
|
50
|
Kiyofuji S, Neff BA, Carlson ML, Driscoll CLW, Link MJ. Large and small vestibular schwannomas: same, yet different tumors. Acta Neurochir (Wien) 2021; 163:2199-2207. [PMID: 33471207 DOI: 10.1007/s00701-021-04705-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vestibular schwannomas (VS) present at variable size with heterogeneous symptomatology. Modern treatment paradigms for large VS include gross total resection, subtotal resection (STR) in combination with observation, and/or radiation to achieve optimal function preservation, whereas treatment is felt to be both easier and safer for small VS. The objective is to better characterize the presentation and surgical outcomes of large and small VS. METHODS We collected data of patients who had surgically treated VS with a posterior fossa diameter of 4.0 cm or larger (large tumor group, LTG) and smaller than 1.0 cm in cisternal diameter (small tumor group, STG). Statistical significance was defined as p < 0.05. RESULTS LTG included 48 patients (average tumor size: 44.9 mm) and STG 38 (7.9 mm). Patients in STG presented more frequently with tinnitus and sudden hearing loss. Patients in LTG underwent more STR than STG (50.0% vs. 2.6%, p < 0.0001). LTG had more complications (31.3% vs. 13.2%, p = 0.049). Postoperative facial nerve function in STG was significantly better than LTG. STG had better hearing preoperatively (p < 0.0001) and postoperatively than LTG (p = 0.0002). Postoperative headache was more common in STG (13.2% vs. 2.1%, p = 0.045). The rate of recurrence/progression needing treatment was not statistically different between the groups (12.5% in LTG vs. 7.9% in STG, p = 0.49). Those patients who required periprocedural cerebrospinal fluid diversion had higher risk of infection (20.8% vs 4.8%, p = 0.022). CONCLUSION Large and small VS present differently. LTG showed more unsatisfactory outcomes in facial nerve function and postoperative hearing despite maximal efforts undertaken toward function-preservation strategy; however, similar tumor control was achieved.
Collapse
Affiliation(s)
- Satoshi Kiyofuji
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 154-0023, Japan.
- Department of Neurologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Brian A Neff
- Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Carlson
- Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| |
Collapse
|