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The Journal of Laryngology and Otology Jun 2020To present our data evaluating the feasibility of simultaneous cochlear implantation with resection of acoustic neuroma.
OBJECTIVE
To present our data evaluating the feasibility of simultaneous cochlear implantation with resection of acoustic neuroma.
METHODS
This paper describes a case series of eight adult patients with a radiologically suspected acoustic neuroma, treated at a tertiary referral centre in Newcastle, Australia, between 2012 and 2015. Patients underwent cochlear implantation concurrently with removal of an acoustic neuroma. The approach was translabyrinthine, with facial nerve monitoring and electrically evoked auditory brainstem response testing. Standard post-implant rehabilitation was employed, with three and six months' follow-up data collected. The main outcome measures were: hearing, subjective benefit of implant, operative complications and tumour recurrence.
RESULTS
Eight patients underwent simultaneous cochlear implantation with resection of acoustic neuroma over a 3-year period, and had 25-63 months' follow up. There were no major complications. All patients except one gained usable hearing and were daily implant users.
CONCLUSION
Simultaneous cochlear implantation with resection of acoustic neuroma has been shown to be a safe treatment option, which will be applicable in a wide range of clinical scenarios as the indications for cochlear implantation continue to expand.
Topics: Adolescent; Aged; Australia; Cochlear Implantation; Combined Modality Therapy; Evoked Potentials, Auditory, Brain Stem; Facial Nerve; Feasibility Studies; Follow-Up Studies; Hearing; Hearing Tests; Humans; Middle Aged; Neoplasm Recurrence, Local; Neuroma, Acoustic; Postoperative Complications; Retrospective Studies; Tertiary Care Centers; Treatment Outcome
PubMed: 32613920
DOI: 10.1017/S0022215120000705 -
HNO May 2017Magnetic resonance imaging (MRI) is the imaging method of choice for patients with vestibular schwannoma, with almost 100 % sensitivity and specificity. The role of... (Review)
Review
Magnetic resonance imaging (MRI) is the imaging method of choice for patients with vestibular schwannoma, with almost 100 % sensitivity and specificity. The role of computed tomography (CT) is limited to preoperative planning and the postoperative phase. High-resolution sequences and the application of gadolinium-based i.v. contrast medium are crucial for MRI-based diagnosis. Description of the size and location of the tumor, as well as its relationship to adjacent structures and anatomic features, is essential, since these factors, in addition to clinical findings, influence the type of treatment, surgical options, and associated risks. A postoperative linear contrast enhancement is often seen for up to 6 months and sometimes even longer. However, if this is of nodular structure, a recurrent schwannoma is likely. A sufficient statement regarding tumor response is not possible within the first 24 months after stereotactic radiosurgery. An increasing tumor volume after 24 months indicates failure of the treatment. Knowledge of the features of vestibular schwannomas allows all other possible differential diagnoses to be confidently excluded.
Topics: Contrast Media; Diagnosis, Differential; Evidence-Based Medicine; Gadolinium; Humans; Image Enhancement; Magnetic Resonance Imaging; Neuroimaging; Neuroma, Acoustic; Tomography, X-Ray Computed
PubMed: 27534761
DOI: 10.1007/s00106-016-0227-6 -
Clinical Neurophysiology : Official... Sep 2015
Topics: Electromyography; Facial Nerve; Female; Humans; Male; Monitoring, Intraoperative; Neuroma, Acoustic
PubMed: 25680949
DOI: 10.1016/j.clinph.2015.01.002 -
Laryngo- Rhino- Otologie Mar 2024The treatment of vestibular schwannomas (VS) has always posed a challenge for physicians. Three essential treatment principles are available: wait-and-scan, surgery, and... (Review)
Review
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.
Topics: Humans; Hearing; Neuroma, Acoustic; Radiosurgery; Treatment Outcome
PubMed: 38128578
DOI: 10.1055/a-2222-0878 -
Otolaryngologic Clinics of North America Jun 2023Vestibular schwannomas continue to cause hearing loss, facial nerve paralysis, imbalance, and tinnitus. These symptoms are compounded by germline neurofibromatosis type... (Review)
Review
Vestibular schwannomas continue to cause hearing loss, facial nerve paralysis, imbalance, and tinnitus. These symptoms are compounded by germline neurofibromatosis type 2 (NF2) gene loss and multiple intracranial and spinal cord tumors associated with NF2-related schwannomatosis. The current treatments of observation, microsurgical resection, or stereotactic radiation may prevent catastrophic brainstem compression but are all associated with the loss of cranial nerve function, particularly hearing loss. Novel targeted treatment options to stop tumor progression include small molecule inhibitors, immunotherapy, anti-inflammatory drugs, radio-sensitizing and sclerosing agents, and gene therapy.
Topics: Humans; Neuroma, Acoustic; Neurilemmoma; Neurofibromatoses; Skin Neoplasms; Hearing Loss; Neurofibromatosis 2
PubMed: 37024334
DOI: 10.1016/j.otc.2023.02.013 -
The Journal of International Advanced... Jan 2023Few investigations have been conducted on the clinical characteristics of the differential diagnosis of acoustic neuroma with acute sensorineural hearing loss and...
BACKGROUND
Few investigations have been conducted on the clinical characteristics of the differential diagnosis of acoustic neuroma with acute sensorineural hearing loss and idiopathic sudden sensorineural hearing loss. The aim of the study was to investigate the clinical characteristics of the differential diagnoses between acoustic neuroma and idiopathic sudden sensorineural hearing loss.
METHODS
The medical records of patients with acute sensorineural hearing loss (142 ears), including acoustic neuroma (19 ears) and idiopathic sudden sensorineural hearing loss (123 ears), who underwent audiometric and hematologic examinations and received systemic corticosteroid treatment, were retrospectively reviewed.
RESULTS
Hematological examination revealed that the erythrocyte sedimentation rate and fibrinogen values were significantly higher in the idiopathic sudden sensorineural hearing loss group compared to the acoustic neuroma group. Although all patients received corticosteroid treatment, hearing thresholds at the initial examination and 3 months after corticosteroid treatment were significantly higher in the idiopathic sudden sensorineural hearing loss group compared to the acoustic neuroma group at all frequencies. However, hearing recovery was worse in the acoustic neuroma group compared to the idiopathic sudden sensorineural hearing loss group. Furthermore, speech discrimination and short increment sensitivity index tests were not significantly different between the acoustic neuroma and idiopathic sudden sensorineural hearing loss groups.
CONCLUSION
This is the first study to reveal that speech discrimination and short increment sensitivity index tests are not useful for the differential diagnoses between acoustic neuroma and idiopathic sudden sensorineural hearing loss, whereas erythrocyte sedimentation rate and fibrinogen, blood biomarkers of inflammation and blood viscosity, would be considered valuable. Furthermore, acoustic neuroma should be considered in cases where acute sensorineural hearing loss did not recover after corticosteroid treatment, although the initial hearing loss was mild.
Topics: Humans; Neuroma, Acoustic; Retrospective Studies; Hearing Loss, Sensorineural; Hearing Loss, Sudden; Adrenal Cortex Hormones; Fibrinogen
PubMed: 36718029
DOI: 10.5152/iao.2023.22720 -
Neurology India 2023Stereotactic radiosurgery (SRS) is an established modality of treatment for vestibular schwannomas (VS). We aim to summarize the evidence-based use of SRS in VSs and... (Review)
Review
Stereotactic radiosurgery (SRS) is an established modality of treatment for vestibular schwannomas (VS). We aim to summarize the evidence-based use of SRS in VSs and address the specific considerations pertaining to the same, along with our own clinical experiences. A thorough review of the literature was done to gather evidence regarding the safety and efficacy of SRS in VSs. Additionally, we have reviewed the senior author's experience in treating VSs (N = 294) between 2009 and 2021 and our experiences with microsurgery in post-SRS patients. Available scientific evidence upholds the role of SRS in VSs, in small-to-medium-sized tumors (5-year local tumor control >95%). The risk of adverse radiation effects remains minimal, while the hearing preservation rates are variable. Our center's post-GammaKnife VS follow-up cohort (sporadic - 157, neurofibromatosis-2 - 14) showed excellent tumor control rates at the last follow-up of 95.5% (sporadic) and 93.8% (neurofibromatosis-2), with a median margin dose of 13 Gy and mean follow-up periods of 3.6 (sporadic) and 5.2 (neurofibromatosis-2) years. Microsurgery in post-SRS VSs poses a formidable challenge due to the resulting thickened arachnoid and adhesions to critical neurovascular structures. Near-total excision is the key to better functional outcomes in such cases. SRS is here to stay as a trusted alternative in the management of VSs. Further studies are required to propose means of accurate prediction of hearing preservation rates and also to compare the relative efficacies of various SRS modalities.
Topics: Humans; Neuroma, Acoustic; Radiosurgery; Hearing Tests; Microsurgery; Neurofibromatoses; Treatment Outcome; Follow-Up Studies; Retrospective Studies
PubMed: 37026342
DOI: 10.4103/0028-3886.373653 -
NeuroRehabilitation 2022Acoustic Neuroma (AN) is a benign tumour of the eighth cranial nerve. Stereotactic Radiosurgery (SRS) is a common treatment approach. Studies have explored the primary...
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.
Topics: Cognition; Humans; Neuroma, Acoustic; Quality of Life; Radiosurgery; Treatment Outcome
PubMed: 34957955
DOI: 10.3233/NRE-210106 -
Progress in Neurological Surgery 2019Vestibular schwannomas (VS) are benign tumors predominantly originating from the balance portion of cranial nerve VIII. These tumors have an incidence of 1-2 per 100,000... (Review)
Review
Vestibular schwannomas (VS) are benign tumors predominantly originating from the balance portion of cranial nerve VIII. These tumors have an incidence of 1-2 per 100,000 people. The growth of these tumors is approximately 1-2 mm per year. A VS can result in significant neurologic dysfunction from continued growth or the management paradigms designed to control this predominantly benign tumor. The impacts on the critical space within the auditory canal and cerebellopontine angle can lead to hearing deficits, tinnitus, vestibular dysfunction, facial nerve deficits, and brain stem compression.
Topics: Humans; Neuroma, Acoustic; Radiosurgery
PubMed: 31096208
DOI: 10.1159/000493053 -
Sichuan Da Xue Xue Bao. Yi Xue Ban =... Jul 2022Vestibular schwannoma (VS) is one of the most common types of benign tumors of the central nervous system. At present, the prevailing treatment methods of VS include... (Review)
Review
Vestibular schwannoma (VS) is one of the most common types of benign tumors of the central nervous system. At present, the prevailing treatment methods of VS include surgery, stereotactic radiotherapy, and follow-up observation, etc. However, there is still no drug therapy available for treating VS. Although the surgical technique is relatively mature, the complications cannot be completely avoided. Furthermore, both the growth rate of different cases and patients' sensitivity to radiotherapy vary greatly. With the constant progress made in molecular biology research, most of the studies on the growth mechanism of VS focus on the upstream and downstream of neurofibromin 2 ( 2) gene and merlin protein, and a number of corresponding targets, including receptor protein tyrosine kinase (RTK), vascular endothelial growth factor receptor (VEGFR), mammalian target of rapamycin complex 1 (mTORC1) and platelet derived growth factor receptor (PDGFR). It has been reported in some studies that quite a few drugs could inhibit the proliferation of VS cells. Most of the studies are still in the stage of cell experiment and/or animal experiment. A small number of studies have entered phase Ⅰ and phase Ⅱ clinical trials, but have not led to any clinical treatment yet. This paper provides a comprehensive understanding of the current status and the prospects of drug therapies of VS, which is conducive to the development of subsequent research.
Topics: Animals; Mammals; Neurofibromin 2; Neuroma, Acoustic; Vascular Endothelial Growth Factor A
PubMed: 35871721
DOI: 10.12182/20220760202