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Neurosurgical Review Apr 2021Management options for newly diagnosed vestibular schwannoma (VS) include observation, surgery, or radiation. There are no randomized trials to guide management of... (Review)
Review
Management options for newly diagnosed vestibular schwannoma (VS) include observation, surgery, or radiation. There are no randomized trials to guide management of patients with VS. This article is a short review of the role of stereotactic radiosurgery in management of newly diagnosed VS.
Topics: Disease Management; Female; Humans; Neuroma, Acoustic; Prospective Studies; Radiosurgery
PubMed: 32170501
DOI: 10.1007/s10143-020-01279-2 -
Epidemiology (Cambridge, Mass.) Sep 2014
Topics: Cell Phone; Female; Humans; Male; Neuroma, Acoustic
PubMed: 25076157
DOI: 10.1097/EDE.0000000000000134 -
Neuroimaging Clinics of North America Nov 2021Appropriate imaging strategies for the detection, treatment planning, and posttreatment monitoring of vestibular schwannomas will be discussed. The typical and variant... (Review)
Review
Appropriate imaging strategies for the detection, treatment planning, and posttreatment monitoring of vestibular schwannomas will be discussed. The typical and variant imaging appearances of vestibular schwannomas, as well as the imaging features that should prompt consideration of differential diagnoses, will be illustrated. Understanding the natural history of vestibular schwannomas, optimal measurement and definition of tumour growth helps the radiologist evaluate for the failure of conservative management and requirement for surgery or radiotherapy. In order to determine the success of conservative management, the radiologist is required to understand the natural history of vestibular schwannomas and how tumour growth is defined. Finally, the imaging features which help guide appropriate treatment with surgery or radiotherapy will be highlighted, and the expected posttreatment imaging changes will be described.
Topics: Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Neuroma, Acoustic; Radiologists
PubMed: 34689927
DOI: 10.1016/j.nic.2021.05.006 -
British Journal of Neurosurgery Oct 2023Malignant change in vestibular schwannoma is rare and intracranial metastatic deposits have not been reported.
BACKGROUND
Malignant change in vestibular schwannoma is rare and intracranial metastatic deposits have not been reported.
CLINICAL PRESENTATION
We report the case of a 64 year old woman with a benign vestibular schwannoma who underwent translabyrinthine excision in 1996 and Gamma Knife radiosurgery (Elekta AB, Stockholm, Sweden) (GKRS) in 2006. She presents 10 years after GKRS with progressive neurological deterioration. Histopathologic analysis confirms a malignant peripheral nerve sheath tumour, WHO grade IV with subsequent metastatic spread to the left thalamus confirmed on biopsy.
CONCLUSION
We report a rare case of a vestibular schwannoma metastasizing with histological confirmation. It also reminds us of malignant conversion of a benign vestibular schwannoma following GKRS and subsequent aggressive behaviour, with poor prognosis.
Topics: Female; Humans; Middle Aged; Neuroma, Acoustic; Radiosurgery
PubMed: 33686895
DOI: 10.1080/02688697.2021.1884650 -
Der Nervenarzt Jun 2019Vestibular schwannomas are primary benign tumors of the cerebellopontine angle originating either from the superior or the inferior vestibular nerve. Hearing... (Review)
Review
Vestibular schwannomas are primary benign tumors of the cerebellopontine angle originating either from the superior or the inferior vestibular nerve. Hearing deterioration is the leading symptom, which is why the widespread name for this tumor is acoustic neuroma. Due to the widespread availability of magnetic resonance imaging (MRI), the diagnosis of vestibular schwannoma is frequently made in an early stage of the disease. In these cases a wait and scan policy is recommended. If the tumor grows, the therapeutic options are stereotactic radiotherapy or microsurgical tumor operation. Young patient age, functional hearing ability, persistent dizziness, cystic tumor consistence and large space-occupying tumor size are in favor of surgery via the retrosigmoid, transmeatal approach. In experienced hands excellent results in terms of functional preservation of the facial nerve and the cochlear nerve and radical tumor resection can be obtained.
Topics: Humans; Magnetic Resonance Imaging; Neuroma, Acoustic; Radiosurgery
PubMed: 31076802
DOI: 10.1007/s00115-019-0721-7 -
Laryngo- Rhino- Otologie Dec 2017
Topics: Aged; Audiometry, Speech; Cochlear Implantation; Diagnosis, Differential; Disease Progression; Dysarthria; Female; Humans; Interdisciplinary Communication; Intersectoral Collaboration; Magnetic Resonance Imaging; Neuroma, Acoustic; Postoperative Complications; Reoperation; Speech Perception
PubMed: 28666284
DOI: 10.1055/s-0043-113041 -
HNO May 2017Recent surgical treatment concepts for patients with vestibular schwannoma (VS) require an interdisciplinary approach as well as recognition and mastering of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recent surgical treatment concepts for patients with vestibular schwannoma (VS) require an interdisciplinary approach as well as recognition and mastering of complications.
OBJECTIVE
This paper provides an overview of indications, as well as possible options for function preservation and management of complications in the surgical resection of these tumors.
METHODS
Up-to-date treatment concepts and surgical indications were differentiated according to size and extent of tumors. The frequency of important complications was extracted from the literature. Technical options to avoid and correct complications were compiled from personal experience and review of the literature.
RESULTS
Complications unrelated to cranial nerves are not infrequent, particularly in older patients. Small and medium-sized tumors that do not reach the fundus and cochlear fossa can be completely removed with good chances of hearing preservation. As long as these tumors do not grow, patients benefit from observation. Large tumors are overrepresented in surgical series compared to their prevalence. Postoperative facial nerve function correlates to tumor volume. Hearing preservation in these tumors is rare. Intraoperative electrophysiological techniques are valuable for attempted preservation of cranial nerve function. Persistent facial palsies can be remedied by dynamic and static interventions for facial rehabilitation.
CONCLUSION
Mortality and morbidity associated with surgical treatment of VS are very acceptable. Surgical concepts should be custom-tailored to the individual patient in order to ensure high quality of life.
Topics: Evidence-Based Medicine; Humans; Incidence; Microsurgery; Neoplasm Recurrence, Local; Neuroma, Acoustic; Neurosurgical Procedures; Postoperative Complications; Risk Factors; Treatment Outcome
PubMed: 28108789
DOI: 10.1007/s00106-016-0320-x -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Dec 2022To analyze the clinical characteristics of unilateral acoustic neuroma(AN) with normal hearing, so as to provide evidence for early identification AN. Clinical datas...
To analyze the clinical characteristics of unilateral acoustic neuroma(AN) with normal hearing, so as to provide evidence for early identification AN. Clinical datas from 73 patients of unilateral AN with normal hearing of Otorhinolaryngology Head and Neck Surgery of Beijing Tiantan Hospital affiliated of Capital Medical University from August 2019 to April 2022 admitted to department were retrospectively analyzed. All patients underwent pure tone audiometry(PTA), speech discrimination score(SDS), auditory brainstem response(ABR), distortion product otoacoustic emission(DPOAE) and head enhanced MRI. The incidence of normal hearing among patients with AN was 10.7%. Male∶female=1∶2.2; the mean age of the patients was(37.3±9.4) years; the mean tumor size was(24.2±11.2) mm. Tinnitus was the most common reason for visit; the patients who had headache and dizziness had larger tumors. Surgery was the main treatment, and the patients who underwent surgery had larger tumors than those of follow-up. Heterogeneous tumors were the most common type of MRI, homogeneous tumors were smaller than heterogeneous and cystic tumors. The sensitivity of ABR in the diagnosis of AN with normal hearing was 95.9%, and that of ≥20 mm tumors was 100%; prolonged Ⅴ-waves were the most common, patients with Ⅴ-wave deletion had larger tumors than those with normal or prolonged Ⅴ-waves. Patients who had the longer the Ⅴ-wave and the longer difference between Ⅰ-Ⅴ wave had larger tumors. DPOAE was not elicited at full frequency in 11 patients. There was no statistically significant difference in age among patients with different symptoms, treatments, types of MRI, ABR and DPOAE. AN of normal hearing was most common in 30-39 years old women. Patients had different symptoms, phenotypes of MRI and ABR. Patients with normal hearing who had tinnitus, dizziness, headache, facial paraesthesia, and recovery after sudden haring loss can be further examination of ABR and DPOAE for early identification AN. The sensitivity of ABR in diagnosis of hearing normal AN was 95.9%, and the abnormal type of Ⅴ-wave is related to tumor size.
Topics: Female; Humans; Tinnitus; Neuroma, Acoustic; Retrospective Studies; Dizziness; Auditory Threshold; Hearing; Evoked Potentials, Auditory, Brain Stem; Vertigo; Audiometry, Pure-Tone
PubMed: 36543395
DOI: 10.13201/j.issn.2096-7993.2022.12.002 -
Science Advances Nov 2023Vestibular schwannoma (VS) is an intracranial tumor arising from neoplastic Schwann cells and typically presenting with hearing loss. The traditional belief that hearing...
Vestibular schwannoma (VS) is an intracranial tumor arising from neoplastic Schwann cells and typically presenting with hearing loss. The traditional belief that hearing deficit is caused by physical expansion of the VS, compressing the auditory nerve, does not explain the common clinical finding that patients with small tumors can have profound hearing loss, suggesting that tumor-secreted factors could influence hearing ability in VS patients. We conducted profiling of patients' plasma for 66 immune-related factors in patients with sporadic VS ( > 170) and identified and validated candidate biomarkers associated with tumor size (S100B) and hearing (MCP-3). We further identified a nine-biomarker panel (TNR-R2, MIF, CD30, MCP-3, IL-2R, BLC, TWEAK, eotaxin, and S100B) with outstanding discriminatory ability for VS. These findings revealed possible therapeutic targets for VS, providing a unique diagnostic tool that may predict hearing change and tumor growth in VS patients, and may inform the timing of tumor resection to preserve hearing.
Topics: Humans; Neuroma, Acoustic; Hearing Loss; Hearing; Biomarkers; Deafness
PubMed: 37948527
DOI: 10.1126/sciadv.adf7295 -
The Journal of International Advanced... Apr 2018The wait and scan policy is being increasingly used as the first measure after the diagnosis of a vestibular schwannoma (VS) using magnetic resonance imaging (MRI). As... (Review)
Review
The wait and scan policy is being increasingly used as the first measure after the diagnosis of a vestibular schwannoma (VS) using magnetic resonance imaging (MRI). As part of the European Academy of Otology and Neuro-Otology (EAONO) position statement on VS, the frequency of imaging has been studied in the literature. Among 163 studies, 29 fulfilled the inclusion criteria and were scored using the Grading of Recommendations, Assessment, Development, and Evaluation system. Because tumor growth rate during the first 5 years of follow-up is predictive of further growth during the upcoming years, a protocol for wait and scan is useful for centers dealing with this condition. The EAONO proposal is that after the initial diagnosis by MRI, a first new MRI would take place after 6 months, annually for 5 years, and then every other year for 4 years, followed by a lifelong MRI follow-up every 5 years. The first early MRI is to screen for fast-growing tumors, and the lifelong follow-up with tapered intervals is to detect late repeated growth.
Topics: Aftercare; Disease Progression; Humans; Magnetic Resonance Imaging; Meta-Analysis as Topic; Neoplasm Grading; Neurofibromatosis 2; Neuroma, Acoustic; Practice Guidelines as Topic; Prospective Studies; Retrospective Studies; Watchful Waiting
PubMed: 29764780
DOI: 10.5152/iao.2018.5348