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Otolaryngologic Clinics of North America Dec 2018Current consensus on optimal treatment of vestibular schwannoma remains poorly established; treatment options include observation, stereotactic radiosurgery,... (Review)
Review
Current consensus on optimal treatment of vestibular schwannoma remains poorly established; treatment options include observation, stereotactic radiosurgery, microsurgical resection, medical therapy, or a combination of these. Treatment should be individualized and incorporate the multitude of patient- and tumor-specific characteristics known to affect outcome. Treatment paradigms for sporadic and neurofibromatosis type 2-related tumors are distinct and decision-making in neurofibromatosis type 2 is uniquely challenging. In all cases, treatment should maximize tumor control and minimize functional deficit.
Topics: Facial Nerve; Hearing Loss; Humans; Microsurgery; Neuroma, Acoustic; Radiosurgery; Plastic Surgery Procedures; Treatment Outcome
PubMed: 30390772
DOI: 10.1016/j.otc.2018.07.015 -
Otolaryngology--head and Neck Surgery :... Aug 2016Examine possible prognostic factors for the persistence of tinnitus after acoustic neuroma resection.
OBJECTIVE
Examine possible prognostic factors for the persistence of tinnitus after acoustic neuroma resection.
STUDY DESIGN
Case series with chart review.
SETTING
Tertiary academic medical center.
SUBJECTS AND METHODS
The records of 166 patients who underwent acoustic neuroma resection from 2009 to 2014 were reviewed. Patients were asked to complete a survey, including the Tinnitus Handicap Inventory, 1 to 6 years postoperatively.
RESULTS
Of the 53 patients who completed the survey, 17% reported that their tinnitus resolved; 9% reported improvement; 23% reported no change; 43% reported that their tinnitus worsened; and 8% were unsure. Respondents ≥50 years old and those with nonserviceable hearing preoperatively were more likely to report that their tinnitus resolved or improved (P < .01 and P = .02, respectively). Respondents <50 years old and those with serviceable hearing preoperatively were more likely to report that their tinnitus was the same or worse (P < .001 and P = .036, respectively). Respondents with age <50 years, serviceable hearing preoperatively, and residual tumor had a higher average Tinnitus Handicap Inventory score (P = .016, P = .048, and P = .047, respectively). Sex, tumor size, surgical approach, hearing preservation, and cochlear nerve status did not correlate with the prognosis of tinnitus postoperatively. Respondents whose tinnitus resolved postoperatively were more likely to report being "very satisfied" with their care (P = .012).
CONCLUSION
In this study, 83% of respondents had persistent tinnitus after acoustic neuroma resection. The prognosis of tinnitus was worse for younger respondents, those with serviceable hearing preoperatively, and those with residual tumor postoperatively. Respondents' satisfaction was higher if their tinnitus resolved.
Topics: Adult; Aged; Disability Evaluation; Female; Humans; Male; Middle Aged; Neuroma, Acoustic; Neurosurgical Procedures; Prognosis; Tinnitus; Treatment Outcome
PubMed: 27095048
DOI: 10.1177/0194599816642427 -
British Journal of Neurosurgery Jun 2016To assess patient-reported outcomes and experience of vestibular schwannoma (VS) management.
OBJECTIVE
To assess patient-reported outcomes and experience of vestibular schwannoma (VS) management.
STUDY DESIGN
Survey of members of the British Acoustic Neuroma Association (BANA).
METHODS
Members of the BANA were invited to complete an online survey. Questions were divided into five areas: Demographic details; symptoms at diagnosis; level of information received; treatment after-effects; and overall experience of diagnosis and/or treatment.
DEMOGRAPHICS
598 (58%) BANA members completed the survey. 77.1% of respondents were aged between 41 and 70 years. Symptoms at diagnosis: hearing loss (84%), unilateral tinnitus (40%) and imbalance (51%) were commonest. Isolated tinnitus and imbalance occurred in 2% and 6%, respectively. Information received: 39% stated they were given 'just the right amount of information about all management options', and 32% 'not enough information'. Treatment after-effects: Overall quality of life was classified as 'a lot better' (11%), 'a little better' (7%), 'unchanged' (25%), 'a little worse' (38%) and 'a lot worse' (19%). 61% respondents continued in the same job. Return to social life, hobbies and sports was impaired in 65%. Overall experience: Experience of treatment was graded as 'much better than expected' (20%), 'a little better' (15%), 'about the same' (27%), 'a little worse' (22%) and 'much worse' (16%).
CONCLUSION
Quality of life measures are important in assessing VS management outcomes, and will increasingly inform clinical decision-making. Further examination of how patients with VS perceive their disease, cope with illness and use social support networks may also help to inform future practice and the creation of decision analytical models.
Topics: Adult; Aged; Female; Hearing Loss; Humans; Male; Middle Aged; Neuroma, Acoustic; Quality of Life; Self Report; Surveys and Questionnaires; Tinnitus
PubMed: 26523744
DOI: 10.3109/02688697.2015.1071323 -
World Neurosurgery Feb 2022The Hannover classification of vestibular schwannomas is designed to stratify tumors based on extrameatal extension and compression of the brainstem. We have previously...
BACKGROUND
The Hannover classification of vestibular schwannomas is designed to stratify tumors based on extrameatal extension and compression of the brainstem. We have previously reported the reliability of the Koos system, but to date, no study has assessed the reliability of the similar Hannover classification.
OBJECTIVE
We present an assessment of the intrarater and interrater reliability of the Hannover classification system.
METHODS
After institutional review board approval was obtained, a cross-sectional group of the magnetic resonance imaging of 40 patients with vestibular schwannomas varying in size comprised the study sample. Four raters were selected to assign a Hannover grade to 50 total scans. Interrater and intrarater reliability was calculated and reported using Fleiss's kappa, Kendall's W, and intraclass correlation coefficient (ICC).
RESULTS
Interrater observer reliability was found to be moderate when measured using Fleiss' kappa (0.49), extremely strong using Kendall's W (0.93), and excellent as calculated by ICC (0.88). The results were all statistically significant (P < 0.05). Intrarater reliability for Hannover grade ranged from 0.77 to 1.00 (substantial to perfect). By Kendall's W and ICC, all raters had near perfect or excellent agreement. The results were all statistically significant (P < 0.05).
CONCLUSIONS
The Hannover classification is a reliable system for grading the size of vestibular schwannomas. This supports its continued use and previously published results of the literature in studies relying on this classification. Further studies are needed to evaluate its validity and determine its role in preoperative counseling and determining microsurgery and radiosurgery outcomes.
Topics: Cross-Sectional Studies; Humans; Magnetic Resonance Imaging; Neuroma, Acoustic; Observer Variation; Reproducibility of Results
PubMed: 34718198
DOI: 10.1016/j.wneu.2021.10.151 -
World Neurosurgery Aug 2018To determine the clinical and radiologic outcome of patients with acoustic neuroma (AN) treated with linear accelerator (LINAC) or CyberKnife-based stereotactic...
OBJECTIVE
To determine the clinical and radiologic outcome of patients with acoustic neuroma (AN) treated with linear accelerator (LINAC) or CyberKnife-based stereotactic radiosurgery with respect to tumor control, preservation of serviceable hearing, and toxicity.
METHODS
A retrospective monocentric analysis including all patients who underwent single-fraction LINAC- or CyberKnife-based radiosurgery for AN between 1991 and 2015. Patient data were analyzed in terms of radiologic and clinical tumor control (no further intervention needed), treatment-related complications, preservation of serviceable hearing, and objectified hearing loss using pure tone average levels.
RESULTS
We included 335 patients (median age 58.2 years, treated either by LINAC-based [n = 270] or CyberKnife [n = 65] stereotactic radiosurgery). The median tumor volume was 1.1 mL (0.1-23.7 mL). The median radiation dose was 12 Gy (LINAC 12 Gy, 11-20 Gy; CyberKnife 13 Gy, 12-13 Gy) at an isodose level of 71.7% (LINAC 68.3%, 31.9%-86.2%; CyberKnife 80%, 65%-81%). The median follow-up was 30 months (LINAC 43 months, 2-224 months; CyberKnife 13 months, 4-37 months). Clinical tumor control was 98%, 89%, and 88% at 2, 5, and 10 years. The objective actuarial hearing preservation rate was 89%, 80%, and 55% at 1, 2, and 5 years. New symptoms were observed in 11.3% and classified as Common Terminology Criteria for Adverse Events grade 1/2, apart from 4 patients (1.2%), who developed Common Terminology Criteria for Adverse Events grade 3.
CONCLUSIONS
Our study shows that in AN, high tumor control and considerable hearing preservation rates can be achieved by single-dose radiosurgery at low toxicity rates, resulting in a positive impact on long-term clinical outcome.
Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Hearing Tests; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroma, Acoustic; Radiosurgery; Retrospective Studies; Treatment Outcome
PubMed: 29715569
DOI: 10.1016/j.wneu.2018.04.149 -
Acta Otorrinolaringologica Espanola 2024Vestibular schwannoma (VS) is the most common tumour of the cerebellopontine angle. The greater accessibility to radiological tests has increased its diagnosis. Taking...
INTRODUCTION
Vestibular schwannoma (VS) is the most common tumour of the cerebellopontine angle. The greater accessibility to radiological tests has increased its diagnosis. Taking into account the characteristics of the tumour, the symptoms and the age of the patient, three therapeutic strategies have been proposed: observation, surgery or radiotherapy. Choosing the most appropriate for each patient is a frequent source of controversy.
MATERIAL AND METHODS
This paper includes an exhaustive literature review of issues related to VS that can serve as a clinical guide in the management of patients with these lesions. The presentation has been oriented in the form of questions that the clinician usually asks himself and the answers have been written and/or reviewed by a panel of national and international experts consulted by the Otology Commission of the SEORL-CCC.
RESULTS
A list has been compiled containing the 13 most controversial thematic blocks on the management of VS in the form of 50 questions, and answers to all of them have been sought through a systematic literature review (articles published on PubMed and Cochrane Library between 1992 and 2023 related to each thematic area). Thirty-three experts, led by the Otology Committee of SEORL-CCC, have analyzed and discussed all the answers. In Annex 1, 14 additional questions divided into 4 thematic areas can be found.
CONCLUSIONS
This clinical practice guideline on the management of VS offers agreed answers to the most common questions that are asked about this tumour. The absence of sufficient prospective studies means that the levels of evidence on the subject are generally medium or low. This fact increases the interest of this type of clinical practice guidelines prepared by experts.
Topics: Humans; Neuroma, Acoustic; Prospective Studies; Magnetic Resonance Imaging; Radiosurgery; Microsurgery
PubMed: 38346489
DOI: 10.1016/j.otoeng.2023.10.005 -
Journal of Neurosurgery Mar 2022In this study, the authors aimed to clarify the relationship between hearing loss and tumor volumetric growth rates in patients with untreated vestibular schwannoma (VS).
OBJECTIVE
In this study, the authors aimed to clarify the relationship between hearing loss and tumor volumetric growth rates in patients with untreated vestibular schwannoma (VS).
METHODS
Records of 128 treatment-naive patients diagnosed with unilateral VS between 2012 and 2018 with serial audiometric assessment and MRI were reviewed. Tumor growth rates were determined from initial and final tumor volumes, with a median follow-up of 24.3 months (IQR 8.5-48.8 months). Hearing changes were based on pure tone averages, speech discrimination scores, and American Academy of Otolaryngology-Head and Neck Surgery hearing class. Primary outcomes were the loss of class A hearing and loss of serviceable hearing, estimated using the Kaplan-Meier method and with associations estimated from Cox proportional hazards models and reported as hazard ratios.
RESULTS
Larger initial tumor size was associated with an increased risk of losing class A (HR 1.5 for a 1-cm3 increase; p = 0.047) and serviceable (HR 1.3; p < 0.001) hearing. Additionally, increasing volumetric tumor growth rate was associated with elevated risk of loss of class A hearing (HR 1.2 for increase of 100% per year; p = 0.031) and serviceable hearing (HR 1.2; p = 0.014). Hazard ratios increased linearly with increasing growth rates, without any evident threshold growth rate that resulted in a large, sudden increased risk of hearing loss.
CONCLUSIONS
Larger initial tumor size and faster tumor growth rates were associated with an elevated risk of loss of class A and serviceable hearing.
Topics: Hearing; Hearing Loss; Hearing Tests; Humans; Neuroma, Acoustic; Proportional Hazards Models; Radiosurgery; Retrospective Studies; Treatment Outcome
PubMed: 34416729
DOI: 10.3171/2021.2.JNS203609 -
Laryngo- Rhino- Otologie Dec 2018Vestibular schwannomas are benign neoplasms originating from the Schwann cells of the vestibular vestibular nerve of the vestibulocochlear nerve, and rarely from the...
Vestibular schwannomas are benign neoplasms originating from the Schwann cells of the vestibular vestibular nerve of the vestibulocochlear nerve, and rarely from the pars cochlearis. These are tumors that are in contact with the nerve but do not bind the fibers. Benign neoplasms of the Schwann cells of the auditory and equilibrium nerves can also occur primarily in the inner ear and are referred to as intralabyrinthine schwannomas (ILS). Vestibular schwannomas represent 6-7 % of all intracranial and 90 % of cerebellopontine angle tumors. Bilateral occurrence occurs in < 5 % of cases, and then corresponds to type 2 neurofibromatosis. The first symptom is often a unilateral hearing loss. It may then lead to balance disorders, tinnitus, facial paralysis and other impairments. Diagnosis is audiological, vestibular and imaging. Magnetic resonance imaging currently represents the gold standard. Management chooses between an observational strategy and surgery, depending on tumor size, age, and other factors. The possible access routes offer different advantages and disadvantages; the potential complications include the liquorrhoea. Radiation therapy is possible in special cases, and drug therapies are also being tested. In the rehabilitation of the hearing function, in addition to a CROS or BICROS restoration, the cochlear implant has been used with good success. The impact on quality of life is largely determined by hearing impairment, balance disorders, tinnitus, and possibly headache, which must be considered in patient consultation and long-term care.
Topics: Adult; Aged, 80 and over; Cochlear Implants; Facial Paralysis; Female; Hearing Loss, Unilateral; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroma, Acoustic; Quality of Life; Tinnitus
PubMed: 30536286
DOI: 10.1055/a-0652-7096 -
JAMA Jan 2015
Topics: Adult; Audiometry; Ear Canal; Female; Hearing Loss, Sensorineural; Humans; Magnetic Resonance Imaging; Neuroma, Acoustic
PubMed: 25562271
DOI: 10.1001/jama.2014.12418 -
British Journal of Neurosurgery Aug 2023We present a case of spontaneous 79% regression in the size of a vestibular schwannoma (VS). A 41-year-old lady with a large (36 mm) vestibular schwannoma underwent...
We present a case of spontaneous 79% regression in the size of a vestibular schwannoma (VS). A 41-year-old lady with a large (36 mm) vestibular schwannoma underwent serial follow-up MRI scans which demonstrated the shrinkage over 9 years; the highest relative spontaneous regression recorded in the literature for vestibular schwannoma of this size.
Topics: Female; Humans; Adult; Neuroma, Acoustic; Radiosurgery; Magnetic Resonance Imaging
PubMed: 30829550
DOI: 10.1080/02688697.2019.1582749