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Neurosurgical Review Jan 2024Vestibular schwannomas (VS) account for approximately 8% of all intracranial neoplasms. Importantly, the cost of the diagnostic workup for VS, including the screening...
Vestibular schwannomas (VS) account for approximately 8% of all intracranial neoplasms. Importantly, the cost of the diagnostic workup for VS, including the screening modalities most commonly used, has not been thoroughly investigated. Our aim is to conduct a systematic review of the published literature on costs associated with VS screening. A systematic review of the literature for cost of VS treatment was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The terms "vestibular schwannoma," "acoustic neuroma," and "cost" were queried using the PubMed and Embase databases. Studies from all countries were considered. Cost was then corrected for inflation using the US Bureau of Labor Statistics Inflation Calculator, correcting to April 2022. The search resulted in an initial review of 483 articles, of which 12 articles were included in the final analysis. Screening criteria were used for non-neurofibromatosis type I and II patients who complained of asymmetric hearing loss, tinnitus, or vertigo. Patients included in the studies ranged from 72 to 1249. The currency and inflation-adjusted mean cost was $418.40 (range, $21.81 to $487.03, n = 5) for auditory brainstem reflex and $1433.87 (range, $511.64 to $1762.15, n = 3) for non-contrasted computed tomography. A contrasted magnetic resonance imaging (MRI) scan was found to have a median cost of $913.27 (range, $172.25-$2733.99; n = 8) whereas a non-contrasted MRI was found to have a median cost of $478.62 (range, $116.61-$3256.38, n = 4). In terms of cost reporting, of the 12 articles, 1 (8.3%) of them separated out the cost elements, and 10 (83%) of them used local prices, which include institutional costs and/or average costs of multiple institutions. Our findings describe the limited data on published costs for screening and imaging of VS. The paucity of data and significant variability of costs between studies indicates that this endpoint is relatively unexplored, and the cost of screening is poorly understood.
Topics: Humans; Neuroma, Acoustic; Brain Neoplasms; Brain Stem; Databases, Factual; Tomography, X-Ray Computed
PubMed: 38252395
DOI: 10.1007/s10143-024-02305-3 -
Journal of Clinical Medicine Mar 2024Radiotherapy (RT) plays an important role in the therapeutic management of vestibular schwannoma (VS). Fractionated stereotactic radiotherapy (FSRT) or radiosurgery... (Review)
Review
BACKGROUND
Radiotherapy (RT) plays an important role in the therapeutic management of vestibular schwannoma (VS). Fractionated stereotactic radiotherapy (FSRT) or radiosurgery (SRS) are the two modalities available. The purpose of this article is to review the results of VS RT studies carried out over the last ten years.
MATERIALS AND METHODS
A literature search was performed with PubMed and Medline by using the words vestibular schwannoma, acoustic neuroma, radiotherapy, and radiosurgery.
RESULTS
In small (<3 cm) VS, SRS offers a local control rate of >90%, which seems similar to microsurgery, with a favorable tolerance profile. Hypofractionated FSRT (three to five fractions) is a relatively recent modality and has shown similar outcomes to normofractionated FSRT. Hearing preservation may highly differ between studies, but it is around 65% at 5 years.
CONCLUSIONS
SRS and FRST are non-invasive treatment options for VS. SRS is often preferred for small lesions less than 3 cm, and FSRT for larger lesions. However, no randomized study has compared these modalities.
PubMed: 38541837
DOI: 10.3390/jcm13061611 -
European Heart Journal Sep 2023
Topics: Humans; Neuroma, Acoustic; Sick Sinus Syndrome
PubMed: 37358884
DOI: 10.1093/eurheartj/ehad354 -
British Journal of Cancer Jun 2024Vestibular schwannomas (VSs) remain a challenge due to their anatomical location and propensity to growth. Macrophages are present in VS but their roles in VS...
BACKGROUND
Vestibular schwannomas (VSs) remain a challenge due to their anatomical location and propensity to growth. Macrophages are present in VS but their roles in VS pathogenesis remains unknown.
OBJECTIVES
The objective was to assess phenotypic and functional profile of macrophages in VS with single-cell RNA sequencing (scRNAseq).
METHODS
scRNAseq was carried out in three VS samples to examine characteristics of macrophages in the tumour. RT-qPCR was carried out on 10 VS samples for CD14, CD68 and CD163 and a panel of macrophage-associated molecules.
RESULTS
scRNAseq revealed macrophages to be a major constituent of VS microenvironment with three distinct subclusters based on gene expression. The subclusters were also defined by expression of CD163, CD68 and IL-1β. AREG and PLAUR were expressed in the CD68+CD163+IL-1β+ subcluster, PLCG2 and NCKAP5 were expressed in CD68+CD163+IL-1β- subcluster and AUTS2 and SPP1 were expressed in the CD68+CD163-IL-1β+ subcluster. RT-qPCR showed expression of several macrophage markers in VS of which CD14, ALOX15, Interleukin-1β, INHBA and Colony Stimulating Factor-1R were found to have a high correlation with tumour volume.
CONCLUSIONS
Macrophages form an important component of VS stroma. scRNAseq reveals three distinct subsets of macrophages in the VS tissue which may have differing roles in the pathogenesis of VS.
Topics: Humans; Neuroma, Acoustic; Single-Cell Analysis; Macrophages; Sequence Analysis, RNA; Tumor Microenvironment; Female; Male; Middle Aged; Antigens, CD; Antigens, Differentiation, Myelomonocytic; Interleukin-1beta
PubMed: 38480935
DOI: 10.1038/s41416-024-02646-2 -
British Journal of Neurosurgery Aug 2023A 77-year old female with a history of neurofibromatosis type 2 (NF2) was diagnosed with a spinal schwannoma that was managed conservatively over a decade. During this...
A 77-year old female with a history of neurofibromatosis type 2 (NF2) was diagnosed with a spinal schwannoma that was managed conservatively over a decade. During this time, follow up imaging revealed this lesion had been growing and the patient had become symptomatic from it necessitating surgical decompression. However, the patient had been diagnosed with multiple myeloma and underwent treatment with Pomalidomide chemotherapy which delayed surgery for the spinal schwannoma. Further imaging of the spine revealed significant regression in the size of the spinal schwannoma. This phenomenon has not previously been reported and this report aims to explore the implications of Pomalidomide in patients with NF2 related spinal schwannomas.
Topics: Female; Humans; Aged; Neurilemmoma; Neurofibromatosis 2; Treatment Outcome
PubMed: 32188281
DOI: 10.1080/02688697.2020.1742292 -
Operative Neurosurgery (Hagerstown, Md.) Dec 2023The correct positioning of the transverse-sigmoid sinus junction (TSSJ) during retrosigmoid craniotomy (RC) is crucial for enhancing surgical efficiency and preventing...
BACKGROUND AND OBJECTIVES
The correct positioning of the transverse-sigmoid sinus junction (TSSJ) during retrosigmoid craniotomy (RC) is crucial for enhancing surgical efficiency and preventing complications. An augmented reality technology may provide low-cost guidance for the TSSJ position. The authors aimed to investigate the clinical application of a self-developed mobile augmented reality navigation system (MARNS) for TSSJ positioning during RC and present their findings.
METHODS
This observational research enrolled patients who underwent RC at Fujian Provincial Hospital from May 2023 to June 2023. All patients had their TSSJs located by MARNS. The surgical incision and skull "keyhole" for drilling were determined separately based on the projections of TSSJ on the 3-dimensional model displayed by MARNS. This method was assessed using matching error, positioning time, integrity of the bone flap, incidence of transversal sigmoid sinus injury, and other complications.
RESULTS
Seven patients diagnosed with acoustic neuroma, trigeminal neuralgia, and hemifacial spasm were enrolled in this study. The MARNS system exhibited a matching error with an average magnitude of 2.88 ± 0.69 mm. The positioning procedure necessitated an average duration of 279.71 ± 27.29 seconds. In every instance, the inner edge of the TSSJ was precisely identified and exposed while the bone flap was successfully formed and maintained an average integrity of 86.7%.
CONCLUSION
This study demonstrated the efficacy of MARNS in the precise placement of the TSSJ during RC procedures. It offers advantages for convenience, cost-effectiveness, and reliability for neurosurgical navigation.
PubMed: 38084985
DOI: 10.1227/ons.0000000000001026 -
BMC Public Health Sep 2023The aim of this study is to report the epidemiologic characteristics of tumors of the cerebellopontine angle (CPAT) and internal acoustic meatus in adult Polish...
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.
Topics: Humans; Adult; Female; Middle Aged; Poland; Cerebellopontine Angle; Retrospective Studies; Neoplasms; Hearing Loss, Sensorineural; Acoustics
PubMed: 37674102
DOI: 10.1186/s12889-023-16551-5 -
Acta Oncologica (Stockholm, Sweden) Mar 2024An increasing trend in incidence of vestibular schwannomas (VS) has been reported, though not consistently, across populations. Materials and methods: We obtained data...
BACKGROUND
An increasing trend in incidence of vestibular schwannomas (VS) has been reported, though not consistently, across populations. Materials and methods: We obtained data from the Finnish Cancer Registry on 1,149 VS cases diagnosed in 1990-2017 with tabular data up to 2022. We calculated age-standardised incidence rates (ASR) overall, by sex, and for 10-year age groups. We analysed time trends using Poisson and joinpoint regression.
RESULTS
The average ASR of VS in Finland during 1990-2017 was 8.6/1,000,000 person-years for women and 7.5/1,000,000 for men. A declining trend was found with an average annual percent change of -1.7% (95% confidence interval [CI]: -2.8%, -0.6%) for women, -2.2% (95% CI: -3.6%, -0.7%) for men, and -1.9% (95% CI: -2.9%, -1.0%) for both sexes combined. The ASR in women was 11.6/1,000,000 person-years in 1990 and it decreased to 8.2/1,000,000 by 2017. Correspondingly, the incidence in men was 7.1/1,000,000 in 1990 and decreased to 5.1/1,000,000 by 2017. Some decline in incidence over time was found in all age groups below 80 years, but the decline (2.3-3.1% per year) was statistically significant only in age groups 40-49, 50-59, and 60-69 years. In the oldest age group (80+ years), the incidence of VS increased by 16% per year. For 2018-2022, the ASR was 7.6/1,000,000 for both sexes combined, with a decline by -1.7% (95% CI: -2.3%, -1.2%) annually for the entire period 1990-2022.
CONCLUSION
In contrast to the increasing incidence reported in some studies, we found a decreasing trend in VS incidence for both sexes in Finland.
Topics: Male; Humans; Female; Aged, 80 and over; Adult; Neuroma, Acoustic; Finland; Incidence; Registries
PubMed: 38578202
DOI: 10.2340/1651-226X.2024.20352 -
The New England Journal of Medicine Jun 2024-related schwannomatosis (-SWN, formerly called neurofibromatosis type 2) is a tumor predisposition syndrome that is manifested by multiple vestibular schwannomas,...
BACKGROUND
-related schwannomatosis (-SWN, formerly called neurofibromatosis type 2) is a tumor predisposition syndrome that is manifested by multiple vestibular schwannomas, nonvestibular schwannomas, meningiomas, and ependymomas. The condition is relentlessly progressive with no approved therapies. On the basis of preclinical activity of brigatinib (an inhibitor of multiple tyrosine kinases) in -driven nonvestibular schwannoma and meningioma, data were needed on the use of brigatinib in patients with multiple types of progressive -SWN tumors.
METHODS
In this phase 2 platform trial with a basket design, patients who were 12 years of age or older with -SWN and progressive tumors were treated with oral brigatinib at a dose of 180 mg daily. A central review committee evaluated one target tumor and up to five nontarget tumors in each patient. The primary outcome was radiographic response in target tumors. Key secondary outcomes were safety, response rate in all tumors, hearing response, and patient-reported outcomes.
RESULTS
A total of 40 patients (median age, 26 years) with progressive target tumors (10 vestibular schwannomas, 8 nonvestibular schwannomas, 20 meningiomas, and 2 ependymomas) received treatment with brigatinib. After a median follow-up of 10.4 months, the percentage of tumors with a radiographic response was 10% (95% confidence interval [CI], 3 to 24) for target tumors and 23% (95% CI, 16 to 30) for all tumors; meningiomas and nonvestibular schwannomas had the greatest benefit. Annualized growth rates decreased for all tumor types during treatment. Hearing improvement occurred in 35% (95% CI, 20 to 53) of eligible ears. Exploratory analyses suggested a decrease in self-reported pain severity during treatment (-0.013 units per month; 95% CI, -0.002 to -0.029) on a scale from 0 (no pain) to 3 (severe pain). No grade 4 or 5 treatment-related adverse events were reported.
CONCLUSIONS
Brigatinib treatment resulted in radiographic responses in multiple tumor types and clinical benefit in a heavily pretreated cohort of patients with -SWN. (Funded by the Children's Tumor Foundation and others; INTUITT-NF2 ClinicalTrials.gov number, NCT04374305.).
Topics: Humans; Male; Adult; Female; Pyrimidines; Neurilemmoma; Adolescent; Organophosphorus Compounds; Young Adult; Middle Aged; Skin Neoplasms; Child; Neurofibromatoses; Neurofibromatosis 2; Antineoplastic Agents; Protein Kinase Inhibitors
PubMed: 38904277
DOI: 10.1056/NEJMoa2400985 -
Otology & Neurotology : Official... Oct 2023Vestibular schwannoma (VS) is a tumor of the vestibulocochlear nerve. Current literature indicates that 1.6% of patients undergoing magnetic resonance imaging of the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Vestibular schwannoma (VS) is a tumor of the vestibulocochlear nerve. Current literature indicates that 1.6% of patients undergoing magnetic resonance imaging of the internal auditory meatus (MRI IAM) for audiovestibular symptoms are diagnosed with a VS. However, there is limited research reporting on patients who present with unilateral tinnitus without asymmetrical hearing loss. This study is a systematic review and meta-analysis evaluating how many of those patients had a VS diagnosed on MRI IAM.
DATABASES USED
Online searches of PubMed, Medline, and Embase databases were performed up to October 2022.
METHODS
This meta-analysis was undertaken aligning with PRISMA guidelines. Articles reporting on patients having MRI IAM for unilateral tinnitus without asymmetrical hearing loss were included. Outcomes measures were patient demographics, VS cases, incidental findings, size, and management of tumor. A meta-analysis of proportions was performed using a random-effects model with the restricted maximum likelihood method. Quality assessment was performed using the Joanna Briggs Institute critical appraisal checklist.
RESULTS
Seven case series were included in the review: a total of 1,394 patients. Seven patients had a VS, with a median size of 4 mm. The pooled detection rate for VS was 0.08% (95% confidence interval = 0.00-0.45). Subsequent management was reported in six cases of which four were actively monitored and two surgically excised. The most common incidental finding was sinus disease (49 patients).
CONCLUSION
Our findings indicate that MRI IAM has a low diagnostic yield for VS detection in patients presenting with unilateral tinnitus without asymmetrical hearing loss, with mostly small tumors that are conservatively managed.
Topics: Humans; Neuroma, Acoustic; Tinnitus; Incidence; Cochlear Nerve; Databases, Factual
PubMed: 37621105
DOI: 10.1097/MAO.0000000000003987