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JPMA. the Journal of the Pakistan... May 2020The approach to treating vestibular schwannomas ranges from wait-and-scan policies to micro-and radiosurgery. However, in the past few decades, Stereotac tic... (Review)
Review
The approach to treating vestibular schwannomas ranges from wait-and-scan policies to micro-and radiosurgery. However, in the past few decades, Stereotac tic Radiosurgery (SRS) has emerged as an approved primary treatment option as well. In this review, we have assessed some of the existing literature on the role of SRS in the management of vestibular schwannomas, and to estimate its efficacy in tumour control and conservation of cranial nerve function.
Topics: Humans; Neuroma, Acoustic; Radiosurgery; Treatment Outcome
PubMed: 32400760
DOI: No ID Found -
Auris, Nasus, Larynx Aug 2022To analyze the preoperative patterns of caloric test, eye tracking test (ETT), and optokinetic pattern (OKP) in patients with acoustic neuroma (AN) and compare them with...
OBJECTIVE
To analyze the preoperative patterns of caloric test, eye tracking test (ETT), and optokinetic pattern (OKP) in patients with acoustic neuroma (AN) and compare them with the postoperative patterns of ETT and OKP results METHODS: A total of 166 patients with AN (102 women; mean age: 41 years, range: 11-79 years) who were being treated at our hospital between 2013 and 2016 were enrolled. Preoperatively, a detailed history was taken regarding the presence of subjective symptoms of equilibrium dysfunction, and the patients underwent caloric test, ETT, and OKP. They were classified into three groups based on the preoperative ETT and OKP results as follows: Group A, normal ETT and OKP; Group B, either ETT or OKP was abnormal; and Group C, both ETT and OKP were abnormal. All patients were evaluated for subjective symptoms of vestibular dysfunction and were also grouped based on the tumor size on imaging. All surgeries were performed by a neurosurgeon using the lateral suboccipital retrosigmoid approach. About one month later after surgery, postoperatively ETT was performed on 150 patients and OKP was performed on 148 patients. The preoperative and postoperative ETT and OKP results were compared. The same two specialists analyzed the postoperative ETT and OKP findings as improved, unchanged, or worse. Student t-test was used for statistical analysis and a P-value of <0.05 was considered to indicate a statistically significant difference.
RESULTS
The average canal paresis(CP) % was 65.8%. No correlation was found between tumor size and CP%. The other side, the average tumor size in each group was 26.6 mm, 28.7 mm, and 37.8 mm in the Group A, B, and C, respectively. The average tumor size in Group C was significantly greater than those of Group A and B (P<0.01). The presence of gait disturbance in Group C was significantly higher than the other groups (P<0.01). The other side, abnormal ETT and OKP were seen in 32.5% and 31.9% of all patients, respectively. ETT and OKP results improved postoperatively in 67.4% and 68.9% of these patients.
CONCLUSIONS
Abnormal ETT and OKP results showed positive correlations with the tumor size and presence of subjective symptoms. Further, dysfunction of cerebellum and brain stem owing to tumor compression was observed to recover in many cases after surgery.
Topics: Adolescent; Adult; Aged; Caloric Tests; Child; Electronystagmography; Female; Humans; Middle Aged; Neuroma, Acoustic; Postoperative Period; Young Adult
PubMed: 34802775
DOI: 10.1016/j.anl.2021.10.010 -
Otolaryngologic Clinics of North America Jun 2023The future of the management of both sporadic and neurofibromatosis type 2-asscoiated vestibular schwannomas (VSs) will be shaped by cutting-edge technologic and... (Review)
Review
The future of the management of both sporadic and neurofibromatosis type 2-asscoiated vestibular schwannomas (VSs) will be shaped by cutting-edge technologic and biomedical advances to enable personalized, precision medicine. This scoping review envisions the future by highlighting the most promising developments published, ongoing, planned, or potential that are relevant for VS, including integrated omics approaches, artificial intelligence algorithms, biomarkers, liquid biopsy of the inner ear, digital medicine, inner ear endomicroscopy, targeted molecular imaging, patient-specific stem cell-derived models, ultra-high dose rate radiotherapy, optical imaging-guided microsurgery, high-throughput development of targeted therapeutics, novel immunotherapeutic strategies, tumor vaccines, and gene therapy.
Topics: Humans; Neuroma, Acoustic; Artificial Intelligence; Neurofibromatosis 2; Ear, Inner; Algorithms
PubMed: 37019772
DOI: 10.1016/j.otc.2023.02.018 -
Otolaryngologic Clinics of North America Jun 2023
Topics: Humans; Neuroma, Acoustic
PubMed: 37029059
DOI: 10.1016/j.otc.2023.03.002 -
Wiener Medizinische Wochenschrift (1946) Feb 2022Vestibular schwannomas can severely impair the quality of life of patients. Next to impaired hearing function, facial palsy is perceived as particularly disturbing in...
Vestibular schwannomas can severely impair the quality of life of patients. Next to impaired hearing function, facial palsy is perceived as particularly disturbing in this context. Varying growth rates of these benign tumors complicate a prediction of functional impairment of cranial nerves. Therefore, a regular update on current therapeutic strategies and alternative treatment options is relevant for both physicians and patients.
Topics: Aftercare; Humans; Neuroma, Acoustic; Quality of Life
PubMed: 33439379
DOI: 10.1007/s10354-020-00800-y -
Neurosurgical Review Jun 2020Neuromas are benign intracranial tumors with indolent natural history. Surgery is the mainstay of treatment and only after the introduction of single-fraction... (Review)
Review
Neuromas are benign intracranial tumors with indolent natural history. Surgery is the mainstay of treatment and only after the introduction of single-fraction stereotactic radiosurgery (SRS), radiotherapy emerged as an alternative viable option. In this review, we focused on SRS or conventionally fractionated stereotactic radiotherapeutic (FSRT) approaches. We described the results of different doses used for SRS and FSRT, the current status, and a comparison between the two radiotherapy approaches. Stereotactic radiotherapy techniques aim to control tumor growth with minimal toxicity. SRS using either a cobalt unit or a linear accelerator has given high rates of tumor control and of cranial nerve function preservation with marginal doses range of 12-14 Gy. Fractionated stereotactic radiotherapy (FSRT) is optimal for tumors larger than 3 cm. Doses as low as 50.4 Gy provide excellent control rates and low morbidity. Overall, both SRS and FSRT are equally effective and safe options for neuroma patients who do not need immediate surgical decompression.
Topics: Humans; Neuroma, Acoustic; Radiosurgery; Radiotherapy
PubMed: 30982152
DOI: 10.1007/s10143-019-01103-6 -
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 -
Laryngo- Rhino- Otologie Sep 2022
Topics: Humans; Neuroma, Acoustic
PubMed: 36041442
DOI: 10.1055/a-1870-2799 -
The Laryngoscope Mar 2021To examine whether simple mobility assessments can predict functional limitations and length of hospitalization after acoustic neuroma (AN) resection.
OBJECTIVES
To examine whether simple mobility assessments can predict functional limitations and length of hospitalization after acoustic neuroma (AN) resection.
STUDY DESIGN
Prospective case series.
METHODS
A prospective clinical study of adult patients undergoing AN resection by either the translabyrinthine, retrosigmoid, or middle fossa approach was conducted at a tertiary center. Preoperative mobility assessments included the functional gait assessment (FGA) and the 10-m walk (10 MW). Postoperatively, the Activity Measure for Post-Acute Care (AMPAC, at 48 hours), FGA, and 10 MW (at 1 week) were obtained. Demographic and medical data were collected.
RESULTS
One hundred and thirty-eight patients were analyzed (mean age: 48.3 years, 68.8% female). Mean length of stay (LOS) was 3.1 days. The translabyrinthine approach was most commonly performed (48.6%). On regression analyses, preoperative FGA (P = 0.03) and 48-hour postoperative AM-PAC (P < 0.001) independently predicted LOS, even after accounting for age, gender, body mass index, and tumor size. On receiver operating characteristic analysis, a preoperative FGA cut score of 25.5 predicted a protracted hospital stay (>4 days) with a sensitivity of 77% and specificity of 50% (area under curve: 68.5).
CONCLUSION
This study demonstrated that preoperative mobility assessments can predict functional limitations and LOS after AN resection. These objective tools can be used by clinicians to manage expectations and guide preoperative counseling in patients considering surgery.
LEVEL OF EVIDENCE
3 Laryngoscope, 131:644-648, 2021.
Topics: Adult; Area Under Curve; Disability Evaluation; Female; Gait Analysis; Humans; Length of Stay; Male; Middle Aged; Mobility Limitation; Neuroma, Acoustic; Otologic Surgical Procedures; Postoperative Complications; Preoperative Period; Prospective Studies; ROC Curve; Regression Analysis; Sensitivity and Specificity; Treatment Outcome; Walk Test
PubMed: 32757415
DOI: 10.1002/lary.28910 -
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