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Neurosurgery Feb 2018Adults diagnosed with vestibular schwannomas.
TARGET POPULATION
Adults diagnosed with vestibular schwannomas.
QUESTION 1
What is the prognostic significance of Antoni A vs B histologic patterns in vestibular schwannomas?
RECOMMENDATION
No recommendations can be made due to a lack of adequate data.
QUESTION 2
What is the prognostic significance of mitotic figures seen in vestibular schwannoma specimens?
RECOMMENDATION
No recommendations can be made due to a lack of adequate data.
QUESTION 3
Are there other light microscopic features that predict clinical behavior of vestibular schwannomas?
RECOMMENDATION
No recommendations can be made due to a lack of adequate data.
QUESTION 4
Does the KI-67 labeling index predict clinical behavior of vestibular schwannomas?
RECOMMENDATION
No recommendations can be made due to a lack of adequate data.
QUESTION 5
Does the proliferating cell nuclear antigen labeling index predict clinical behavior of vestibular schwannomas?
RECOMMENDATION
No recommendations can be made due to a lack of adequate data.
QUESTION 6
Does degree of vascular endothelial growth factor expression predict clinical behavior of vestibular schwannomas?
RECOMMENDATION
No recommendations can be made due to a lack of adequate data. The full guideline can be found at: https://www.cns.org/guidelines/guidelines-management-patients-vestibular-schwannoma/chapter_6.
Topics: Adult; Humans; Neuroma, Acoustic; Prognosis
PubMed: 29309662
DOI: 10.1093/neuros/nyx514 -
Neurosurgical Review Aug 2021Intramedullary schwannomas (IMS) represent exceptional rare pathologies. They commonly present as solitary lesions; only five cases of multiple IMS have been described... (Review)
Review
Intramedullary schwannomas (IMS) represent exceptional rare pathologies. They commonly present as solitary lesions; only five cases of multiple IMS have been described so far. Here, we report the sixth case of a woman with multiple IMS. Additionally, we performed the first complete systematic review of the literature for all cases reporting IMS. We performed a systematic review of the literature in PubMed, EMBASE and Cochrane Central Register of Controlled (CENTRAL) to retrieve all relevant studies and case reports on IMS. In a second step, we analysed all reported studies with respect to additional cases, which were not identified through the database search. Studies published in other languages than English were included. One hundred nineteen studies including 165 reported cases were included. In only five cases, the patients harboured more than one IMS. Gender ratio showed a ratio of nearly 3:2 (male:female); mean age of disease presentation was 40.2 years; 11 patients suffered from neurofibromatosis (NF) type 1 or 2 (6.6%). IMS are rare. Our first systematic review on this pathology revealed 166 cases, including the here reported case of multiple IMS. Our review offers a basis for further investigation on this disease.
Topics: Female; Humans; Neurilemmoma; Neurofibromatosis 1; Neurofibromatosis 2; Spine
PubMed: 32935226
DOI: 10.1007/s10143-020-01357-5 -
The Journal of Laryngology and Otology Aug 2019To review the literature regarding screening for vestibular schwannoma in the context of demographic changes leading to increasing numbers of elderly patients presenting...
OBJECTIVE
To review the literature regarding screening for vestibular schwannoma in the context of demographic changes leading to increasing numbers of elderly patients presenting with asymmetric auditory symptoms.
METHODS
A systematic review of the literature was performed, with narrative synthesis and statistical analysis of data where appropriate.
RESULTS
Vestibular schwannomas diagnosed in patients aged over 70 years exhibit slower growth patterns and tend to be of smaller size compared to those tumours in younger age groups. This fact, combined with reduced life expectancy, renders the probability of these tumours in the elderly requiring active treatment with surgery or stereotactic radiotherapy to be extremely low. Vestibular schwannomas in the elderly are much more likely to be managed by serial monitoring with magnetic resonance imaging. The weighted yield of magnetic resonance imaging in the diagnosis of vestibular schwannoma in all age groups is 1.18 per cent, with almost 85 scans required to diagnose 1 tumour.
CONCLUSION
An evidence-based approach to the investigation of asymmetric hearing loss and tinnitus in the elderly patient can be used to formulate guidelines for the rational use of magnetic resonance imaging in this population.
Topics: Aged; Aging; Evidence-Based Medicine; Female; Hearing Loss; Humans; Magnetic Resonance Imaging; Male; Neuroma, Acoustic; Population Surveillance; Tinnitus
PubMed: 31366414
DOI: 10.1017/S0022215119000963 -
Acta Neurochirurgica Feb 2024Stereotactic radiosurgery (SRS) is a well-established treatment option for Koos stage I-III vestibular schwannomas (VS), often used as the first line of treatment or... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Stereotactic radiosurgery (SRS) is a well-established treatment option for Koos stage I-III vestibular schwannomas (VS), often used as the first line of treatment or after subtotal resection. However, the optimal treatment for Koos-IV VS remains unclear. Therefore, our study aimed to evaluate the effectiveness of SRS as a primary treatment for large VS classified as Koos-IV.
METHODS
A systematic search was performed on December 28th, 2022, based on PubMed, Web of Science, and Scopus according to the PRISMA statement. The review was updated on September 7th, 2023. The risk of bias was assessed using the NIH Quality Assessment Tool. The R software (ver. 4.3.2) was used for all quantitative analyses and preparation of the forest plots. Publication bias and sensitivity analysis were performed to evaluate the reliability of the obtained results.
RESULTS
Among 2941 screened records, ten studies (1398 patients) have been included in quantitative synthesis. The overall tumor control rate was 90.7% (95%CI 86.3-94.4). Kaplan-Meier estimates of tumor control at 2, 6, and 10 years were 96.0% (95% CI 92.9-97.6%), 88.8% (95% CI 86.9-89.8%), and 84.5% (95% CI, 81.2-85.8%), respectively. The overall hearing preservation rate was 56.5% (95%CI 37-75.1). Kaplan-Meier estimates of hearing preservation rate at 2, 6, and 10 years were 77.1% (95% CI 67.9-82.5%), 53.5% (95% CI 44.2-58.5%), and 38.1% (95% CI 23.4-40.7%), respectively. The overall facial nerve preservation rate was 100% (95%CI 99.9-100.0). The overall trigeminal neuropathy rate reached 5.7% (95%CI 2.9-9.2). The overall rate of new-onset hydrocephalus was 5.6% (95%CI 3-9). The overall rates of worsening or new-onset tinnitus and vertigo were 6.8% (95%CI 4.2-10.0) and 9.1% (95%CI 2.1-19.6) respectively. No publication bias was detected according to the used methods.
CONCLUSIONS
Our systematic review and meta-analysis demonstrated a high overall tumor control rate, excellent facial nerve preservation, and low incidence of new-onset or worsened tinnitus and vertigo. However, several drawbacks associated with SRS should be noted, such as the presence of post-SRS hydrocephalus risk, mediocre long-term hearing preservation, and the lack of immediate tumor decompression. Nevertheless, the use of SRS may be beneficial in appropriately selected cases of Koos-IV VS. Moreover, further prospective studies directly comparing SRS with surgery are necessary to determine the optimal treatment for large VS and verify our results on a higher level of evidence. Registration and protocol: CRD42023389856.
Topics: Humans; Hydrocephalus; Neuroma, Acoustic; Radiosurgery; Retrospective Studies; Tinnitus; Treatment Outcome; Vertigo
PubMed: 38393397
DOI: 10.1007/s00701-024-05995-2 -
Journal of Neurosurgery Jul 2005Magnetic resonance (MR) imaging now permits diagnosis of increasing numbers of small, minimally symptomatic vestibular schwannomas (VSs). Because VS growth patterns over... (Review)
Review
OBJECT
Magnetic resonance (MR) imaging now permits diagnosis of increasing numbers of small, minimally symptomatic vestibular schwannomas (VSs). Because VS growth patterns over time are very important in refining treatment strategies, these matters were systematically reviewed.
METHODS
An extensive MEDLINE search was performed to cull studies on VS growth according to sequential imaging. The percentages of growing and regressing tumors and lesions requiring treatment during follow-up periods were calculated. Factors associated with differences among studies were identified. Twenty-six studies including 1340 patients met all inclusion criteria. The overall frequency of VS growth during a mean follow-up period of 38 months was 46% (95% confidence interval [CI] 43-48%) and that of regression was 8% (95% CI 6-10%). The mean annual tumor growth rate was 1.2 mm/year. Furthermore, the percentage of cases requiring treatment during follow up was 18% (95% CI 16-21%). According to results of a sensitivity analysis, evaluation by serial MR imaging (39%, 95% CI 35-43%) and a prospective study design (29%, 95% CI 21-37%) were associated with less frequent reported tumor growth.
CONCLUSIONS
Although their applicability may be limited to relatively elderly patients with small tumors, data revealing a limited frequency of VS enlargement and an infrequent necessity for eventual therapy should assist decision-making in the treatment of small VSs causing minimal symptoms.
Topics: Aged; Female; Humans; Male; Middle Aged; Neuroma, Acoustic; Treatment Outcome
PubMed: 16121974
DOI: 10.3171/jns.2005.103.1.0059 -
Journal of Neuro-oncology Sep 2019Individual evidence suggests that the anti-angiogenic agent bevacizumab may control vestibular schwannoma (VS) growth and promote hearing preservation in patients with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Individual evidence suggests that the anti-angiogenic agent bevacizumab may control vestibular schwannoma (VS) growth and promote hearing preservation in patients with neurofibromatosis type 2 (NF2). However, such metadata has yet to be consolidated, as well as its side-effect profile yet to be fully understood. Our aim was to pool systematically-identified metadata in the literature and substantiate the clinical efficacy and safety of bevacizumab with respect to radiographic tumor response, hearing, and treatment outcomes.
METHODS
Searches of seven electronic databases from inception to March 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidence of outcomes was then extracted and pooled by random-effects meta-analysis of proportions.
RESULTS
Eight articles reporting 161 NF2 patients with 196 assessable VS met satisfied all criteria. Radiographic response to bevacizumab was partial regression in 41% (95% CI 31-51%), no change in 47% (95% CI 39-55%), and tumor progression in 7% (95% CI 1-15%). In patients with assessable audiometric data, bevacizumab treatment resulted in hearing improvement in 20% (95% CI 9-33%), stability in 69% (95% CI 51-85%) and additional loss in 6% (95% CI 1-15%) Serious bevacizumab toxicity was observed in 17% (95% CI 10-26%). Subsequent surgical intervention was required in 11% (95% CI 2-20%).
CONCLUSIONS
Bevacizumab may arrest both tumor progression and hearing loss in select NF2 patients presenting with VS lesions. However, a considerable proportion of patients are anticipated to experience serious adverse events; correspondingly, judicious use of bevacizumab for symptomatic management of VS in NF2 is recommended.
Topics: Angiogenesis Inhibitors; Bevacizumab; Hearing Loss; Humans; Neurofibromatosis 2; Neuroma, Acoustic; Treatment Outcome
PubMed: 31254266
DOI: 10.1007/s11060-019-03234-8 -
Otology & Neurotology : Official... Oct 2019This study aimed to evaluate the diagnostic accuracy of high-resolution T2-weighted magnetic resonance imaging (T2wi) in terms of detecting vestibular schwannoma... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study aimed to evaluate the diagnostic accuracy of high-resolution T2-weighted magnetic resonance imaging (T2wi) in terms of detecting vestibular schwannoma compared with gadolinium-enhanced T1-weighted MRI (GdT1wi).
DATA SOURCES
Five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database).
DATA SELECTION
Two authors independently searched five databases up to January 2019 on diagnosis of vestibular schwannomas via T2wi.
DATA EXTRACTION
In the included studies, tumor diameters reported using T2wi were compared with those revealed by GdT1wi and correlation coefficients were calculated. Data on true-positives, true-negatives, false-positives, and false-negatives were extracted from the relevant articles. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Inter-rater agreement among different observers and intra-rater agreement among different measurements made by a single observer was assessed.
DATA SYNTHESIS
Outcomes subjected to analysis included diagnostic accuracy (the diagnostic odds ratio); summary receiver operating characteristic curve and area under the curve values. The summary intra-class correlation coefficient was used for various random-effects models. The quality of each study was analyzed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool.
CONCLUSIONS
T2wi performed without the use of a contrast agent is a highly accurate diagnostic and monitor tool compared with GdT1wi and also demonstrated high reliability. However, further studies are required to confirm the results of this study.
Topics: Humans; Magnetic Resonance Imaging; Neuroimaging; Neuroma, Acoustic; ROC Curve; Reproducibility of Results; Sensitivity and Specificity
PubMed: 31469788
DOI: 10.1097/MAO.0000000000002416 -
Neurosurgery Feb 2018What is the expected diagnostic yield for vestibular schwannomas when using a magnetic resonance imaging (MRI) to evaluate patients with previously published definitions...
QUESTION 1
What is the expected diagnostic yield for vestibular schwannomas when using a magnetic resonance imaging (MRI) to evaluate patients with previously published definitions of asymmetric sensorineural hearing loss?
TARGET POPULATION
These recommendations apply to adults with an asymmetric sensorineural hearing loss on audiometric testing.
RECOMMENDATION
Level 3: On the basis of an audiogram, it is recommended that MRI screening on patients with ≥10 decibels (dB) of interaural difference at 2 or more contiguous frequencies or ≥15 dB at 1 frequency be pursued to minimize the incidence of undiagnosed vestibular schwannomas. However, selectively screening patients with ≥15 dB of interaural difference at 3000 Hz alone may minimize the incidence of MRIs performed that do not diagnose a vestibular schwannoma.
QUESTION 2
What is the expected diagnostic yield for vestibular schwannomas when using an MRI to evaluate patients with asymmetric tinnitus, as defined as either purely unilateral tinnitus or bilateral tinnitus with subjective asymmetry?
TARGET POPULATION
These recommendations apply to adults with subjective complaints of asymmetric tinnitus.
RECOMMENDATION
Level 3: It is recommended that MRI be used to evaluate patients with asymmetric tinnitus. However, this practice is low yielding in terms of vestibular schwannoma diagnosis (<1%).
QUESTION 3
What is the expected diagnostic yield for vestibular schwannomas when using an MRI to evaluate patients with a sudden sensorineural hearing loss?
TARGET POPULATION
These recommendations apply to adults with a verified sudden sensorineural hearing loss on an audiogram.
RECOMMENDATION
Level 3: It is recommended that MRI be used to evaluate patients with a sudden sensorineural hearing loss. However, this practice is low yielding in terms of vestibular schwannoma diagnosis (<3%). The full guideline can be found at: https://www.cns.org/guidelines/guidelines-management-patients-vestibular-schwannoma/chapter_2.
Topics: Adult; Audiometry; Female; Hearing Loss, Sensorineural; Humans; Magnetic Resonance Imaging; Male; Mass Screening; Middle Aged; Neuroma, Acoustic; Sensitivity and Specificity; Tinnitus
PubMed: 29309699
DOI: 10.1093/neuros/nyx509 -
Otology & Neurotology : Official... Jul 2022To characterize the natural history of hearing loss for patients presenting with serviceable hearing (SH) who undergo a wait-and-scan approach for sporadic vestibular...
OBJECTIVE
To characterize the natural history of hearing loss for patients presenting with serviceable hearing (SH) who undergo a wait-and-scan approach for sporadic vestibular schwannoma (VS) using aggregate time-to-event survival analysis.
STUDY DESIGN
Systematic review.
SETTING
Published international English literature, January 1, 2000 to May 31, 2020.
PATIENTS
Patients with sporadic VS entering a wait-and-scan approach with SH at diagnosis.
INTERVENTIONS
Observation with serial MRI and audiometry.
RESULTS
In total, 3,652 patients from 26 studies were included for analysis. Mean age at diagnosis was 58.8 years (SD, 4.1). Mean follow-up was 49.2 months (SD, 26.5). In total, 755 patients (21%) failed conservative treatment and underwent radiosurgery or microsurgery at the time of last follow-up. The average loss to follow-up was 6.9% (SD, 11.1). A total of 1,674 patients had SH at the time of diagnosis. Survival rates for maintaining SH were 96% at 1 year, 77% at 3 years, 62% at 5 years, and 42% at 10 years following diagnosis.
CONCLUSION
In this systematic review, aggregate data from 3,652 patients across 26 studies show consistent patterns in progression of hearing loss during observation for patients with sporadic VS as a function of time. As an easy-toremember conservative benchmark for those presenting with SH at diagnosis: approximately 75% retain SH at 3 years, 60% at 5 years, and 40% at 10 years.
Topics: Follow-Up Studies; Hearing; Hearing Loss; Hearing Tests; Humans; Neuroma, Acoustic; Radiosurgery; Retrospective Studies; Treatment Outcome
PubMed: 35261385
DOI: 10.1097/MAO.0000000000003520 -
Neurosurgical Focus Mar 2018OBJECTIVE Total tumor excision with the preservation of neurological function and quality of life is the goal of modern-day vestibular schwannoma (VS) surgery.... (Meta-Analysis)
Meta-Analysis
Preoperative diffusion tensor imaging-fiber tracking for facial nerve identification in vestibular schwannoma: a systematic review on its evolution and current status with a pooled data analysis of surgical concordance rates.
OBJECTIVE Total tumor excision with the preservation of neurological function and quality of life is the goal of modern-day vestibular schwannoma (VS) surgery. Postoperative facial nerve (FN) paralysis is a devastating complication of VS surgery. Determining the course of the FN in relation to a VS preoperatively is invaluable to the neurosurgeon and is likely to enhance surgical safety with respect to FN function. Diffusion tensor imaging-fiber tracking (DTI-FT) technology is slowly gaining traction as a viable tool for preoperative FN visualization in patients with VS. METHODS A systematic review of the literature in the PubMed, Cochrane Library, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and those studies that preoperatively localized the FN in relation to a VS using the DTI-FT technique and verified those preoperative FN tracking results by using microscopic observation and electrophysiological monitoring during microsurgery were included. A pooled analysis of studies was performed to calculate the surgical concordance rate (accuracy) of DTI-FT technology for FN localization. RESULTS Fourteen studies included 234 VS patients (male/female ratio 1:1.4, age range 17-75 years) who had undergone preoperative DTI-FT for FN identification. The mean tumor size among the studies ranged from 29 to 41.3 mm. Preoperative DTI-FT could not visualize the FN tract in 8 patients (3.4%) and its findings could not be verified in 3 patients (1.2%), were verified but discordant in 18 patients (7.6%), and were verified and concordant in 205 patients (87.1%). CONCLUSIONS Preoperative DTI-FT for FN identification is a useful adjunct in the surgical planning for large VSs (> 2.5 cm). A pooled analysis showed that DTI-FT successfully identifies the complete FN course in 96.6% of VSs (226 of 234 cases) and that FN identification by DTI-FT is accurate in 90.6% of cases (205 of 226 cases). Larger studies with DTI-FT-integrated neuronavigation are required to look at the direct benefit offered by this specific technique in preserving postoperative FN function.
Topics: Data Analysis; Diffusion Tensor Imaging; Facial Nerve; Humans; Microsurgery; Neuroma, Acoustic; Neuronavigation; Preoperative Care
PubMed: 29490547
DOI: 10.3171/2017.12.FOCUS17672