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The Journal of Family Practice Jun 2011Tumor size and a patient's age, condition, and personal preference are key factors in choosing among watchful waiting, microsurgery, or stereotactic radiosurgery. (Review)
Review
Tumor size and a patient's age, condition, and personal preference are key factors in choosing among watchful waiting, microsurgery, or stereotactic radiosurgery.
Topics: Humans; Microsurgery; Neuroma, Acoustic; Radiosurgery; Watchful Waiting
PubMed: 21647465
DOI: No ID Found -
Journal of Neurology, Neurosurgery, and... Aug 2000
Topics: Deafness; Disease Management; Evoked Potentials, Auditory, Brain Stem; Health Services Accessibility; Hearing Tests; Humans; Neuroma, Acoustic; Patient Care Team
PubMed: 10896683
DOI: 10.1136/jnnp.69.2.147 -
European Heart Journal Sep 2023
Topics: Humans; Neuroma, Acoustic; Sick Sinus Syndrome
PubMed: 37358884
DOI: 10.1093/eurheartj/ehad354 -
Head and Neck Pathology Dec 2020Vestibular schwannoma (VS) is a Schwann cell-derived tumour arising from the vestibulocochlear nerve. Although benign, it represents a threat to intracranial structures... (Review)
Review
Vestibular schwannoma (VS) is a Schwann cell-derived tumour arising from the vestibulocochlear nerve. Although benign, it represents a threat to intracranial structures due to mass effect and carries a small risk of malignant transformation. VS therefore represents an important healthcare burden. We review the literature regarding pathogenesis, risk factors, and diagnosis of VS. The current and future potential management strategies are also discussed. A narrative review of all relevant papers known to the authors was conducted. The majority of VS remain clinically stable and do not require interventional procedures. Nevertheless, various surgical techniques exist for removing VS, the most common of which are translabyrinthine and retrosigmoid approaches. Due to surgical risks such as hearing loss, facial nerve dysfunction, post-operative headache, and cerebrospinal fluid leakage, a "watch and rescan" approach is adopted for most patients. Radiotherapy is a useful alternative and has been shown to have a similar response for growth restriction. Due to the heterogeneous nature of VS, there is a lack of consensus regarding management of tumours that are too large for conservative management but too small to indicate surgery. Emerging biologic therapies, such as Bevacizumab, Everolimus, and Lapatinib, as well as anti-inflammatories like aspirin are promising potential treatments; however, long-term evidence of their efficacy is required. The knowledge base regarding VS continues to improve. With increased understanding of the pathogenesis of these tumors, we believe future work should focus on pharmacologic intervention. Biologic therapies aimed toward improved patient outcomes are particularly promising.
Topics: Humans; Neuroma, Acoustic; Risk Factors
PubMed: 32232723
DOI: 10.1007/s12105-020-01155-x -
Casopis Lekaru Ceskych 2010Acoustic neuroma, properly called vestibular schwannoma, arises from the Schwann cells of the vestibular transitional zone of the vestibulocochlear nerve as the most... (Review)
Review
Acoustic neuroma, properly called vestibular schwannoma, arises from the Schwann cells of the vestibular transitional zone of the vestibulocochlear nerve as the most frequent tumour of the posterior fossa. Its incidence is estimated at 1.2 vestibular schwannoma per a population of 100,000/year. As to size, vestibular schwannoma is classified into grades I to IV. Its benign variety threatens the patient with hearing and balance impairment; uncontrolled growth can lead to death. About one third of small vestibular schwannoma show hardly any growth, the larger ones grow aggressively. The author's conclusion is based on 33 years of experience with hundreds of surgically treated vestibular schwannoma (now at the ENT Department of Head and Neck Surgery, CU 1st Medical Faculty and FN Teaching Hospital, Prague Motol). Three different therapeutic strategies are currently used: 1. Wait and rescan--close follow-up with regular MRI and hearing tests. Growing tumours require active intervention. 2. Stereoradio-surgery using the Leksell gamma knife is a suitable option for small tumours (grades I and II). Irradiation for larger vestibular schwannoma is decreasingly efficacious. 3. Microsurgery with intraoperative monitoring of facial and acoustic nerve function offers scope for radical removal of vestibular schwannoma of any size (grades I-IV) and for the preservation of facial nerve function and, of late, hearing, too. The larger the tumour, the more difficult it is. The demanding nature of microsurgery requires the patients' concentration in special centres with neurosurgical and ENT cooperation. The worst results are achieved with only a partial resection and follow-up stereoradiosurgical treatment. Secondary microsurgery can hardly prevent the patient's disability.
Topics: Humans; Neuroma, Acoustic
PubMed: 20662473
DOI: No ID Found -
The American Journal of Otology Jan 1994Acoustic neuroma in the pregnant patient has been described infrequently. The symptoms of acoustic neuroma can commence or worsen during the last 3 or 4 months of...
Acoustic neuroma in the pregnant patient has been described infrequently. The symptoms of acoustic neuroma can commence or worsen during the last 3 or 4 months of pregnancy. In women, acoustic tumors have been shown generally to be larger and more vascular, and some acoustic tumors contain estrogen receptors. This is a report of our management of two patients with acoustic neuroma who presented early in pregnancy. Surgery was delayed to the second trimester in each, to avoid spontaneous abortion. Both patients underwent translabyrinthine tumor removal at 18-19 weeks gestation, and each had an uncomplicated postoperative course. Examination of the tumor for estrogen receptors was performed for the second patient and was negative. Uncomplicated acoustic neuroma surgery can be performed in pregnant patients during the second trimester.
Topics: Adult; Audiometry; Female; Humans; Neuroma, Acoustic; Pregnancy; Pregnancy Complications, Neoplastic; Risk Factors
PubMed: 8109621
DOI: No ID Found -
Progress in Brain Research 2022Vestibular Schwannomas are well treated by GKNS. This can be used alone for tumors up to 20cm. For larger tumors subtotal, intracapsular resection followed by GKNS a few...
Vestibular Schwannomas are well treated by GKNS. This can be used alone for tumors up to 20cm. For larger tumors subtotal, intracapsular resection followed by GKNS a few months later would seem to give the best results. While there remain disagreements relating to optimal treatment for VSs among colleagues using different techniques, there are indications that these are becoming less confrontational. The evidence in this chapter suggests that early GKNS intervention results in better hearing preservation and tumor control in small tumors. The evidence in favor of "wait and see" depends on series reporting on changes in tumor size using suboptimal measurements. It is more important to record the fate of hearing, and this would seem to be better preserved following early GKNS. The results of GKNS for NF2 are by no means as good as could be wished but would seem to be superior to those of microsurgery. The importance of screening of family members cannot be over emphasized.
Topics: Hearing; Humans; Neuroma, Acoustic; Radiosurgery; Treatment Outcome
PubMed: 35074078
DOI: 10.1016/bs.pbr.2021.10.030 -
Journal of Clinical Neuroscience :... May 2014A 74-year-old man suffered contralateral hearing loss after left acoustic neuroma surgery. Steroid therapy was administered, but no improvement was observed.... (Review)
Review
A 74-year-old man suffered contralateral hearing loss after left acoustic neuroma surgery. Steroid therapy was administered, but no improvement was observed. Contralateral hearing loss is an extremely rare and distressing complication that can occur following acoustic neuroma surgery. Although the mechanism of this rare phenomenon remains unclear, we speculate that in this patient the loss of cerebrospinal fluid or internal auditory artery thrombosis may be involved.
Topics: Aged; Hearing Loss, Sensorineural; Humans; Male; Neuroma, Acoustic; Postoperative Complications
PubMed: 24231558
DOI: 10.1016/j.jocn.2013.06.019 -
BMJ (Clinical Research Ed.) Oct 1995
Review
Topics: Cerebellopontine Angle; Humans; Magnetic Resonance Imaging; Neuroma, Acoustic; Postoperative Complications
PubMed: 7580712
DOI: 10.1136/bmj.311.7013.1141 -
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