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MMW Fortschritte Der Medizin Sep 2017
Topics: Adult; Awareness; Combined Modality Therapy; Diagnosis, Differential; Diagnostic Techniques, Otological; Ear, Inner; Electronystagmography; Endolymphatic Hydrops; Humans; Image Enhancement; Magnetic Resonance Imaging; Medical History Taking; Meniere Disease; Neurologic Examination; Neuroma, Acoustic; Otoscopy; Postural Balance; Vestibular Diseases
PubMed: 28924703
DOI: 10.1007/s15006-017-9591-8 -
Revista de Neurologia
Topics: Aged; Cysts; Female; Humans; Magnetic Resonance Imaging; Neuroma, Acoustic
PubMed: 15573319
DOI: No ID Found -
Neurosurgery Clinics of North America Apr 2008This article reviews the microsurgical anatomy important to preserving the involved cranial nerves and adjacent neural and vascular structures during acoustic neuroma...
This article reviews the microsurgical anatomy important to preserving the involved cranial nerves and adjacent neural and vascular structures during acoustic neuroma removal. These anatomic considerations are divided into sections dealing with the relationships at the lateral end of the tumor in the meatus and those on the medial end of the tumor at the brain stem. The anatomy of the region offers the opportunity for three approaches to the tumor in the meatus and cerebellopontine angle. One is directed through the middle cranial fossa and the roof of the meatus. Another is directed throught the labyrinth and posterior surface of the temporal bone. The third is directed through the posterior cranial fossa and posterior meatel lip. The anatomy presented by all three approaches is reviewed in this article.
Topics: History, 21st Century; Humans; Microsurgery; Neuroma, Acoustic
PubMed: 18534333
DOI: 10.1016/j.nec.2008.02.005 -
The Keio Journal of Medicine Oct 2001
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The Journal of the Oklahoma State... May 1988
Review
Topics: Ear, Inner; Hearing Tests; Humans; Neuroma, Acoustic; Time Factors
PubMed: 3054023
DOI: No ID Found -
World Neurosurgery Sep 2019Evolving technologies and health care quality metrics have altered treatment algorithms for acoustic neuromas (ANs), increasing trends toward observation and...
BACKGROUND
Evolving technologies and health care quality metrics have altered treatment algorithms for acoustic neuromas (ANs), increasing trends toward observation and radiosurgery, with proportionate declines in use of microsurgery. A correlation between increasing surgical volumes and superior outcomes has been investigated previously in numerous surgical diseases, including AN.
OBJECTIVE
To re-evaluate the volume-outcome relationship of AN resection in a changing health care system, with evolving treatment strategies.
METHODS
Patients who underwent AN resection between 2009 and 2013 were retrospectively identified in the State Inpatient Database subset of the Healthcare Cost and Utilization Project. Generalized linear mixed-effect models were used to assess odds of various outcome measures (length of stay [LOS], discharge disposition, and facial nerve or severe clinical complications). Institutions were grouped into low-volume centers (1-6 cases/year) and high-volume centers (HVC; ≥31 cases/year) for analysis.
RESULTS
A total of 1873 patients underwent AN resection between 2009 and 2013 with a mean age of 50.1 ± 14.1 years (±standard deviation). For each additional case treated annually, patients were 2% (odds ratio [OR], 0.98; 95% confidence interval, 0.96-0.99) less likely to experience a severe complication (P = 0.004). Each additional case also trended toward a decreased rate of facial nerve complications and nonroutine discharge. Inpatient LOS was also shorter for patients at HVCs (median, 4 vs. 5 days; P < 0.001).
CONCLUSIONS
Despite a relative decline in microsurgery compared with previous eras, care at HVCs is still associated with superior short-term outcomes, such as decreased LOS, facial nerve or other severe complications, and nonroutine discharges.
Topics: Adult; Aged; Databases, Factual; Delivery of Health Care; Female; Humans; Male; Microsurgery; Middle Aged; Neuroma, Acoustic; Outcome Assessment, Health Care; Radiosurgery; Treatment Outcome
PubMed: 31203081
DOI: 10.1016/j.wneu.2019.06.017 -
The American Journal of Otology Jan 1990The diagnostic findings in 300 patients with acoustic neuromas are reported. Because of a centralized treatment of acoustic neuromas, we have a uniform diagnostic...
The diagnostic findings in 300 patients with acoustic neuromas are reported. Because of a centralized treatment of acoustic neuromas, we have a uniform diagnostic work-up of all patients, which enables us to make a nonselected comparison of the diagnostic efficiency of the various tests. In patients with hearing better than 80 dB, a normal auditory brainstem response, the presence of recruitment, and normal caloric reaction, the presence of a tumor can be excluded. In patients with poor hearing, tomography is necessary if one does not prefer to perform CT directly. If CT, even with contrast enhancement, is negative, we continue to perform air CT. Only then do we know whether or not the patient has a tumor. Magnetic resonance imaging has not been available to us, but with this diagnostic modality even intrameatal tumors are visualized. However, with the present economy involved with magnetic resonance imaging it is not realistic at the present time to use this way of imaging as a screening procedure. In spite of an intensive campaign for making early diagnosis of acoustic neuromas, our attempts have not been successful, since we have even more tumors measuring over 40 mm in diameter among the latest 100 patients than among the first one hundred. Both patients and physicians (otologists) to some extent are still ignoring the possible significance of a unilateral, progressive, sensorineural hearing impairment. Guidelines for improving this situation are given. Twenty-one patients were followed for an average of 4 years, repeated CT scans were performed, and the tumor appeared to be progressing to a size requiring surgical intervention in only three of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Adolescent; Adult; Aged; Female; Hearing Loss, Sensorineural; Humans; Male; Middle Aged; Neuroma, Acoustic; Time Factors
PubMed: 2305850
DOI: No ID Found -
Otology & Neurotology : Official... Jul 2003Stereotactic radiosurgery for vestibular schwannoma entails uncertain long-term risk of tumor recurrence and delayed cranial neuropathies. In addition, the underlying... (Review)
Review
OBJECTIVE
Stereotactic radiosurgery for vestibular schwannoma entails uncertain long-term risk of tumor recurrence and delayed cranial neuropathies. In addition, the underlying histopathologic changes to the tumor bed are not fully characterized. We seek to understand the clinical and histologic features of recurrent vestibular schwannoma after stereotactic radiation therapy.
STUDY DESIGN
Retrospective review.
SETTING
Tertiary referral center.
PATIENTS
Four patients who underwent microsurgical resection of vestibular schwannoma after primary stereotactic radiation therapy.
INTERVENTION
Patients were treated primarily with gamma knife radiosurgery or fractionated stereotactic radiotherapy followed by salvage microsurgery. Retrosigmoid craniotomy was used in all cases.
MAIN OUTCOME MEASURES
Histopathologic review. Preoperative and postoperative facial nerve function was assessed with the House-Brackmann scale.
RESULTS
We observed highly inconsistent radiation changes in the cerebellopontine angle and internal auditory canal. Fibrosis outside and within the tumor bed varied markedly, complicating microsurgical dissection. Light microscopy confirmed the presence of viable tumor in all cases. Histopathologic features were typical of vestibular schwannoma, and there was no significant scarring that could be attributed to radiation effect.
CONCLUSIONS
The variable fibrosis in the cerebellopontine angle and lack of radiation changes seen histopathologically in irradiated vestibular schwannoma suggest that a uniform treatment effect was not achieved in these cases. Although all four patients with preoperative cranial neuropathies were found intraoperatively to have fibrosis in the cerebellopontine angle, excellent preservation of facial nerve anatomy and function was possible with salvage microsurgical resection. Additional analyses are needed to clarify the histopathologic and molecular characteristics associated with vestibular schwannoma growth after stereotactic radiation.
Topics: Aged; Female; Humans; Intraoperative Period; Magnetic Resonance Imaging; Microsurgery; Middle Aged; Neoplasm Recurrence, Local; Neuroma, Acoustic; Radiosurgery; Stereotaxic Techniques
PubMed: 12851560
DOI: 10.1097/00129492-200307000-00020 -
Annals of the Academy of Medicine,... May 1999The treatment of acoustic neuroma (vestibular schwannoma) has evolved greatly. In this report, we studied the history of acoustic tumour surgery, and documented the...
The treatment of acoustic neuroma (vestibular schwannoma) has evolved greatly. In this report, we studied the history of acoustic tumour surgery, and documented the value of technical advances in benefiting patients. We also present our outcome of surgery for this benign tumour in support of its use as the treatment of choice. In 611 patients undergoing initial surgery at Johns Hopkins from 1973-1994, complete resection was obtained in all but one case (intentional), and permanent morbidity and mortality rate was 0.3%. Including temporary morbidity, the rate was 3.8%. Tumour recurrence was seen in only 0.8% of cases. The facial nerve was preserved in 97.6% and function at one-year was House-Brackmann grade 1 or 2 in 89.7%. Lastly, we present results of an anatomical study localizing the nerves and vessels, and the frequency of involvement by tumour, associated with acoustic neuromas in 1006 surgical cases. We continue to offer surgery as the best treatment option for the majority of our patients, and prefer the suboccipital route because of its unrestricted access to all posterior fossa structures, and ability to preserve hearing.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Baltimore; Cochlear Nerve; Facial Nerve; General Surgery; History, 20th Century; Humans; Middle Aged; Neuroma, Acoustic; Surgical Procedures, Operative; Treatment Outcome
PubMed: 10575527
DOI: No ID Found -
Presse Medicale (Paris, France : 1983) May 1997
Topics: Aged; Female; Hearing Loss, Sensorineural; Humans; Neuroma, Acoustic; Tomography, X-Ray Computed
PubMed: 9205494
DOI: No ID Found