-
World Neurosurgery Feb 2021The popularization and application of microscopy, the in-depth study of the microanatomy of the cerebellopontine angle, and the application of intraoperative... (Meta-Analysis)
Meta-Analysis
Reliability of Preoperative Prediction of the Location of the Facial Nerve Using Diffusion Tensor Imaging-Fiber Tracking in Vestibular Schwannoma: A Systematic Review and Meta-Analysis.
The popularization and application of microscopy, the in-depth study of the microanatomy of the cerebellopontine angle, and the application of intraoperative electrophysiological monitoring technology to preserve facial nerve function have laid a solid foundation for the modern era of neurosurgery. The preoperative prediction of the location of the facial nerve is a long-desired goal of neurosurgeons. The advances in neuroimaging seem to be making this goal a reality. Many studies investigating the reliability of the preoperative prediction of the location of the facial nerve using diffusion tensor imaging-fiber tracking in vestibular schwannoma have been reported in the last 20 years. The PubMed, Embase, and Cochrane databases were searched for articles published before March 30, 2020. A comprehensive review of published studies was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Authors performed a systematic review and meta-analysis of the reported data to assess the reliability of the preoperative prediction of the location of the facial nerve using diffusion tensor imaging-fiber tracking in vestibular schwannoma. The data were analyzed using a fixed-effects model. The estimated overall intraoperative verification concordance rate was 89.05% (95% confidence interval 85.06%-92.58%). Preoperatively predicting the location of the facial nerve using diffusion tensor imaging-fiber tracking in vestibular schwannoma is reliable, but the extent to which it contributes to long-term facial nerve function is still unclear. To further verify these results, studies with larger sample sizes are needed in the future, especially prospective randomized controlled trials focusing on the long-term functional preservation of the facial nerve.
Topics: Diffusion Tensor Imaging; Facial Nerve; Facial Nerve Injuries; Humans; Intraoperative Complications; Neuroma, Acoustic; Neurosurgical Procedures; Preoperative Care; Reproducibility of Results
PubMed: 33130136
DOI: 10.1016/j.wneu.2020.10.136 -
Neurosurgical Review Aug 2021Most studies reported that cystic vestibular schwannoma (CVS) surgery has a less favourable prognosis than solid vestibular schwannoma (SVS) surgery. However, some... (Meta-Analysis)
Meta-Analysis Review
Most studies reported that cystic vestibular schwannoma (CVS) surgery has a less favourable prognosis than solid vestibular schwannoma (SVS) surgery. However, some studies report that it is unclear whether surgical outcomes for these conditions exhibit significant differences. The aim of this meta-analysis was to pool the current literature and describe and analyse any differences in the clinical symptoms and surgical outcomes among CVS and SVS. PubMed, Embase, and Cochrane databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines through April 22, 2020. Outcomes were analysed using a meta-analysis of the proportions. The results of the search yielded 17 studies that met the criteria for inclusion and analysis, involving 3074 participants (including 821 patients with CVSs and 2253 patients with SVSs). No significant differences in the extent of tumour resection (gross-total resection versus non-gross-total resection; RR, 0.93; 95% CI, 0.86-1.01; p = 0.096) and most other outcomes were noted between CVS and SVS cohorts. However, facial nerve function (House-Brackmann Grade I or II versus III or more) of CVS patients was worse (RR, 0.86; 95% CI, 0.78-0.93; p < 0.001) compared with SVS patients with more than 1 year of follow-up after surgery. The criteria of cystic acoustic neuroma needs to be further unified, and prospective cohort studies with larger sample sizes should be performed for further verification of these results in the future.
Topics: Facial Nerve; Humans; Neuroma, Acoustic; Retrospective Studies; Treatment Outcome
PubMed: 33009643
DOI: 10.1007/s10143-020-01400-5 -
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 -
Otology & Neurotology : Official... Oct 2020Hearing loss remains a significant morbidity for patients with vestibular schwannomas (VS). A growing number of reports suggest audibility with cochlear implantation...
OBJECTIVE
Hearing loss remains a significant morbidity for patients with vestibular schwannomas (VS). A growing number of reports suggest audibility with cochlear implantation following VS resection; however, there is little consensus on preferred timing and cochlear implant (CI) performance.
DATA SOURCES
A systematic literature search of the Ovid Medline, Embase, Scopus, and clinicaltrails.gov databases was performed on 9/7/2018. PRISMA reporting guidelines were followed.
STUDY SELECTION
Included studies reported CI outcomes in an ear that underwent a VS resection. Untreated VSs, radiated VSs, and CIs in the contralateral ear were excluded.
DATA EXTRACTION
Primary outcomes were daily CI use and attainment of open-set speech. Baseline tumor and patient characteristics were recorded. Subjects were divided into two groups: simultaneous CI placement with VS resection (Group 1) versus delayed CI placement after VS resection (Group 2).
DATA SYNTHESIS
Twenty-nine articles with 93 patients met inclusion criteria. Most studies were poor quality due to their small, retrospective design. Group 1 had 46 patients, of whom 80.4% used their CI on a daily basis and 50.0% achieved open-set speech. Group 2 had 47 patients, of whom 87.2% used their CI on a daily basis and 59.6% achieved open-set speech. Group 2 had more NF2 patients and larger tumors. CI timing did not significantly impact outcomes.
CONCLUSIONS
Audibility with CI after VS resection is feasible. Timing of CI placement (simultaneous versus delayed) did not significantly affect performance. Overall, 83.9% used their CI on a daily basis and 54.8% achieved open-set speech.
Topics: Cochlear Implantation; Cochlear Implants; Hearing Loss; Humans; Neuroma, Acoustic; Retrospective Studies; Treatment Outcome
PubMed: 32925835
DOI: 10.1097/MAO.0000000000002784 -
Stereotactic and Functional Neurosurgery 2021Trigeminal neuralgia (TN) secondary to tumors is encountered in up to 6% of patients with facial pain syndromes and is considered to be associated with tumors affecting... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Trigeminal neuralgia (TN) secondary to tumors is encountered in up to 6% of patients with facial pain syndromes and is considered to be associated with tumors affecting the trigeminal nerve pathways. The most frequent are meningiomas and vestibular schwannomas (VS). Stereotactic radiosurgery (SRS) has emerged as a valuable treatment, with heterogeneity of clinical results. We sought to review the medical literature on TN treated with SRS for meningiomas and VS and investigate the rates of improvement of TN symptoms.
METHODS
We reviewed articles published between January 1990 and December 2019 in PubMed. Pain relief after SRS, the maintenance of pain relief, and TN recurrence and complications were evaluated with separate meta-analyses, taking into account the data on individual patients.
RESULTS
Pain relief after SRS was reported as Barrow Neurological Institute (BNI) pain intensity scores of BNI I in 50.5% (range 36-65.1%) of patients and BNI I-IIIb in 83.8% (range 77.8-89.8%). There was no significant difference in series discussing outcomes for tumor targeting versus tumor and nerve targeting. Recurrences were described in 34.7% (range 21.7-47.6; tumor targeting). Maintenance of BNI I was reported in 36.4% (range 20.1-52.7) and BNI I-IIIb in 41.2% (range 29.8-52.7; tumor targeting series). When both the nerve and the tumor were targeted, only 1 series reported 86.7% with BNI I-IIIb at last follow-up. Complications were encountered in 12.6% (range 6.3-18.8; tumor targeting series) of patients; however, they were much higher, as high as 26.7%, in the only study reporting them after targeting both the nerve and the tumor. The most common complication was facial numbness.
CONCLUSION
SRS for TNB secondary to benign tumors, such as meningiomas and VS, is associated with favorable clinical course, but less favorable than in idiopathic TN. There was, however, heterogeneity among reports and targeting approaches. Although targeting both the nerve and the tumor seemed to achieve better long-term results, the rate of complications was much higher and the number of patients treated was limited. Future clinical studies should focus on the standard reporting of clinical outcomes and randomization of targeting methods.
Topics: Humans; Meningeal Neoplasms; Meningioma; Neuroma, Acoustic; Pain Management; Radiosurgery; Retrospective Studies; Treatment Outcome; Trigeminal Neuralgia
PubMed: 32906130
DOI: 10.1159/000509842 -
Acta Neurochirurgica Nov 2020The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVE
The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective.
MATERIAL AND METHODS
A systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. A subgroup analysis screening all surgical series published within the last 20 years (January 2000 to March 2020) was performed. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using meta-analysis models. This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management.
RESULTS
Tumor classification grades should be systematically used in the perioperative management of patients, with large vestibular schwannomas (VS) defined as > 30 mm in the largest extrameatal diameter. Grading scales for pre- and postoperative hearing (AAO-HNS or GR) and facial nerve function (HB) are to be used for reporting functional outcome. There is a lack of consensus to support the superiority of any surgical strategy with respect to extent of resection and use of adjuvant radiosurgery. Intraoperative neuromonitoring needs to be routinely used to preserve neural function. Recommendations for postoperative clinico-radiological evaluations have been elucidated based on the surgical strategy employed.
CONCLUSION
The main goal of management of large vestibular schwannomas should focus on maintaining/improving quality of life (QoL), making every attempt at facial/cochlear nerve functional preservation while ensuring optimal oncological control, thereby allowing to meet patient expectations. Despite the fact that this analysis yielded only a few Class B evidences and mostly expert opinions, it will guide practitioners to manage these patients and form the basis for future clinical trials.
Topics: Consensus; Hearing; Humans; Microsurgery; Neuroma, Acoustic; Neurosurgical Procedures; Postoperative Complications; Quality of Life; Radiosurgery; Skull Base; Treatment Outcome
PubMed: 32728903
DOI: 10.1007/s00701-020-04491-7 -
Clinical Neurology and Neurosurgery Sep 2020To date, the literature directly comparing the translabyrinthine approach and retrosigmoid approach in the operation of patients with vestibular schwannoma was limited.... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
To date, the literature directly comparing the translabyrinthine approach and retrosigmoid approach in the operation of patients with vestibular schwannoma was limited. We aimed to evaluate postoperative complications between translabyrinthine approach and retrosigmoid approach for treating vestibular schwannoma patients.
MATERIAL AND METHOD
Potential publications were selected from PubMed, Web of Science and Cochrane Library. Gray relevant studies were manually searched. We set the searching time spanning from the creation date of electronic engines to February 2020. STATA version 12.0 was exerted to process the pooled data.
RESULTS
A total of 9 literature included in the study, involving 2429 patients, hails from the Germany, USA, Canada, Italy, and France. Of these 2429 patients with vestibular schwannoma, there were 1628 cases from the translabyrinthine approach group versus 801 cases from the retrosigmoid approach group. The results demonstrated that the translabyrinthine approach group was associated with a lower rate of tinnitus (OR = 2.687; 95 %CI, 1.167-6.191; P = 0.02) and cranial nerve deficit (OR = 2.946; 95 %CI, 1.562-5.557; P = 0.001). And the translabyrinthine approach group was associated with a higher total resection rate (OR = 0.246; 95 %CI (0.071-0.848); P = 0.026). However, no statistic differences were found in the incidence of the near total (OR = 0.751; P = 0.351), subtotal resection (OR = 3.664; P = 0.109), postoperative facial nerve dysfunctions (OR, 0.763; P = 0.626), postoperative meningitis (OR = 2.7; P = 0.279), cerebrospinal fluid leak (OR = 1.225; P = 0.777), postoperative headache (OR = 1.412; P = 0.339), ophthalmic complications (OR = 0.87; P = 0.59), and vascular complications (OR = 2.501; P = 0.139).
CONCLUSION
Based on current evidence, the translabyrinthine approach was associated with a higher rate of total resection and a lower rate of the tinnitus and cranial nerve deficit. But the risk of cranial nerve deficit was clearly affected by the preoperative status. And a translabyrintine approach could imply a complete sensorineural hearing loss, which contribute to the lower rate of postoperative tinnitus. Consequently, more evidence-based researches are needed to supplement this opinion.
Topics: Cerebrospinal Fluid Leak; Cranial Nerve Injuries; Craniotomy; Headache Disorders, Secondary; Humans; Incidence; Meningitis; Neuroma, Acoustic; Observational Studies as Topic; Occipital Bone; Postoperative Complications; Randomized Controlled Trials as Topic; Tinnitus; Treatment Outcome; Vascular Diseases; Vestibule, Labyrinth; Vision Disorders
PubMed: 32540713
DOI: 10.1016/j.clineuro.2020.105994 -
Journal of Neurosurgery. Pediatrics May 2020Sporadic unilateral vestibular schwannomas are rare in the pediatric population. Little has been reported in the literature on the presentation, tumor size, response to... (Review)
Review
OBJECTIVE
Sporadic unilateral vestibular schwannomas are rare in the pediatric population. Little has been reported in the literature on the presentation, tumor size, response to surgical treatment, and recurrence rates in these younger patients. The authors' goal was to describe their institutional experience with pediatric sporadic vestibular schwannomas and to conduct a meta-analysis of the existing literature to provide further insight into the presentation, tumor characteristics, and surgical outcomes for these rare tumors to help direct future treatment strategies.
METHODS
The authors performed a retrospective review of all patients 21 years of age or younger with unilateral vestibular schwannomas and without neurofibromatosis type 2 who underwent resection by the senior authors between 1997 and 2019. A systematic review of the literature and meta-analysis was also performed by entering the search terms "pediatric" and "vestibular schwannoma" or "acoustic neuroma," as well as "sporadic" into PubMed. Presentation, treatment, clinical outcomes, and follow-up were analyzed.
RESULTS
Fifteen patients were identified at the authors' institution, ranging in age from 12 to 21 years (mean 16.5 years). Common presenting symptoms included hearing loss (87%), headache (40%), vertigo (33%), ataxia (33%), and tinnitus (33%). At the time of surgery, the mean tumor size was 3.4 cm, with four 1-cm tumors. Four patients had residual tumor following their first surgery, 3 (75%) of whom had significant radiographic regrowth that required further treatment. The literature review identified an additional 81 patients from 26 studies with patient-specific clinical data available for analysis. This resulted in a total of 96 reported patients with an overall average age at diagnosis of 12.1 years (range 6-21 years) and an average tumor size of 4.1 cm.
CONCLUSIONS
Pediatric vestibular schwannomas present similarly to those in adults, although symptoms of mass effect are more common, as these tumors tend to be larger at diagnosis. Some children are found to have small tumors and can be successfully treated surgically. Residual tumors in pediatric patients were found to have a higher rate of regrowth than those in their adult counterparts.
PubMed: 32470932
DOI: 10.3171/2020.3.PEDS19514 -
Neurosurgical Review Apr 2021Hydrocephalus (HC) can be associated with vestibular schwannoma (VS) at presentation. Although spontaneous resolution of HC after VS removal is reported, first-line... (Meta-Analysis)
Meta-Analysis
Hydrocephalus (HC) can be associated with vestibular schwannoma (VS) at presentation. Although spontaneous resolution of HC after VS removal is reported, first-line treatment is varied including preoperative ventriculoperitoneal (VP) shunt, external ventricular drainage (EVD), or lumbar drainage (LD). We performed a systematic review to clarify optimal management of HC associated with VS at presentation, as well as characteristics of patients with initial and persistent HC after VS removal, and prevalence of HC associated with VS. Fourteen studies were included. Patients were grouped according to the timing of HC treatment. The overall rate of VP shunts was 19.4%. Among patients who received VS removal as first-line treatment, 6.9% underwent permanent shunts. In a subgroup of 132 patients (studies with no-aggregate data), t test analysis for mean tumor size (P = 0.02) and mean CSF protein level (P < 0.001) demonstrated statistically significant differences between patients with resolved HC (3.48 cm and 201 mg/dL) and patients with persistent HC (2.46 cm and 76.8 mg/dL) after VS resection. Transient treatment of HC using EVD or LD further resolved the HC in 87.5% and 82.9% of patients, respectively, before and after VS removal. The overall prevalence of HC associated with VS in a population of 2336 patients was 9.3%. Schwannoma removal as first-line treatment is justified by its low rate of persistent HC requiring VP shunt (roughly 7%). Patients with smaller VS and lower CSF proteins present higher risk of persistent HC after schwannoma removal. Temporary treatment of HC contributes to its resolution, both before and after VS removal.
Topics: Adult; Aged; Aged, 80 and over; Disease Management; Drainage; Female; Humans; Hydrocephalus; Male; Middle Aged; Neuroma, Acoustic; Retrospective Studies; Ventriculoperitoneal Shunt
PubMed: 32266553
DOI: 10.1007/s10143-020-01287-2 -
Otology & Neurotology : Official... Jun 2020To determine short- and intermediate-term hearing preservation rates after microsurgical resection of vestibular schwannoma (VS).
OBJECTIVE
To determine short- and intermediate-term hearing preservation rates after microsurgical resection of vestibular schwannoma (VS).
DATA SOURCES
Systematic review of the Ovid, Cochrane, EMBASE, and Web of Science databases.
STUDY SELECTION
This study was restricted to full-text English-language articles detailing VS resection via the middle cranial fossa or retrosigmoid approaches. Documentation of pre- and posttreatment hearing outcomes with American Academy of Otolaryngology-Head and Neck Surgery, Gardner-Robertson, or word recognition score scales, as well as time to follow-up were required. Duplicate data sets, studies with >10% of patients with neurofibromatosis two, previous or nonsurgical VS treatment, case reports with
DATA EXTRACTION
Two authors independently performed full-text reviews to determine study eligibility. Discrepancies were settled by consensus. "Class A/B, I/II" hearing was defined as AAO-HNS Class A or B, Gardner-Robertson Class 1 or 2, or PTA ≤ 50 dB with word recognition score ≥ 50% on audiogram.
DATA SYNTHESIS
Pooled estimates of preserved Class A/B, I/II hearing at last postoperative follow-up.
CONCLUSIONS
Of 1323 reports, 14 were utilized in analyses yielding data from 2,977 patients. Mean follow-up was 52.5 months (SD = 19.9). Class A/B, 1/2 hearing was preserved at last follow-up in 57% of patients. Meta-regression revealed that resection through the middle cranial fossa was associated with preservation of serviceable hearing. Moreover, when preserved in the immediate postoperative period, it seems to be stable over time.
Topics: Cranial Fossa, Middle; Hearing; Hearing Tests; Humans; Microsurgery; Neuroma, Acoustic; Retrospective Studies; Treatment Outcome
PubMed: 32150025
DOI: 10.1097/MAO.0000000000002598