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Clinical Neurology and Neurosurgery Jun 2020Vestibular schwannomas can be treated in different ways, but for symptomatic or growing tumors, the gold standard is surgical removal of the lesion. In order to preserve... (Meta-Analysis)
Meta-Analysis
Vestibular schwannomas can be treated in different ways, but for symptomatic or growing tumors, the gold standard is surgical removal of the lesion. In order to preserve neurovascular structures, partial removal is often performed, leaving a residual that may grow in subsequent years. To date, there is no consensus with regard to surgical treatment of vestibular schwannoma residuals, and so this review focuses on this topic. A structured search was performed on PubMed searching for all articles discussing vestibular schwannoma residuals and recurrences. Only articles discussing surgical treatment were included, focusing on studies which also examined facial nerve outcomes. A total of 51 articles were eligible for review and these included 375 patients. Statistical analysis was performed by correlating the following parameters: patients' gender and age at first surgery, surgical approach adopted at first and subsequent surgeries, tumor and residual size, and extent of resection (gross total, near total, subtotal or others) at first and subsequent surgical procedures. Facial nerve function was also analyzed focusing on its performance when correlated with the different surgical approaches. The data were analyzed by linear regression but there were no correlations between any of the parameters chosen. There was a statistically significant difference between the first approach used (mainly the retrosigmoid route) compared with subsequent approaches (mainly the translabyrinthine route). In total, 8.5 % of patients needed further treatment due to residual regrowth. Facial nerve outcome was independent of the parameters chosen. Exclusive surgical treatment for vestibular schwannoma residuals had a very low failure rate in terms of requiring further treatment. The approach usually chosen for second surgery was the translabyrinthine technique, and this may be explained by the location of the residual, rather than its size. The choice of a particular surgical approach rather than another had no influence on facial nerve function. Complications rates are comparable to Gamma Knife Radiosurgery's as reported in the literature.
Topics: Humans; Neoplasm Recurrence, Local; Neuroma, Acoustic; Neurosurgical Procedures; Treatment Outcome
PubMed: 32146233
DOI: 10.1016/j.clineuro.2020.105769 -
Neurosurgical Review Feb 2021The surgical injury of the intracranial portion of the facial nerve (FN) is a severe complication of many skull base procedures, and it represents a relevant issue in... (Comparative Study)
Comparative Study Meta-Analysis
Comparison between VII-to-VII and XII-to-VII coaptation techniques for early facial nerve reanimation after surgical intra-cranial injuries: a systematic review and pooled analysis of the functional outcomes.
The surgical injury of the intracranial portion of the facial nerve (FN) is a severe complication of many skull base procedures, and it represents a relevant issue in terms of patients' discomfort, social interactions, risk for depression, and social costs. The aim of this study was to investigate the surgical and functional outcomes of the most common facial nerve rehabilitation techniques. The present study is a systematic review of the pertinent literature, according to the PRISMA guidelines. Two different online medical databases (PubMed, Scopus) were screened for studies reporting the functional outcome, measured by the House-Brackman (HB) scale, and complications, in FN early reanimation, following surgical injuries on its intracranial portion. Data on the VII-to-VII and XII-to-VII coaptation, the surgical technique, the use of a nerve graft, the duration of the deficit, and complications were collected and pooled. The XII-to-VII end-to-side coaptation seems to provide higher chances for functional restoration (HB 1-3) than the VII-to-VII (68.8% vs 60.6%), regardless of the duration of the palsy deficit, the use or not of a nerve graft, and the use of stitches or glues. However, its complication rate was as high as 28.6%, and a second procedure is then often needed. The XII-to-VII side-to-end coaptation is the most effective in providing a functional outcome (HB 1-3), even though it is associated to a higher complication rate. Further trials are needed to better investigate this relevant topic, in terms of health-related social costs and patients' quality of life.
Topics: Facial Nerve; Facial Nerve Injuries; Facial Paralysis; Humans; Hypoglossal Nerve; Neurosurgical Procedures; Postoperative Complications; Skull Base; Treatment Outcome
PubMed: 31912333
DOI: 10.1007/s10143-019-01231-z -
A Systematic Review of Interventions for Balance Dysfunction in Patients With Vestibular Schwannoma.Otology & Neurotology : Official... Mar 2020Dizziness is a major contributing factor to poor quality of life for patients with vestibular schwannoma (acoustic neuroma). We wished to review the literature on...
OBJECTIVE
Dizziness is a major contributing factor to poor quality of life for patients with vestibular schwannoma (acoustic neuroma). We wished to review the literature on interventions for balance dysfunction in these patients.
DATA SOURCES
A systematic literature review was performed identifying studies that measured balance function before and after treatment for vestibular schwannoma. Data sources include Medline (1950-present), EMBASE (1974-present), Cochrane Library (issue 3, 2008), NHS Centre of reviews and dissemination, Clinical Evidence, Cochrane central register of controlled trial, and CINAHL.
STUDY SELECTION
A minimum follow-up of 6 months was required, to estimate long-term balance function. Eight articles were identified, including five studies with surgical intervention, two studies with stereotactic radiotherapy, and one comparing the two. Study design was generally poor with a high risk of bias. These studies all utilized the Dizziness Handicap Inventory (DHI) as a measure of pre- and postintervention balance function.
DATA EXTRACTION
Results showed that overall DHI scores are not statistically affected by intervention irrespective of modality (surgery or stereotactic radiotherapy). Patients selected with severe dizziness, who undergo surgery, improved postoperatively. No other studies for severe dizziness were noted for comparison.
CONCLUSIONS
Age, sex, and tumor size have no statistically significant effect on DHI outcomes, and no evidence to suggest which treatment modality has better dizziness related outcomes.No specific treatment modality was superior in terms of long-term balance function. Patients with severe dizziness may benefit from surgery, although no comparator studies were identified.
Topics: Dizziness; Humans; Neuroma, Acoustic; Postural Balance; Quality of Life; Vertigo
PubMed: 31834215
DOI: 10.1097/MAO.0000000000002530 -
European Archives of... Feb 2020Cochlear implantation (CI) in patients with sensorineural hearing loss caused by a vestibular schwannoma (VS) represents a unique subtype of hearing rehabilitation, as... (Comparative Study)
Comparative Study
PURPOSE
Cochlear implantation (CI) in patients with sensorineural hearing loss caused by a vestibular schwannoma (VS) represents a unique subtype of hearing rehabilitation, as the outcome may be compromised by vestibulocochlear nerve injury as part of the natural VS history or due to iatrogenic trauma induced by surgical tumor removal. This paper aims to review and report contemporary knowledge and practice regarding feasibility and outcomes of simultaneous vestibular schwannoma resection and cochlear implantation to serve as a reference and guide for future surgery and studies.
METHODS
The current literature was searched systematically according to the PRISMA guidelines and after criteria-based selection, 29 studies were identified, including a total of 86 patients who had undergone surgical resection of a vestibular schwannoma and subsequent cochlear implantation in a single procedure.
RESULTS
The postoperative outcomes were reported with a high degree of heterogeneity, hindering a proper meta-analysis. However, pooling those cases with reported speech discrimination outcomes demonstrated mean scores equivalent to moderate-to-high performance. A few cases had no audibility. A positive cochlear nerve test result was not a secure positive predictor of success. Complications were rare.
CONCLUSION
NF2-associated and sporadic VS had good and comparable postoperative outcomes despite significant differences in tumor size, location and surgical approach.
Topics: Cochlear Implantation; Genes, Neurofibromatosis 2; Hearing Loss, Sensorineural; Humans; Neuroma, Acoustic; Vestibulocochlear Nerve; Vestibulocochlear Nerve Injuries
PubMed: 31802225
DOI: 10.1007/s00405-019-05741-w -
Journal of Neurological Surgery. Part... Dec 2019This study was aimed to perform a systematic literature review by examining outcomes in patients with sporadic vestibular schwannoma (VS) undergoing ipsilateral...
This study was aimed to perform a systematic literature review by examining outcomes in patients with sporadic vestibular schwannoma (VS) undergoing ipsilateral cochlear implant (CI). PubMed-NCBI (National Center for Biotechnology Information) and Scopus databases were searched through October 2017. Studies reporting auditory outcomes for each patient when a CI was placed with an ipsilateral sporadic VS were included. Demographic variables, VS characteristics, preoperative hearing metrics, duration of deafness, CI type, approach to tumor resection, postoperative auditory outcomes, and postoperative tinnitus outcomes were reported for each eligible patient within studies. Each study was evaluated for quality and bias. Fifteen studies and 45 patients met inclusion criteria. Mean speech discrimination score (SDS) improved from 30.0 to 56.4% after CI placement. The majority when reported had an improvement in tinnitus. Preoperative ipsilateral SDS was a negative predictor of postoperative SDS, while neither tumor resection status, tumor location, duration of deafness, ipsilateral pure tone average, nor timing of CI placement had a significant effect on patient outcome. Notwithstanding the challenges inherent with surveillance magnetic resonance imaging (MRI) in the setting of a cochlear implant magnet, select sporadic vestibular schwannoma patients can be considered for cochlear implantation.
PubMed: 31750050
DOI: 10.1055/s-0038-1676768 -
Journal of Radiosurgery and SBRT 2019Vestibular schwannomas (VS) are benign tumors with a slow growth rate. There exists controversy regarding whether patients should receive upfront observation, SRS, FSRT,...
INTRODUCTION
Vestibular schwannomas (VS) are benign tumors with a slow growth rate. There exists controversy regarding whether patients should receive upfront observation, SRS, FSRT, or surgery at the time of diagnosis. For patients declining resection, this systematic review evaluates the risks and benefits between observation and SRS upon diagnosis of VS.
METHODS
Published studies on VS (including acoustic neuromas) were systematically reviewed for clinical series including patients with newly/recently diagnosed unilateral VS. Studies that included patients with previous treatment for the VS or focused on patients with neurofibromatosis (or other genetic conditions) were excluded. Review articles and systematic reviews were excluded but reviewed for relevant references that would otherwise meet search criteria.
RESULTS
Most patients electing observation underwent their first surveillance scan 6 months after initial diagnosis, then annually or every-other-year thereafter. Follow up was similar for patients receiving radiosurgery. The follow up period varied between studies as not all studies published at a specific time point. Observation alone conferred a radiographic tumor control rate of 65% and serviceable hearing in 71.3% at by the end of the follow up period in the reviewed studies, and 34% of patients initially opting for observation went on to ultimately elect for treatment. Initial radiosurgery resulted in a tumor control rate of 97% and serviceable hearing rate of 73.8% at by the end of the follow up period. Radiosurgery resulted in improved tumor control at the end of the follow up period (p < 0.0001), and serviceable hearing did not statistically differ (p = 0.69). There is an early risk of progressive hearing decline on patients who chose initial observation.
CONCLUSION
Based on the available published data, observation after initial diagnosis is appropriate for many patients with VS without symptomatic brainstem compression. However, initial observation does risk early progressive hearing dysfunction and patients with serviceable hearing at diagnosis may benefit from early therapy. Long term follow up is critical, and an algorithm to better risk-stratify patients with newly diagnosed VS is underway.
PubMed: 31641546
DOI: No ID Found -
Journal of Neuro-oncology Nov 2019Communicating hydrocephalus (cHCP) after radiosurgery (RS) for vestibular schwannomas (VS) has been reported. Many hypothetical mechanisms for this pathology have been... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Communicating hydrocephalus (cHCP) after radiosurgery (RS) for vestibular schwannomas (VS) has been reported. Many hypothetical mechanisms for this pathology have been proposed without consensus. The aim of this study is to determine if the platform used to treat the disease, Gamma Knife (GK) versus linear accelerator (LINAC)-based RS, makes a difference in outcome.
METHODS
We conducted a meta-analysis of databases PubMed and Cochrane to identify all articles for the period January 2000-August 2018 with the following inclusion criteria: (1) VS treated with single fraction SRS (2) > 10 patients (3) original reports only (4) hydrocephalus reported as complication (5) human study.
RESULTS
A total of 7039 and 988 VS patients reported in 35 and 10 papers were treated with GK or LINAC RS, respectively. Demographic baseline characteristics not reported in aggregate did not differ between the two groups. The incidence of cHCP was 3% [95% CI 2-4] and 2% [95% CI 1-3] for GK and LINAC RS patients, respectively. Surgical CSF diversion was performed in 88% and 68% of patients evaluated for cHPC in the GK and LINAC group, respectively. Follow-up range was 30-150 and 29-92 months for GK and LINAC, respectively.
CONCLUSIONS
The incidence of cHCP following RS for VS is very low in both GK and LINAC treated patients, albeit not identical. The higher reported surgical intervention rate for VS patients treated with GK RS might be multi-factorial, including longer follow-up in the GK group.
Topics: Humans; Hydrocephalus; Neuroma, Acoustic; Radiosurgery; Treatment Outcome
PubMed: 31621039
DOI: 10.1007/s11060-019-03305-w -
Cochlear Implants International Jan 2020Vestibular schwannomas (VS) are rare benign tumours of the vestibular nerve that cause hearing loss. Management strategies include watchful waiting, radiotherapy or...
Vestibular schwannomas (VS) are rare benign tumours of the vestibular nerve that cause hearing loss. Management strategies include watchful waiting, radiotherapy or surgical resection. Historically, the presence of retrocochlear disease has been considered to be a contra-indication to cochlear implantation (CI). The aim of this systematic review is to assess hearing rehabilitation outcomes for CI recipients with VS, either sporadic or associated with neurofibromatosis type 2, whose tumours have been managed with either observation or radiotherapy. PubMed, Embase, and Cochrane Library databases were searched from inception through to November 2018. 50 cases from 12 studies met the inclusion criteria. Patient demographics, VS characteristics, management strategy, pre-CI hearing status, electrical promontory stimulation testing, post-CI hearing status and speech perception scores, functional benefits and follow-up length are reported. Radiotherapy and observation groups had similar patient demographics in terms of age at CI, tumour size and duration of deafness. Following CI, 64% and 60% of patients in the radiotherapy and observation groups achieved open-set speech perception, respectively. Pure tone average thresholds (33 vs. 39 dB) and speech scores were also comparable between both groups. Ipsilateral CI in patients with VS that have not been surgically resected can provide beneficial hearing rehabilitation outcomes.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Audiometry, Pure-Tone; Cochlear Implantation; Correction of Hearing Impairment; Female; Hearing Loss; Humans; Male; Middle Aged; Neurofibromatosis 2; Neuroma, Acoustic; Radiotherapy; Treatment Outcome; Watchful Waiting; Young Adult
PubMed: 31496442
DOI: 10.1080/14670100.2019.1662161 -
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 -
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