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Journal of Neurological Surgery. Part... Apr 2023K -67 is often used as a proliferation index to evaluate how aggressive a tumor is and its likelihood of recurrence. Vestibular schwannomas (VS) are a unique benign...
K -67 is often used as a proliferation index to evaluate how aggressive a tumor is and its likelihood of recurrence. Vestibular schwannomas (VS) are a unique benign pathology that lends itself well to evaluation with K -67 as a potential marker for disease recurrence or progression following surgical resection. All English language studies of VSs and K -67 indices were screened. Studies were considered eligible for inclusion if they reported series of VSs undergoing primary resection without prior irradiation, with outcomes including both recurrence/progression and K -67 for individual patients. For published studies reporting pooled K -67 index data without detailed by-patient values, we contacted the authors to request data sharing for the current meta-analysis. Studies reporting a relationship between K -67 index and clinical outcomes in VS for which detailed patients' outcomes or K -67 indices could not be obtained were incorporated into the descriptive analysis, but excluded from the formal (i.e., quantitative) meta-analysis. A systematic review identified 104 candidate citations of which 12 met inclusion criteria. Six of these studies had accessible patient-specific data. Individual patient data were collected from these studies for calculation of discrete study effect sizes, pooling via random-effects modeling with restricted maximum likelihood, and meta-analysis. The standardized mean difference in K -67 indices between those with and without recurrence was calculated as 0.79% (95% confidence interval [CI]: 0.28-1.30; = 0.0026). K -67 index may be higher in VSs that demonstrate recurrence/progression following surgical resection. This may represent a promising means of evaluating tumor recurrence and potential need for early adjuvant therapy for VSs.
PubMed: 36895813
DOI: 10.1055/a-1760-2126 -
European Archives of... Jan 2024To review the literature on intratympanic gentamicin treatment as prehabilitation for patients undergoing surgery for a unilateral vestibular schwannoma. (Review)
Review
The effect of intratympanic gentamicin as a prehabilitation strategy for objective and subjective vestibular function in patients undergoing microsurgery for a unilateral vestibular schwannoma.
OBJECTIVE
To review the literature on intratympanic gentamicin treatment as prehabilitation for patients undergoing surgery for a unilateral vestibular schwannoma.
DATA SOURCES
A systematic literature search was conducted up to March 2023 in Pubmed, Embase, Cochrane, Web of Science, Academic Search Premier, Google Scholar and Emcare databases.
REVIEW METHODS
Articles on the effect of intratympanic gentamicin followed by vestibular schwannoma surgery were reviewed. Data on objective vestibular function and subjective outcomes were compiled in tables for analysis. Relevance and methodological quality were assessed with the methodological index for non-randomized tool.
RESULTS
A total of 281 articles were identified. After screening and exclusion of duplicates, 13 studies were reviewed for eligibility, of which 4 studies could be included in the review. The posturography test, the subjective visual horizontal test, and the optokinetic nystagmus test showed decreased vestibular function in the group of patients who received intratympanic gentamicin before microsurgery compared to the group of patients without gentamicin. Other objective tests did not show significant differences between patient groups. Subjective vestibular outcomes, as evaluated by questionnaires on quality of life and/or dizziness, did not seem to improve from intratympanic gentamicin pretreatment.
CONCLUSION
Vestibular schwannoma patients who received intratympanic gentamicin before surgical resection of the tumor performed better in the posturography test, subjective visual horizontal test, and the optokinetic nystagmus test afterwards. However, studies that also evaluated subjective outcomes such as dizziness, anxiety, depression, and balance self-confidence did not show a positive effect of intratympanic gentamicin on the vestibular complaints and symptoms.
Topics: Humans; Dizziness; Gentamicins; Microsurgery; Neuroma, Acoustic; Preoperative Exercise; Quality of Life; Vertigo
PubMed: 37750993
DOI: 10.1007/s00405-023-08240-1 -
Journal of Clinical Neurology (Seoul,... May 2023Vestibular schwannoma (VS) is the most common type of tumor found in the cerebellopontine angle that accounts for 8% of all intracranial tumors. VS management is...
BACKGROUND AND PURPOSE
Vestibular schwannoma (VS) is the most common type of tumor found in the cerebellopontine angle that accounts for 8% of all intracranial tumors. VS management is currently a challenge due to the unpredictable nature of the tumor. Few studies have compared the results and complications of various therapeutic approaches to VS. Therefore, as a treatment option for VSs smaller than 25 mm, we conducted a systematic review to compare Gamma Knife radiosurgery (GKRS) with conventional surgery.
METHODS
Literature searches were conducted of four online databases (PubMed, Google Scholar, Cochrane, and ScienceDirect) using the following keyword search: ("vestibular schwannoma" OR "acoustic neuroma") AND ("gamma knife" OR "gamma knife radiosurgery") AND ("resection" OR "open surgery") AND ("hearing preservation" OR "facial nerve" OR "tumor growth").
RESULTS
We identified six retrospective cohort studies, five of which were of fair-to-good quality. All studies showed that GKRS was superior to surgery in hearing preservation. Two studies indicated that surgery was superior to GKRS in maintaining tumor control, one indicated that GKRS was superior, and the remainder indicated that there was no significant difference in maintaining tumor control between GKRS and microsurgery.
CONCLUSIONS
Based on the three outcomes chosen for this review, GKRS was superior to microsurgery in small VS.
PubMed: 36647227
DOI: 10.3988/jcn.2022.0116 -
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 -
Brazilian Journal of Otorhinolaryngology 2019Intralabyrinthine schwannoma is a rare, benign tumor that affects the most terminal portions of the vestibular and cochlear nerves. This tumor can be classified into 10...
INTRODUCTION
Intralabyrinthine schwannoma is a rare, benign tumor that affects the most terminal portions of the vestibular and cochlear nerves. This tumor can be classified into 10 subtypes, according to its inner ear location.
OBJECTIVE
To carry out a comprehensive review of the most frequent auditory manifestations secondary to the intralabyrinthine schwannoma, describing the possible underlying pathophysiological mechanisms.
METHODS
Systematic review of the literature until October 2017 using the PubMed, Web of Science and Scopus databases. The inclusion criteria were clinical manifestations of the intralabyrinthine schwannoma. Three researchers independently assessed the articles and extracted relevant information. The description of a case of an intravestibular subtype intralabyrinthine schwannoma with multiple forms of clinical presentations was used as an example.
RESULTS
Twenty-seven studies met our inclusion criteria. The most common intralabyrinthine schwannoma subtype was the intracochlear, followed by the intravestibular type. All the cases demonstrated hearing loss, usually progressive hearing loss.
CONCLUSION
The diagnosis of intralabyrinthine schwannomas is based on high-resolution magnetic resonance imaging and should be included in the differential diagnosis of patients with vestibulocochlear complaints. Although there are approximately 600 cases in the literature, we still lack a detailed description of the clinical evolution of the patients, correlating it with MRI findings of temporal bones and tumor subtype.
Topics: Adult; Audiometry; Disease Progression; Female; Hearing Loss; Humans; Labyrinth Diseases; Magnetic Resonance Imaging; Neuroma, Acoustic
PubMed: 29980446
DOI: 10.1016/j.bjorl.2018.05.007