-
Neuro-oncology Nov 2011Acoustic neuromas present a challenging problem, with the major treatment modalities involving operative excision, stereotactic radiosurgery, observation, and...
Acoustic neuromas present a challenging problem, with the major treatment modalities involving operative excision, stereotactic radiosurgery, observation, and fractionated stereotactic radiotherapy. The morbidity/mortality following excision may differ by patient race. To address this concern, the morbidity of acoustic neuroma excision was assessed on a nationwide level. The Nationwide Inpatient Sample from 1994-2003 was used for analysis. Only patients admitted for acoustic neuroma excision were included (International Classification of Diseases, 9th edition, Clinical Modification = 225.1; primary procedure code = 04.01). Analysis was adjusted for several variables, including patient age, race, sex, primary payer for care, income in ZIP code of residence, surgeon caseload, and hospital caseload. Multivariate analyses revealed that postoperative mortality following acoustic neuroma excision was 0.5%, with adverse discharge disposition of 6.1%. The odds ratio for mortality in African Americans compared with Caucasians was 8.82 (95% confidence interval = 1.85-41.9, P = .006). Patients with high-caseload surgeons (more than 2 excisions/year), private insurance, and younger age had decreased mortality, better discharge disposition, and lower overall morbidity (P < .04). Neither hospital caseload nor median income were predictive factors. African Americans were 9 times more likely to die following surgery than Caucasians over a decade-long analysis. Given the relatively benign natural history of acoustic neuroma and the alarmingly increased mortality rate following surgical excision among older patients, African Americans, and patients receiving care from low-caseload surgeons, acoustic neuromas in these patient populations may be best managed by a more minimally invasive modality such as observation, fractionated stereotactic radiotherapy, or stereotactic radiosurgery.
Topics: Adolescent; Adult; Black or African American; Aged; Aged, 80 and over; Female; Follow-Up Studies; Healthcare Disparities; Humans; Length of Stay; Male; Middle Aged; Morbidity; Neuroma, Acoustic; Odds Ratio; Postoperative Complications; Radiosurgery; Survival Rate; Treatment Outcome; White People; Young Adult
PubMed: 21856684
DOI: 10.1093/neuonc/nor118 -
Turkish Journal of Medical Sciences Oct 2021The study aims to evaluate the usage of gold weight implants and monitor complaints and comfort of patients.
BACKGROUND
The study aims to evaluate the usage of gold weight implants and monitor complaints and comfort of patients.
METHODS
A hundred and ninety-one implantations performed between January 2009 and January 2019 were analyzed. Seventy-eight patients included in this study The average age of the patients was 51.3 ± 14.5 years. Forty-five (57.7%) of them were male and 33 (42.3%) female. Patient satisfaction was measured with a questionnaire containing the most common complaints related to gold weight in the literature through telephone surveys.
RESULTS
The average follow-up time was 74.5 months. Ninety-three-point-five percent of subjects had operational causes, among which the most widespread was acoustic neuroma (44.9%). The average time between facial paralysis and implantation was 141.1 days. Implantation was performed 26.6 days on average after acoustic neuroma surgery and 3.2 days on average after temporal zone malignancy surgery. Thirty-eight patients had their implants removed over either complication (n = 14) or recovery (n = 24). Recovery was the fastest after facial nerve decompression (mean= 4.75 ± 3.6 (2-10) months) and the slowest after 7-12 cranial nerve transfer (mean= 18.3 ± 8.2 (3-31) months). Twenty-six-point-nine percent (n = 21) of patients had complications, of which the most common was extrusion (n = 10). The overall satisfaction rate was 88.5% with the highest in visual acuity and the lowest in continuous requirement for artificial tear.
DISCUSSION
The gold weight implantation is an effective, reversible, and easy procedure significantly reducing complaints regarding paralytic lagophthalmos. Early implementation may be beneficial for ocular complications. A dynamic facial reanimation could terminate need of implant.
Topics: Humans; Female; Male; Adult; Middle Aged; Aged; Neuroma, Acoustic; Prostheses and Implants; Facial Paralysis; Eye; Gold
PubMed: 34174800
DOI: 10.3906/sag-2104-50 -
International Journal of Molecular... Mar 2023Although diagnosis and treatment of vestibular schwannomas (VSs) improved in recent years, no factors have yet been identified as being capable of predicting tumor...
Although diagnosis and treatment of vestibular schwannomas (VSs) improved in recent years, no factors have yet been identified as being capable of predicting tumor growth. Molecular rearrangements occur in neoplasms before any macroscopic morphological changes become visible, and the former are the underlying cause of disease behavior. Tumor microenvironment (TME) encompasses cellular and non-cellular elements interacting together, resulting in a complex and dynamic key of tumorigenesis, drug response, and treatment outcome. The aim of this systematic, narrative review was to assess the level of knowledge on TME implicated in the biology, behavior, and prognosis of sporadic VSs. A search (updated to November 2022) was run in Scopus, PubMed, and Web of Science electronic databases according to the PRISMA guidelines, retrieving 624 titles. After full-text evaluation and application of inclusion/exclusion criteria, 37 articles were included. VS microenvironment is determined by the interplay of a dynamic ecosystem of stromal and immune cells which produce and remodel extracellular matrix, vascular networks, and promote tumor growth. However, evidence is still conflicting. Further studies will enhance our understanding of VS biology by investigating TME-related biomarkers able to predict tumor growth and recognize immunological and molecular factors that could be potential therapeutic targets for medical treatment.
Topics: Humans; Ecosystem; Neuroma, Acoustic; Treatment Outcome; Tumor Burden; Tumor Microenvironment
PubMed: 37047498
DOI: 10.3390/ijms24076522 -
Acta Otorhinolaryngologica Italica :... Jun 2021
Review
Topics: Humans; Microsurgery; Neurilemmoma; Neuroma, Acoustic
PubMed: 34264923
DOI: 10.14639/0392-100X-N1443 -
The Journal of International Medical... Dec 2021We evaluated the outcomes of resection of small acoustic neuromas using the transcanal transvestibular endoscopic approach. Two patients with a small acoustic neuroma...
We evaluated the outcomes of resection of small acoustic neuromas using the transcanal transvestibular endoscopic approach. Two patients with a small acoustic neuroma were treated using this approach. The sizes of the tumors were 11 × 6 mm and 12 × 10 mm. Both tumors were removed completely without residual tumor tissue, and damage to the facial nerve and cochlear nerve was avoided. No patients developed postoperative vertigo, aggravation of postoperative facial paralysis, severe pain, or permanent postoperative complications. The patients were followed up for 6 months, and none developed recurrence. Resection of small acoustic neuromas by the transcanal transvestibular endoscopic approach is a simple and safe technique that achieves excellent functional results.
Topics: Facial Paralysis; Humans; Neoplasm, Residual; Neuroma, Acoustic; Postoperative Complications
PubMed: 34929111
DOI: 10.1177/03000605211062445 -
Clinical Imaging 1997While an acoustic neuroma is the most common cause of a cerebellopontine angle (CPA) mass, it accounts for only 1-10% of cases of sensorineural hearing loss (SNHL).... (Review)
Review
While an acoustic neuroma is the most common cause of a cerebellopontine angle (CPA) mass, it accounts for only 1-10% of cases of sensorineural hearing loss (SNHL). There are many other etiologies of SNHL, with characteristic imaging features, which may or may not be confined to the CPA.
Topics: Arachnoid Cysts; Brain Diseases; Cerebellopontine Angle; Diagnosis, Differential; Hearing Loss, Sensorineural; Humans; Lipoma; Magnetic Resonance Imaging; Neuroma, Acoustic; Tomography, X-Ray Computed
PubMed: 9156313
DOI: 10.1016/s0899-7071(96)00013-7 -
Gaceta Medica de Mexico 2012The vestibular schwannoma is a benign intracranial tumor of the myelin-forming cells of the vestibulocochlear nerve or cranial nerve VIII. It comprises 8-10% of all...
The vestibular schwannoma is a benign intracranial tumor of the myelin-forming cells of the vestibulocochlear nerve or cranial nerve VIII. It comprises 8-10% of all intracranial neoplasms in adults. It originates in the vestibular portion of the cranial nerve VIII and it is located in the cerebellopontine angle. This disorder is characterized by ipsilateral hearing loss, tinnitus, disturbed sense of balance and altered gait, facial numbness, muscle weakness or ipsilateral paralysis. This report presents the magnetic resonance imaging of a patient with this rare condition.
Topics: Female; Humans; Magnetic Resonance Imaging; Middle Aged; Neuroma, Acoustic
PubMed: 22622319
DOI: No ID Found -
Acta Otorhinolaryngologica Italica :... Aug 2017The aim of this study was to determine the natural history of growth and quality of life (QoL) outcomes for vestibular schwannoma (VS) managed conservatively, and to...
The aim of this study was to determine the natural history of growth and quality of life (QoL) outcomes for vestibular schwannoma (VS) managed conservatively, and to validate the disease-specific Penn Acoustic Neuroma Quality-of-Life (PANQOL) scale in French language. We retrospectively studied 26 patients with VS managed conservatively. Patient characteristics and radiological findings were collected. Two scales were used to measure QoL: the Short Form-36 Health Survey (SF-36) and the PANQOL scale translated into French. Internal consistency and scores were compared with previous studies. The mean follow-up was 25 months (range 6-72). We observed tumour growth in 14 patients (53.8%), no growth in 12 patients (46.2%) and no case of tumour shrinkage. The mean tumour growth was 2.22 mm/year. No predictive factor of growth was found. Patients with vertigo or dizziness experienced a poorer QoL according to the SF-36 (Social Functioning and Emotional Role Limitation dimensions) and to the PANQOL scale (Balance and Energy dimensions). Our results were comparable with the literature using the SF-36. With the PANQOL scale, our scores were not statistically different with those from Dutch and North American studies except in the field of hearing (p = 0.019). Quality of life becomes essential in the management of VS. According to these results, we support a non-conservative strategy associated with vestibular rehabilitation for patients with dizziness or vertigo. The PANQOL is a validated specific scale for VS, which can be useful in French.
Topics: Adult; Aged; Aged, 80 and over; Conservative Treatment; Female; Humans; Male; Middle Aged; Neuroma, Acoustic; Quality of Life; Retrospective Studies; Self Report; Translations
PubMed: 28872162
DOI: 10.14639/0392-100X-1094 -
International Journal of Epidemiology May 2022Exposure to high doses of ionizing radiation is among the few well-established brain tumour risk factors. We used data from the Interphone study to evaluate the effects...
BACKGROUND
Exposure to high doses of ionizing radiation is among the few well-established brain tumour risk factors. We used data from the Interphone study to evaluate the effects of exposure to low-dose radiation from diagnostic radiological examinations on glioma, meningioma and acoustic neuroma risk.
METHODS
Brain tumour cases (2644 gliomas, 2236 meningiomas, 1083 neuromas) diagnosed in 2000-02 were identified through hospitals in 13 countries, and 6068 controls (population-based controls in most centres) were included in the analysis. Participation across all centres was 64% for glioma cases, 78% for meningioma cases, 82% for acoustic neuroma cases and 53% for controls. Information on previous diagnostic radiological examinations was obtained by interviews, including the frequency, timing and indication for the examinations. Typical brain doses per type of examination were estimated based on the literature. Examinations within the 5 years before the index date were excluded from the dose estimation. Adjusted odds ratios were estimated using conditional logistic regression.
RESULTS
No materially or consistently increased odds ratios for glioma, meningioma or acoustic neuroma were found for any specific type of examination, including computed tomography of the head and cerebral angiography. The only indication of an elevated risk was an increasing trend in risk of meningioma with the number of isotope scans, but no such trends for other examinations were observed. No gradient was found in risk with estimated brain dose. Age at exposure did not substantially modify the findings. Sensitivity analyses gave results consistent with the main analysis.
CONCLUSIONS
There was no consistent evidence for increased risks of brain tumours with X-ray examinations, although error from selection and recall bias cannot be completely excluded. A cautious interpretation is warranted for the observed association between isotope scans and meningioma.
Topics: Adult; Brain Neoplasms; Case-Control Studies; Cell Phone; Glioma; Humans; Isotopes; Meningeal Neoplasms; Meningioma; Neuroma, Acoustic; Risk Factors
PubMed: 34648614
DOI: 10.1093/ije/dyab140 -
Audiology & Neuro-otology 2021The aim of this study is to perform a histopathologic analysis of temporal bones with an intralabyrinthine schwannoma (ILS) in order to characterize its extension.
OBJECTIVES
The aim of this study is to perform a histopathologic analysis of temporal bones with an intralabyrinthine schwannoma (ILS) in order to characterize its extension.
METHODS
Archival temporal bones with a diagnosis of sporadic schwannoma were identified. Both symptomatic and occult nonoperated ILS were included for further analysis.
RESULTS
A total of 6 ILS were identified, with 4 intracochlear and 2 intravestibular schwannomas. All intracochlear schwannomas involved the osseous spiral lamina, with 2 extending into the modiolus. The intravestibular schwannomas were limited to the vestibule, but growth into the bone next to the crista of the lateral semicircular canal was observed in 1 patient.
CONCLUSIONS
Complete removal of an ILS may require partial removal of the modiolus or bone surrounding the crista ampullaris as an ILS may extend into these structures, risking damage of the neuronal structures. Due to the slow growth of the ILS, it remains unclear if a complete resection is required with the risk of destroying neural structures hindering hearing rehabilitation with a cochlear implant.
Topics: Cochlea; Cochlear Implantation; Cochlear Implants; Humans; Neurilemmoma; Neuroma, Acoustic
PubMed: 33352553
DOI: 10.1159/000511634