scholarly journals Natural History, Multimodal Management, and Quality of Life Outcomes of Trigeminal Schwannomas

2018 ◽  
Vol 79 (06) ◽  
pp. 586-592 ◽  
Author(s):  
Vincent Ye ◽  
Ryojo Akagami ◽  
Serge Makarenko
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Natural History ◽  
Surgical Resection ◽  
Clinical Presentation ◽  
Treatment Goals ◽  
Life Outcomes ◽  
Quality Of Life Outcomes ◽  
History Of

Background Trigeminal schwannomas are the second most common among intracranial schwannomas. These can arise from anywhere between the root and the distal extracranial branches of the trigeminal nerve. Clinical presentation depends on location and size, including but not limited to facial hypesthesia or pain, headaches, dizziness, ataxia, and diplopia. Literature is strikingly scant discussing the natural history of these lesions, while the treatment goals are heavily dependent on tumor presentation. Management decisions must be individualized to each tumor and each patient, while attempting to maximize the quality of life. We present the natural history of these lesions as well as their management by surgical resection or radiation therapy, and report long-term quality of life outcomes. Methods Between 2001 and 2015, 24 patients (66.7% female) with trigeminal schwannomas were diagnosed and managed at Vancouver General Hospital. We analyzed the clinical presentation, surgical results, resection rates, patient quality of life, and complications. To complete the evaluation, we prospectively collected 36-Item Short Form Health Survey (SF-36) quality of life assessments for comparison. Results We identified 12 patients treated with a craniotomy and surgical resection, 4 were treated with radiation therapy, while 8 patients were followed by observation. Mean age of study cohort was 49.2 years (range, 23–79 years), and most patients presented with facial hypesthesia (54.2%) and headaches (37.5%), while 37.5% were incidental findings. There were no major differences in patient demographics between the three groups. Patients offered surgery had larger lesions (mean diameter, 3.4 ± 1.1 cm) when compared with those that were irradiated or observed, and were more likely to have extracranial extension. Overall patient quality of life improved following treatment (ΔSF-36 + 12.9) at 3.9 years. Conclusions The treatment goals of trigeminal schwannomas focus on improvement in neurologic symptoms, relief of mass effect, and preservation of cranial nerve function. We demonstrate that smaller lesions found incidentally with minimal symptoms can be followed safely with serial imaging, with 1 of 9 (11.1%) progressing to require treatment over the course of 7.1 years. Management of trigeminal schwannomas should be individualized with an involvement of a multidisciplinary skull base team.

scholarly journals Anxiety and Depression in Patients Who Undergo a Cerebrovascular Procedure

2020 ◽  
Author(s):  
Lauren Lombardo ◽  
Richard Shaw ◽  
Kathleen Sayles ◽  
Dorothea Altschul
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Physical Health ◽  
Global Mental Health ◽  
Anxiety And Depression ◽  
Life Outcomes ◽  
Quality Of Life Outcomes ◽  
Significant Difference ◽  
History Of

Abstract Background: Observe the relationship of anxiety and depression on quality of life outcomes after open and endovascular cerebrovascular procedures. Methods: We retrospectively analyzed 349 patients who underwent a procedure for aneurysm, arteriovenous malformation, intraparenchymal hemorrhage, carotid stenosis, acute stroke, and conventional catheter angiogram over three years at a community hospital. We correlated pre-procedural anxiety and depression with Global Physical Health, Global Mental Health, and Modified Rankin Scale scores. We performed univariate and multivariate linear and logistic regression analyses adjusting for past medical history and sociodemographic factors. Results: Anxiety or depression occurred in eighteen percent of patients. Patients with anxiety or depression were more likely to be female (81% vs 60.8%; p=0.002) and younger (54 vs. 59 years old; p=0.025). The groups did not differ in type or urgency of procedure, smoking or history of diabetes, or cardiovascular disease. Patients with anxiety or depression reported lower mental health scores at 30 days (45.1 vs 48.2; p=0.002) post-procedure. In multivariate analyses, anxious or depressed patients had worse mental health scores at 30 days (t=-2.893; p=0.008) than those who did not have a history of anxiety or depression. There was no difference between groups in length of stay, mortality, physical health t-scores, functionality scores, or six month quality of life outcomes. Conclusions: Patients undergoing cerebrovascular procedures who self-reported anxiety or depression showed a significant difference in mental health outcomes at 30 days, but six month mental health and other medical and functional outcomes measures were similar to patients without these diagnoses.

Natural History of Arteriovenous Malformations

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P41-P42
Author(s):  
James Y Suen ◽  
Lisa M Buckmiller ◽  
Chun-Yang Fan ◽  
Gal Shafirstein ◽  
Robert Glade
Keyword(s):  
Quality Of Life ◽  
Natural History ◽  
Surgical Resection ◽  
Healthcare Providers ◽  
Previous Treatment ◽  
Insurance Companies ◽  
Preoperative Embolization ◽  
Presenting Symptoms ◽  
History Of

Objective 1) To demonstrate the natural history of arteriovenous malformation (AVMs) when left untreated or inadequately managed. 2) To demonstrate the need for major treatment to patients, families, healthcare providers, and insurance companies. Methods Records from 10 of 50 representative patients treated at University of Arkansas for Medical Sciences (UAMS) for advanced AVMs were reviewed for age at presentation, gender, presenting symptoms, previous treatment, disease course, and post-presentation management. Patients were asked if quality of life had improved after treatment at UAMS Facial photos from childhood were obtained and compared with photos taken at time of presentation. Results 10 patients (7 male, 3 female, range 21–46 years) received treatment. All patients presented with bleeding, pain and/or facial destruction. 6 of 10 patients received previous embolization. No patients had undergone previous surgical resection. All were informed by a previous physician that the disease was incurable or treatment options had been exhausted. All patients experienced subsequent worsening of symptoMS All patients were treated at UAMS with preoperative embolization followed by surgical resection and required multiple surgeries to remove persistent AVM. All patients indicated quality of life improved after embolization/surgical resection. Comparison of photos revealed progression of disease in all cases marked by facial destruction and deformity. Conclusions AVMs display a progressive and destructive nature when left untreated or inadequately managed. Natural history can be used to demonstrate to patients, families, and healthcare providers the seriousness of disease and convince insurance companies that radical treatment is typically necessary to obtain control or cure.

scholarly journals MP04-11 COMPARING QUALITY OF LIFE OUTCOMES IN MEN RECEIVING EARLY VERSUS LATE POST-PROSTATECTOMY RADIATION THERAPY

2016 ◽  
Vol 195 (4S) ◽  
Author(s):  
Greg Murphy ◽  
Peter Haddock ◽  
Ilene Staff ◽  
Joseph Tortora ◽  
Alison Champagne ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Life Outcomes ◽  
Quality Of Life Outcomes
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