Tinnitus Management in Lateral Skull Base Lesions

AbstractTinnitus, the phantom perception of sound in the absence of a physical sound source, is a complex problem with multiple etiologies. While most commonly presenting in a subjective fashion caused by measurable hearing loss, other etiologies including lateral skull base tumors that encroach on middle and inner ear structures can lead to phantom sound perception as well. In addition to discussing the basic background of tinnitus, here we also review current theories of etiology that include central auditory and nonauditory neural mechanisms and potential treatments that range from sound therapy to medications to cognitive and behavioral therapies and cranial nerve and brain stimulation. One main purpose of this article is to relate tinnitus causes to skull base tumors, surgical removal, and resultant sequelae, including damage to cranial nerves resulting in audiovestibular dysfunction. We also discuss the utility of microvascular decompression for both tumor and nontumor-associated tinnitus and the current literature regarding hearing preservation rates and tinnitus perception, where documented, with the three common treatment modalities employed for most lateral skull base tumors that includes watchful waiting with serial imaging, stereotactic radiosurgery and primary surgical resection using hearing preservation and hearing ablative approaches. The management of skull base tumors is a complex process that depending upon the approach and sequelae, may lead to manageable or worsening phantom sound perception that must be considered when discussing the multiple treatment options with patients.

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Hearing Outcomes Reporting in Lateral Skull Base Surgery

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1676371 ◽

2018 ◽

Vol 80 (02) ◽

pp. 120-124

Author(s):

Geoffrey Casazza ◽

Christian Bowers ◽

Richard Gurgel

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Meta Analysis ◽

Treatment Options ◽

Hearing Preservation ◽

Future Research ◽

Lateral Skull Base ◽

Skull Base Lesions ◽

Hearing Outcomes ◽

Large Groups

AbstractHearing outcomes reporting has evolved significantly and new standards for reporting now enable a more precise and comprehensive representation of hearing outcomes. Hearing is one of the critical sensory domains contained within the lateral skull base and temporal bone. For those patients with serviceable hearing, hearing preservation is a key treatment goal. Pre- and postoperative hearing assessment is fundamental to the diagnostic evaluation of patients preparing to undergo lateral skull base surgery. Standardization in reporting these hearing outcomes is critical to compare the efficacy of different treatment options for lateral skull base lesions. Over the time, reporting of hearing outcomes has evolved from broadly categorizing patients into large groups to comparing individual patients which requires more specific datasets to compare pre- and posttreatment hearing outcomes. Future research in lateral skull base surgery will benefit from precise, accurate, and easily understood reporting outcomes, all of which will allow for more efficient comparability between studies and pooling of data for meta-analysis.

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Full tractography for detecting the position of cranial nerves in preoperative planning for skull base surgery: technical note

Journal of Neurosurgery ◽

10.3171/2019.1.jns182638 ◽

2020 ◽

Vol 132 (5) ◽

pp. 1642-1652 ◽

Cited By ~ 2

Author(s):

Timothee Jacquesson ◽

Fang-Chang Yeh ◽

Sandip Panesar ◽

Jessica Barrios ◽

Arnaud Attyé ◽

...

Keyword(s):

Skull Base ◽

Preoperative Planning ◽

Skull Base Surgery ◽

Cranial Nerves ◽

Patient Specific ◽

Small Scale ◽

Skull Base Tumor ◽

Skull Base Tumors ◽

Brain White Matter ◽

Human Connectome Project

OBJECTIVEDiffusion imaging tractography has allowed the in vivo description of brain white matter. One of its applications is preoperative planning for brain tumor resection. Due to a limited spatial and angular resolution, it is difficult for fiber tracking to delineate fiber crossing areas and small-scale structures, in particular brainstem tracts and cranial nerves. New methods are being developed but these involve extensive multistep tractography pipelines including the patient-specific design of multiple regions of interest (ROIs). The authors propose a new practical full tractography method that could be implemented in routine presurgical planning for skull base surgery.METHODSA Philips MRI machine provided diffusion-weighted and anatomical sequences for 2 healthy volunteers and 2 skull base tumor patients. Tractography of the full brainstem, the cerebellum, and cranial nerves was performed using the software DSI Studio, generalized-q-sampling reconstruction, orientation distribution function (ODF) of fibers, and a quantitative anisotropy–based generalized deterministic algorithm. No ROI or extensive manual filtering of spurious fibers was used. Tractography rendering was displayed in a tridimensional space with directional color code. This approach was also tested on diffusion data from the Human Connectome Project (HCP) database.RESULTSThe brainstem, the cerebellum, and the cisternal segments of most cranial nerves were depicted in all participants. In cases of skull base tumors, the tridimensional rendering permitted the visualization of the whole anatomical environment and cranial nerve displacement, thus helping the surgical strategy.CONCLUSIONSAs opposed to classical ROI-based methods, this novel full tractography approach could enable routine enhanced surgical planning or brain imaging for skull base tumors.

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Survival outcomes of lateral skull base tumors following temporal bone resection

Head & Neck ◽

10.1002/hed.26707 ◽

2021 ◽

Author(s):

Neila L. Kline ◽

Kavita Bhatnagar ◽

David J. Eisenman ◽

Rodney J. Taylor

Keyword(s):

Skull Base ◽

Temporal Bone ◽

Survival Outcomes ◽

Skull Base Tumors ◽

Bone Resection ◽

Lateral Skull Base ◽

Temporal Bone Resection

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Lateral skull base surgery: a complicated pursuit?

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000436 ◽

2007 ◽

Vol 122 (3) ◽

pp. 221-229

Author(s):

V C Cousins

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Treatment Modalities ◽

Published Data ◽

Know How ◽

Team Assessment ◽

Pathological Conditions ◽

Lateral Skull Base ◽

Wide Range ◽

Multi Disciplinary Team

AbstractThe management of lesions of the lateral skull base is a highly sophisticated branch of surgery generally performed by otolaryngology–head and neck surgeons as part of a multi-disciplinary team. Assessment of patients with diseases affecting the lateral skull base can be complex, as can the application of the various treatment modalities and the management of the expected and unexpected side effects of that treatment.A wide range of pathological conditions occur in the lateral skull base. Many operations and procedures have been described for dealing with them. There is not necessarily one correct solution to the management of any particular problem in the skull base, with multiple factors to be considered in planning and intervention.As surgeons, we need to know how our own results and outcomes compare with pooled, published data concerning the implications and complications occurring as a result of intervention, in order to better advise our patients on their management.

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Transcervical Approach for Resection of Lateral Skull Base Tumors

Journal of Otology ◽

10.1016/s1672-2930(07)50021-8 ◽

2007 ◽

Vol 2 (2) ◽

pp. 102-108 ◽

Cited By ~ 1

Author(s):

Liu Jian-feng ◽

Zhang Qiu-hang ◽

Yang Da-zhang ◽

Qu Qiu-yi

Keyword(s):

Skull Base ◽

Skull Base Tumors ◽

Transcervical Approach ◽

Lateral Skull Base

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Patient Outcomes after Reirradiation of Small Skull Base Tumors using Stereotactic Body Radiotherapy, Intensity Modulated Radiotherapy, or Proton Therapy

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1694052 ◽

2019 ◽

Vol 81 (06) ◽

pp. 638-644

Author(s):

Sweet Ping Ng ◽

He Wang ◽

Courtney Pollard ◽

Theresa Nguyen ◽

Houda Bahig ◽

...

Keyword(s):

Skull Base ◽

Stereotactic Body Radiotherapy ◽

Radiation Treatment ◽

Intensity Modulated Radiotherapy ◽

Treatment Modalities ◽

Tumor Control ◽

Skull Base Tumors ◽

Intensity Modulated ◽

Grade 3

Abstract Purpose The aim of this study was to evaluate outcomes of patients who received reirradiation for small skull base tumors utilizing either intensity modulated radiotherapy (IMRT), stereotactic body radiotherapy (SBRT), and proton radiotherapy (PRT). Methods Patients who received IMRT, SBRT or PRT reirradiation for recurrent or new small skull base tumors (< 60 cc) between April 2000 and July 2016 were identified. Those with < 3 months follow-up were excluded. Clinical outcomes and treatment toxicity were assessed. The Kaplan–Meier method was used to estimate the local control (LC), regional control (RC), distant control (DC), progression free survival (PFS), and overall survival (OS). Results Of the 75 patients eligible, 30 (40%) received SBRT, 30 (40%) received IMRT, and 15 (20%) received PRT. The median retreatment volume was 28 cc. The median reirradiation dose was 66 Gy in 33 fractions for IMRT/PRT, and 45 Gy in 5 fractions for SBRT. The median time to reirradiation was 41 months. With a median follow-up of 24 months, the LC, RC, DC, PFS, and OS rates were 84%, 79%, 82%, 60%, and 87% at 1 year, and 75%, 72%, 80%, 49%, and 74% at 2 years. There was no difference in OS between radiation modalities. The 1- and 2-year late Grade 3 toxicity rates were 3% and 11% respectively.. Conclusions Reirradiation of small skull base tumors utilizing IMRT, PRT, or SBRT provided good local tumor control and low rates of Grade 3 late toxicity. A prospective clinical trial is needed to guide selection of radiation treatment modalities.

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