Preoperative Radiographic Predictors of Hearing Preservation After Retrosigmoid Resection of Vestibular Schwannomas

2020 ◽  
pp. 019459982097824
Author(s):  
Yin Ren ◽  
Kareem O. Tawfik ◽  
Bill J. Mastrodimos ◽  
Roberto A. Cueva
Keyword(s):  
Internal Auditory Canal ◽  
Case Series ◽  
Hearing Preservation ◽  
Vestibular Schwannomas ◽  
Tumor Diameter ◽  
Retrospective Case ◽  
Tumor Extension ◽  
Younger Age ◽  
Hearing Outcomes ◽  
Radiographic Data

Objective To identify preoperative radiographic predictors of hearing preservation (HP) after retrosigmoid resection of vestibular schwannomas (VSs). Study Design Retrospective case series with chart review. Setting Tertiary skull base referral center. Methods Adult patients with VSs <3 cm and word recognition scores (WRSs) ≥50% who underwent retrosigmoid resection and attempted HP between February 2008 and December 2018 were identified. Pure tone average (PTA), WRS, and magnetic resonance imaging radiographic data, including tumor diameter and dimensional extension relative to the internal auditory canal (IAC), were examined. Results A total of 151 patients were included. The average tumor size was 13.8 mm (range, 3-28). Hearing was preserved in 41.7% (n = 63). HP rates were higher for intracanalicular tumors than tumors with cerebellopontine angle (CPA) components (57.6% vs 29.4%, P = .03). On multivariate analysis, maximal tumor diameter (odds ratio [OR], 0.892; P < .001) and preoperative PTA (OR, 0.974; P = .026) predicted HP, while mediolateral tumor diameter predicted postoperative PTA (OR, 1.21; P = .005) and WRS (OR, –1.89; P < .001). For tumors extending into the CPA, younger age (OR, 0.913; P = .012), better preoperative PTA (OR, 0.935; P = .049), smaller posterior tumor extension (OR, 0.862; P = .001), and smaller caudal extension relative to the IAC (OR, 0.844; P = .001) all predicted HP. Conclusion Rates of HP are highest in patients with small intracanalicular VSs and good preoperative hearing. For tumors extending into the CPA, greater posterior and caudal tumor extension relative to the IAC may portend worse hearing outcomes.

The Medially-Invasive Cholesteatoma: An Aggressive Subtype of a Common Pathology

2020 ◽  
Vol 130 (1) ◽  
pp. 38-46
Author(s):  
Geoffrey Casazza ◽  
Matthew L. Carlson ◽  
Clough Shelton ◽  
Richard K. Gurgel
Keyword(s):  
Skull Base ◽  
Tertiary Care ◽  
Case Series ◽  
Hearing Preservation ◽  
Csf Leak ◽  
Petrous Apex ◽  
Otic Capsule ◽  
Retrospective Case ◽  
Presenting Symptoms ◽  
Subtotal Petrosectomy

Objective: Describe the outcomes of treatment for patients with cholesteatomas that are medially invasive to the otic capsule, petrous apex, and/or skull base. Study Design: Retrospective case series Setting: Two tertiary care academic centers. Patients: Patients surgically managed for medially-invasive cholesteatoma at two tertiary care institutions from 2001 to 2017. Interventions: Surgical management of medially-invasive cholesteatomas. Main Outcome Measures: The presenting symptoms, imaging, pre- and post-operative clinical course, and complications were reviewed. Results: Seven patients were identified. All patients had pre-operative radiographic evidence of invasive cholesteatoma with erosion into the otic capsule beyond just a lateral semicircular canal fistula. Five patients had a complex otologic history with multiple surgeries for recurrent cholesteatoma including three with prior canal wall down mastoidectomy surgeries. Average age at the time of surgery was 41.3 years (range 20-83). Two patients underwent a hearing preservation approach to the skull base while all others underwent a surgical approach based on the extent of the lesion. Facial nerve function was maintained at the pre-operative level in all but one patient. No patient developed cholesteatoma recurrence. Conclusions: The medially-invasive cholesteatoma demonstrates an aggressive, endophytic growth pattern, invading into the otic capsule or through the perilabyrinthine air cells to the petrous apex. Surgical resection remains the best treatment option for medially-invasive cholesteatoma. When CSF leak is a concern, a subtotal petrosectomy with closure of the ear is often necessary.

Cochlear Implantation in Children with Postlingual Progressive Steeply Sloping High-Frequency Hearing Loss

2017 ◽  
Vol 28 (10) ◽  
pp. 913-919 ◽  
Author(s):  
Margaret A. Meredith ◽  
Jay T. Rubinstein ◽  
Kathleen C. Y. Sie ◽  
Susan J. Norton
Keyword(s):  
Hearing Loss ◽  
Speech Perception ◽  
Hearing Aids ◽  
Cochlear Implantation ◽  
High Frequency ◽  
Case Series ◽  
Hearing Preservation ◽  
Rapid Improvement ◽  
Retrospective Case ◽  
Monosyllabic Word

Background: Children with steeply sloping sensorineural hearing loss (SNHL) lack access to critical high-frequency cues despite the use of advanced hearing aid technology. In addition, their auditory-only aided speech perception abilities often meet Food and Drug Administration criteria for cochlear implantation. Purpose: The objective of this study was to describe hearing preservation and speech perception outcomes in a group of young children with steeply sloping SNHL who received a cochlear implant (CI). Research Design: Retrospective case series. Study Sample: Eight children with steeply sloping postlingual progressive SNHL who received a unilateral traditional CI at Seattle Children’s Hospital between 2009 and 2013 and had follow-up data available up to 24 mo postimplant were included. Data Collection and Analysis: A retrospective chart review was completed. Medical records were reviewed for demographic information, preoperative and postoperative behavioral hearing thresholds, and speech perception scores. Paired t tests were used to analyze speech perception data. Hearing preservation results are reported. Results: Rapid improvement of speech perception scores was observed within the first month postimplant for all participants. Mean monosyllabic word scores were 76% and mean phoneme scores were 86.7% at 1-mo postactivation compared to mean preimplant scores of 19.5% and 31.0%, respectively. Hearing preservation was observed in five participants out to 24-mo postactivation. Two participants lost hearing in both the implanted and unimplanted ear, and received a sequential bilateral CI in the other ear after progression of the hearing loss. One participant had a total loss of hearing in only the implanted ear. Results reported in this article are from the ear implanted first. Bilateral outcomes are not reported. Conclusions: CIs provided benefit for children with steeply sloping bilateral hearing loss for whom hearing aids did not provide adequate auditory access. In our cohort, significant improvements in speech understanding occurred rapidly postactivation. Preservation of residual hearing in children with a traditional CI electrode is possible.

Optimal outcomes for hearing preservation in the management of small vestibular schwannomas

2016 ◽  
Vol 130 (7) ◽  
pp. 606-610 ◽  
Author(s):  
K A Peng ◽  
E P Wilkinson
Keyword(s):  
Hearing Preservation ◽  
Vestibular Schwannomas ◽  
Middle Fossa ◽  
Stereotactic Radiation ◽  
Middle Fossa Approach ◽  
Small Tumour ◽  
Optimal Outcomes ◽  
Definitive Therapy ◽  
Hearing Outcomes

AbstractObjective:To undertake a systematic review of the role of microsurgery, in relation to observation and stereotactic radiation, in the management of small vestibular schwannomas with serviceable hearing.Methods:The Medline database was searched for publications that included the terms ‘vestibular schwannoma’ and/or ‘acoustic neuroma’, occurring in conjunction with ‘hearing’. Articles were manually screened to identify those concerning vestibular schwannomas under 1.5 cm in greatest dimension. Thereafter, only publications discussing both pre-operative and post-operative hearing were considered.Results:Twenty-six papers were identified. Observation is an acceptable strategy for small tumours with slow growth where hearing preservation is not a consideration. In contrast, microsurgery, including the middle fossa approach, may provide excellent hearing outcomes, particularly when a small tumour has begun to cause hearing loss. Immediate post-operative hearing usually predicts long-term hearing. Recent data on stereotactic radiation suggest long-term deterioration of hearing following definitive therapy.Conclusion:In patients under the age of 65 years with small vestibular schwannomas, microsurgery via the middle fossa approach offers durable preservation of hearing.

What Is the Best Method for Reporting Tumor Diameter in Vestibular Schwannoma?

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 634-638 ◽  
Author(s):  
Yuichiro Tanaka ◽  
Kazuhiro Hongo ◽  
Tsuyoshi Tada ◽  
Shigeaki Kobayashi
Keyword(s):  
Tumor Volume ◽  
Three Dimensional ◽  
Internal Auditory Canal ◽  
Vestibular Schwannomas ◽  
Maximum Diameter ◽  
Tumor Diameter ◽  
Constructive Interference ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Abstract OBJECTIVE Various methods have been used to report the tumor diameter of vestibular schwannomas. To clarify the most appropriate method to represent the tumor volume, tumor diameters according to various measuring methods were statistically compared with the actual tumor volume. METHODS Tumor volume was measured by three-dimensional constructive interference in steady state images in 52 unselected vestibular schwannomas. Pearson's correlation coefficient was obtained between the tumor volume and various tumor diameters, such as diameter parallel to the petrous edge (a); a pons-to-petrous diameter (b); √ab, a maximum diameter of the portion in the cerebellopontine angle cistern (max CPA); a maximum diameter of the whole tumor (Max); and a diameter through an axis of the internal auditory canal (Axis). The tumors were divided into three groups on the basis of tumor volume, as follows: Group I (small, &3x003C;0.5 cm3), Group II (medium, 0.5–2 cm3), and Group III (large, &gt;2 cm3). RESULTS Max and Axis correlated best with the tumor volume in Group I and correlated least with the tumor volume in Group II. Any of these measurements was acceptable in Group III tumors. The max CPA consistently revealed good correlation with the tumor volume in all three tumor groups. CONCLUSION The max CPA measurement is the simplest and most appropriate way to represent the tumor volume in unselected tumors. Max or Axis is better only when small tumors (&lt;0.5 cm3 in volume) are being assessed—that is, those with a max CPA of less than 1 cm.

Hearing Preservation After Microsurgical Resection of Large Vestibular Schwannomas

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. 632-640 ◽  
Author(s):  
Salvatore Di Maio ◽  
A Daniel Malebranche ◽  
Brian Westerberg ◽  
Ryojo Akagami
Keyword(s):  
Cerebrospinal Fluid ◽  
Tumor Volume ◽  
Internal Auditory Canal ◽  
Longitudinal Axis ◽  
Hearing Preservation ◽  
Complete Resection ◽  
Tumor Diameter ◽  
Microsurgical Resection ◽  
Preservation Rate

Abstract BACKGROUND: Hearing, which is often still clinically useful at presentation even with larger tumors, is a major determinant of quality of life in vestibular schwannoma (VS) patients. OBJECTIVE: To present the hearing preservation rate after surgery in patients with large (≥3 cm) VSs and identify clinical or radiologic predictors of hearing preservation. METHODS: From April 2003 to March 2009, 192 patients underwent resection of a VS, including 46 large (≥3 cm) tumors, of whom 28 had serviceable hearing preoperatively. Six of 28 patients (21.4%) had preserved hearing postoperatively. RESULTS: Mean tumor diameter was 3.6 cm (range, 3.0-5.0 cm) and tumor volume was 17.2 mL (range, 6.9-45.2 mL). For patients with grade A Sanna-Fukushima hearing, the hearing preservation rate was 4 of 11 (36.4%). Complete resection was achieved in 6 of 6 cases with hearing preservation (41/47 for all patients). Six of 6 patients with preserved hearing had a cerebrospinal fluid cleft in the internal auditory canal (IAC) compared with 9 of 16 patients without preoperative hearing and 9 of 20 for patients with serviceable hearing that was lost postoperatively (P = .045). Six of 6 patients with preserved hearing had less than 35% of the tumor anterior to the longitudinal axis of the IAC compared with 13 of 20 in the serviceable hearing that was lost group (P = .036). CONCLUSION: Our series demonstrates hearing preservation is possible for patients with large VSs and should be attempted in all patients with preoperative hearing. The quality of preoperative hearing, a cerebrospinal fluid cleft at the apex of the IAC, and a smaller proportion of tumor anterior to the IAC were positively associated with hearing preservation.

Hearing preservation in medial vestibular schwannomas

2008 ◽  
Vol 109 (1) ◽  
pp. 70-76 ◽  
Author(s):  
Christian Strauss ◽  
Barbara Bischoff ◽  
Johann Romstöck ◽  
Jens Rachinger ◽  
Stefan Rampp ◽  
...  
Keyword(s):  
Growth Pattern ◽  
Auditory Evoked Potentials ◽  
Internal Auditory Canal ◽  
Hearing Preservation ◽  
Neck Surgery ◽  
Underlying Disease ◽  
Cochlear Nerve ◽  
Vestibular Schwannomas ◽  
Consecutive Series ◽  
Tumor Removal

Object Vestibular schwannomas (VSs) with no or little extension into the internal auditory canal have been addressed as a clinical subentity carrying a poor prognosis regarding hearing preservation, which is attributed to the initially asymptomatic intracisternal growth pattern. The goal in this study was to assess hearing preservation in patients who underwent surgery for medial VSs. Methods A consecutive series of 31 cases in 30 patients with medial VSs (mean size 31 mm) who underwent surgery between 1997 and 2005 via a suboccipitolateral route was evaluated with respect to pre- and postoperative cochlear nerve function, extent of tumor removal, and radiological findings. Intraoperative monitoring of brainstem auditory evoked potentials was performed in all patients with hearing. Patients were reevaluated at a mean of 30 months following surgery. Results Preoperative hearing function revealed American Academy of Otolaryngology–Head and Neck Surgery Foundation Classes A and B in 7 patients each, Class C in 4, and D in 9. Four patients presented with deafness. Hearing preservation was achieved in 10 patients (Classes A–C in 2 patients each, and Class D in 4 patients). Tumor removal was complete in all patients with hearing preservation, except for 2 patients with neurofibromatosis. In 4 patients a planned subtotal excision was performed due to the individual's age or underlying disease. In 1 patient a recurrent tumor was completely removed 3 years after the initial procedure. Conclusions The cochlear nerve in medial VSs requires special attention due to the atypical intracisternal growth pattern. Even in large tumors, hearing could be preserved in 37% of cases, since the cochlear nerve in medial schwannomas may not exhibit the adherence to the tumor capsule seen in tumors with comparable size involving the internal auditory canal.

Spina bifida and lower limb amputation in Northern Ireland: A retrospective study of demographics and outcome

2017 ◽  
Vol 41 (5) ◽  
pp. 503-506 ◽  
Author(s):  
Lorraine Graham
Keyword(s):  
Spina Bifida ◽  
Lower Limb ◽  
Chart Review ◽  
Case Series ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Retrospective Case ◽  
Younger Age ◽  
Chronic Skin ◽  
Almost All

Background: Spina bifida is an uncommon cause for lower limb amputation. The causes and level of amputation and mobility outcome for these patients have not been reported previously. Case description: To identify the causes and level of amputation and the mobility outcome for amputee patients with spina bifida. Study design: Retrospective case series. Methods: Chart review of patients identified by computer as having an amputation secondary to neurological or congenital cause. Additional patients identified from the Regional Spina Bifida Medical Clinic. Demographics, cause and level of mobility pre- and post-amputation recorded from the prosthetic notes. Findings: In total, 16 patients were identified who had a diagnosis of spina bifida and a lower limb amputation. Mean age at the time of amputation was 28.5 years. In total, 15 patients had a transtibial amputation. In total, 14 patients post-amputation were able to maintain their mobility, wheelchair or walking, without any change in type of aid needed. Conclusion: Patients with spina bifida appear to require lower limb amputation at a younger age than patients with peripheral vascular disease. Almost all patients had prior chronic skin infection/osteomyelitis as precursors for amputation. The most common level for amputation was transtibial. Mobility was maintained for all patients, albeit for two in a more supported way. Clinical relevance Spina bifida is an uncommon reason for amputation. Patients, are often younger and medically complicated. Chronic skin ulceration, was the most common indication for amputation. Wheelchair or walking ambulance was maintained at the same level for most patients.

scholarly journals Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between Preservation of Function and Maximal Tumor Removal

2021 ◽  
Author(s):  
Luciano Mastronardi ◽  
Alberto Campione ◽  
Fabio Boccacci ◽  
Carlo Giacobbo Scavo ◽  
Ettore Carpineta ◽  
...  
Keyword(s):  
Functional Results ◽  
Hearing Preservation ◽  
High Rate ◽  
Vestibular Schwannomas ◽  
Maximum Diameter ◽  
Consecutive Series ◽  
Tumor Diameter ◽  
Impaired Hearing ◽  
Class B ◽  
The Right

Abstract Purpose Koos Grade IV vestibular schwannomas (VS) (maximum diameter >3cm) compress the brainstem and displace the fourth ventricle. Microsurgical resection with attention to the right balance between preservation of function and maximal tumour removal is the treatment of choice.Methods Our series consists of 60 consecutive patients with unilateral VS, operated on from December 2010 to July 2019. All patients underwent microsurgical removal via the retrosigmoid approach. The adherence of VS’ capsule to surrounding nervous structures and the excessive tendency of tumor to bleed during debulking, because of a redundant vascular architecture, was evaluated by reviewing video records. Microsurgical removal of tumor was classified as total (T), near-total (NT: residue<5%), subtotal (ST: residue 5-10%) or partial (P: residue>10%).Results Maximal mean tumor diameter was 3,97cm (SD±1,13; range 3,1-5,8cm). Preoperative severely impaired hearing or deafness (AAO-HNS Classes C-D) was present in 52 cases (86,7%). Total or NT resection was accomplished in 46 cases (76,7%), 65,8% in cases with and 95,4% without tight adhesion of capsule to nervous structures (p<0,001). Endoscopic-assisted microsurgical removal of VS in the IAC was performed in 23 patients: in these cases a T resection was obtained in 78,3% versus 45,9% of microsurgery only (p<0,001).The capsule of VS was tightly adherent to nervous structures in 63,3% of patients, whereas hypervascular high-bleeding tumors represented 56,7%. Hearing preservation was possible in 2 out of 8 patients with preoperative class B hearing. At last follow-up, 34 patients (56,7%) had a normal postoperative FN outcome (HBI), 9 (15,0%) were HBII, 8 (13,3%) HBIII, and 9 (15,0%) HBIV. Total-NT resection of solid and low-bleeding VS, without tight capsule adhesion was associated with better FN outcome. Mortality was zero; permanent complications were observed in 2 cases (diplopia, hydrocephalus), transient in 9.Conclusions Microsurgery of Koos Grade IV VS seems to be associated with more than acceptable functional results, with high rate of T and NT removal of tumor. Long-term FN results seem to be worse in patients with cystic Koos Grade IV VS, in cases with tight capsule adherences to nervous structures and in high-bleeding tumors.

scholarly journals Isolated middle ear anomalies: unfamiliar causes of conductive hearing loss: a case series

2020 ◽  
Vol 7 (1) ◽  
pp. 130
Author(s):  
Honnurappa Vijayendra ◽  
Somashekhar Abhilasha ◽  
Vinay Vijayendra ◽  
Nilesh Mahajan
Keyword(s):  
Hearing Loss ◽  
Middle Ear ◽  
Case Series ◽  
Retrospective Case ◽  
Case Series Study ◽  
Ear Anomalies ◽  
Operative Findings ◽  
Hearing Outcomes ◽  
Conductive Hearing ◽  
Series Study

<p class="abstract">In this paper, we highlighted on the various types of isolated congenital middle ear ossicular anomalies we had seen and managed. This is significant as these are rare and go undiagnosed for long period of time. The mainstay of managing these conditions includes proper and timely diagnosis and correction of conducting hearing loss. This was a retrospective case series study done over period of 3 years from July 2016 to June 2019 at a tertiary referral otology centre. The study comprised of 9 patients diagnosed with isolated middle ear anomalies and in total 11 operated ears for the same as two patients underwent bilateral treatment. Each case was handled differently according to the intra operative middle ear findings. We found that in all of our cases the HRCT findings were in correlation with our intra operative findings. All cases had excellent post-operative hearing outcomes. Isolated middle ear deformity even though rare to identity, with recent advancement it is possible to diagnose and treat it on time and hence reduce the disability experienced by the patient. Whatever the type of abnormalities, most of them could be corrected with appropriate ossicular reconstruction by preserving the normal existing anatomy and bypassing the anomalous part.</p><p> </p>

Association of Metformin With the Growth of Vestibular Schwannomas

2020 ◽  
pp. 019459982093797
Author(s):  
Sophia Tran ◽  
Daniel E. Killeen ◽  
Shafeen Qazi ◽  
Sanjana Balachandra ◽  
Jacob B. Hunter
Keyword(s):  
Logistic Regression ◽  
Tumor Volume ◽  
Tertiary Care ◽  
Case Series ◽  
Vestibular Schwannomas ◽  
Tumor Diameter ◽  
Multivariate Logistic Regression ◽  
Volumetric Growth ◽  
Mri Studies ◽  
The Mean

Objective To assess whether medication use, specifically statin, metformin, and aspirin, affects the growth of vestibular schwannomas (VSs). Study Design Retrospective case series. Setting Single tertiary care academic hospital. Subjects and Methods Patients were enrolled if they were diagnosed with sporadic VS and had at least 2 magnetic resonance imaging (MRI) studies at a minimum of 6 months apart prior to any intervention. Electronic medical records were reviewed for demographic and medication data. Tumor volumes on MRI studies were assessed via BrainLab iPlan. The primary endpoint was VS tumor growth, defined as a 20% increase in tumor volume, between consecutive MRI studies or between the first and last available MRI study. Predictors of volumetric growth, specifically statin, aspirin, or metformin use, were analyzed with t tests, chi-square test, univariate logistic regression, and multivariate logistic regression. Results A total of 387 patients met inclusion criteria, 53.5% of whom were women. For all patients, the mean age was 60.6 years (range, 18.2-89.2 years); the mean axial tumor diameter, 11.9 mm (range, 1.7-32.0 mm); and the mean tumor volume, 0.85 cm3 (range, 0.01-13.1 cm3). In review of the electronic medical record, 46 patients (11.9%) were taking metformin; 145 (37.5%), a statin; and 117 (30.2%), aspirin. Among patients taking metformin, 39.1% (18/46) exhibited volumetric growth, as opposed to 58.2% (198/340) of nonusers ( P = .014). Metformin (odds ratio, 0.497; P = .036) is significantly associated with reduced VS growth when controlling for aspirin, statin, and tumor size on multivariate logistic regression. Conclusion Metformin use is associated with reduced volumetric VS growth.

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