Cognitive and psychosocial outcomes following stereotactic radiosurgery for acoustic neuroma

BACKGROUND: Acoustic Neuroma (AN) is a benign tumour of the eighth cranial nerve. Stereotactic Radiosurgery (SRS) is a common treatment approach. Studies have explored the primary effects of SRS and documented equivalent efficacy for tumour control compared to neurosurgery. OBJECTIVE: Examine the longer term cognitive and psychosocial outcomes of SRS in non-Neurofibromatosis Type II patients utilising both objective and subjective cognitive outcomes associated with quality of life and health related distress. METHODS: Nineteen individuals treated via SRS were assessed using a battery of standardised psychometric tests as well as measures of quality of life and psychological distress. RESULTS: Participants had largely preserved cognitive function except for processing speed, aspects of attention and visual memory relative to age norms. Self-reported quality of life was better than in other AN population studies. Level of psychological distress was equivalent to general population norms. More than half of participants reported subjective cognitive decline though this was not fully supported by objective testing. Subjective cognitive complaints may be associated with lower reported quality of life. CONCLUSIONS: Results are largely consistent with previous findings on the effects of SRS in other clinical groups, which supports SRS as a targeted radiation treatment for AN.

Diagnosis and Management of Vestibular Schwannoma: Focus on Dizziness

Vestibular schwannoma (VS) is commonly encountered in the cerebellopontine angle and benign neoplasms that arise from Schwann cells of the eighth cranial nerve, which can show not only hearing loss but also various vestibular symptoms. Dizziness is the symptom causing significantly negative effect on quality of life in patients with VS. Here, we will review the dizziness in VS.

A mechanistic mathematical model of initiation and malignant transformation in sporadic vestibular schwannoma

A vestibular schwannoma (VS) is a relatively rare, benign tumour of the eighth cranial nerve, often involving alterations to the gene NF2. Previous mathematical models of schwannoma incidence have not attempted to account for alterations in specific genes, and could not distinguish between point mutations and loss of heterozygosity (LOH). Here, we present a mechanistic approach to modelling initiation and malignant transformation in Schwannoma. Each parameter is associated with a specific gene or mechanism operative in Schwann cells, and can be determined by combining incidence data with empirical frequencies of pathogenic variants and LOH. This results in new estimates for the base pair mutation rate u = 4.48 × 10−10 and the rate of LOH = 2.03 × 10−6/yr in Schwann cells. In addition to new parameter estimates, we extend the approach to estimate the risk of both spontaneous and radiation-induced malignant transformation. We conclude that radiotherapy is likely to have a negligible excess risk of malignancy for sporadic VS, with a possible exception of rapidly growing tumours.

Potential Molecular Biomarkers of Vestibular Schwannoma Growth: Progress and Prospects

Vestibular schwannomas (VSs, also known as acoustic neuromas) are relatively rare benign brain tumors stem from the Schwann cells of the eighth cranial nerve. Tumor growth is the paramount factor for neurosurgeons to decide whether to choose aggressive treatment approach or careful follow-up with regular magnetic resonance imaging (MRI), as surgery and radiation can introduce significant trauma and affect neurological function, while tumor enlargement during long-term follow-up will compress the adjacent nerves and tissues, causing progressive hearing loss, tinnitus and vertigo. Recently, with the deepening research of VS biology, some proteins that regulate merlin conformation changes, inflammatory cytokines, miRNAs, tissue proteins and cerebrospinal fluid (CSF) components have been proposed to be closely related to tumor volume increase. In this review, we discuss advances in the study of biomarkers that associated with VS growth, providing a reference for exploring the growth course of VS and determining the optimal treatment strategy for each patient.

Recurrent Schowannoma With Extensive Xanthomatous Changes: A Case Report

Schwannoma is one of the most common benign intracranial tumors, which originates from the Schwann cells of neural structures in the upper part of the vestibular branch of the eighth cranial nerve. This report describes a 64-year-old woman with headache and vertigo who had a past surgical history of acoustic schwannoma about 10 years ago. The patient underwent excisional surgery. Histological examinations revealed schwannoma with extensive xanthomatous changes. Immunohistochemistry staining confirmed the diagnosis. Base on the diagnosis, the patient received no more treatment. After 6 months of close follow-up examinations, no recurrence and complication were observed. Schwannoma could be seen with a vast variety of histologic changes. Recurrence of Schownnoma is uncommon in patients without neurofibromatosis, but it should be considered in a proper clinical context.

766 Endoscopic Surgery for Sporadic Vestibular Schwannoma Resection: A Systematic Review of Surgical Outcomes

Introduction Vestibular schwannomas (VS) are benign intracranial tumours originating from the vestibular division of the eighth cranial nerve. The mainstay of their surgical management is microsurgery, other options are radiotherapy or radiological monitoring. Endoscopy (ES) is becoming widely used in neurosurgery and may have a role in improving visualisation and outcomes by enhancing extent of resection, facial nerve, and hearing preservation in VS resection and describe the postoperative outcomes. Method The review was conducted according to the PRISMA guidelines and yielded 31 studies for inclusion. Systematic searches of literature databases were done for studies where endoscopic-assisted and/or endoscopic resection of VS were reported. Results ES facial nerve preservation rates (median 91.3%, range 39.0 - 100%) were comparable to microsurgical treatment. Hearing outcomes were more variable in ES series and were under-reported. A median gross total resection rate of 97.4% (61.0 - 100%) was achieved in the ES series. Conclusions Current data suggest that ES-assisted resection of sporadic VS is not inferior to microsurgical resection with respect to facial nerve outcomes and extent of resection. However, some ES series report poor hearing outcomes, which are under-reported in the literature.

Nasal Schwannoma

Introduction A schwannoma is a benign nerve sheath tumuor of myelinated nerves arising from Schwann cells. In the head and neck region, the most common site is the eighth cranial nerve (vestibulocochlear). Only 4% of schwannomas seen in the head and neck region arise from the nose and paranasal sinuses involving branches of the trigeminal nerve (ophthalmic or maxillary) or from the autonomic nervous system. Case Report A 29 year old female patient presented to the Ear, Nose and Throat Out Patient Department with the complaints of left sided nasal obstruction and left sided nasal bleed. On anterior rhinoscopy, a single, smooth, greyish, non-pulsatile polypoidal mass was seen in the left nasal cavity seeming to be arising medial to middle turbinate. A provisional diagnosis of benign nasal mass was made and the patient underwent excision under general anaesthesia. On histopathology, an impression of Schwannoma was made. Discussion Sino-nasal schwannomas are a very rare entity with non specific imaging studies. A confirmatory diagnosis can be made only after histopathology. The treatment modality of choice is surgical excision of the mass, taking care to leave no residual, so as to prevent a recurrence.

Vestibular neuritis caused by severe acute respiratory syndrome coronavirus 2 infection diagnosed by serology: Case report

Vestibular neuritis is a disorder selectively affecting the vestibular portion of the eighth cranial nerve generally considered to be inflammatory in nature. There have been no reports of severe acute respiratory syndrome coronavirus 2 causing vestibular neuritis. We present the case of a 42-year-old Caucasian male physician, providing care to COVID-19 patients, with no significant past medical history, who developed acute vestibular neuritis, 2 weeks following a mild respiratory illness, later diagnosed as COVID-19. Physicians should keep severe acute respiratory syndrome coronavirus 2 high on the list as a possible etiology when suspecting vestibular neuritis, given the extent and implications of the current pandemic and the high contagiousness potential.

SURGERY OF JUGULAR FORAMEN LESIONS - AN INSTITUTIONAL EXPERIENCE

Jugular foramen tumors are rare skull base tumors having complex neurovascular anatomy. Most common being paragangliomas, lower cranial nerve schwannomas and meningiomas. Being the conduit for important neuro-vascular structures, potential complications following surgery are a frequent source of morbidity. Retrospective study done from March 2008 to September 2014. All patients underwent highresolution computer tomography (HRCT) of temporal bones and magnetic resonance imaging (MRI) with angiography in pre-operative period. Surgical approach and pre-operative endovascular intervention depended on the site and extent of the lesion. Extent of tumor removal was determined at the time of surgery. Patients with incomplete excisions in postoperative imaging were subjected to radiotherapy depending on histo-pathological diagnosis. Total of 22 patients of jugular foramen lesion were operated. Histopathological diagnosis included paraganglioma(n=18), schwannomas(n=2), p l a s m a c y t o m a ( n = 1 ) , s q u a m o u s c e l l carcinoma(n=1). Eighth cranial nerve was the most common involved nerve preoperatively (100%). Infratemporal Fossa approach, along with its modication, and conservative jugulopetrosectomy approach were used for surgical excision as per the extent of tumor. Complete excision was done in 73% (n=16), and postoperative radiotherapy was given to rest of the patients. The most common postoperative complication was lower cranial nerve decit in immediate post op period(n=15, 68%) (new onset n= 3, 13% and n=12, 55% had preoperative paresis), on follow up lower cranial nerve palsy improved in 50% in follow up (n=7). Most common tumor of the jugular foramen was paraganglioma followed by lower cranial nerve schwannoma. Surgical management depends on the extent of tumor. Multidisciplinary approach provides better patient outcome. Histopathological diagnosis aids to give targeted radiotherapy to the local site, and hence surgical excision of JFT(Jugular foramen tumor) is recommended.