Vestibular Schwannoma (Acoustic Neuroma)

[Frédéric]

I wanted to start a thread in the research news section for those who are concerned. First article below:

Comparison of translabyrinthine and retrosigmoid approach for treating vestibular schwannoma: A meta-analysis

Highlights

To roughly evaluate the efficacy and safety between trans-labyrinthine and retrosigmoid approach for treating vestibular schwannomas patients.

Potential studies were selected from PubMed, Web of Science and Cochrane Library. Gray relevant studies were manually searched.

A total of 9 publications, involving 2429 patients, of these 2429 cases with vestibular schwannomas, 1628 were from the translabyrinthine approach group versus 801 from the retrosigmoid approach group.

The results found that the translabyrinthine approach group was associated with a higher total resection rate (OR = 0.246; P = 0.026).

We found that the translabyrinthine approach group was associated with a lower rate of tinnitus (OR = 2.687; P = 0.02) and cranial nerves deficits (OR = 2.946; P = 0.001).

Abstract
Background
To date, the literature directly comparing the translabyrinthine approach and retrosigmoid approach in the operation of patients with vestibular schwannoma was limited. We aimed to evaluate postoperative complications between translabyrinthine approach and retrosigmoid approach for treating vestibular schwannoma patients.

Material and Method
Potential publications were selected from PubMed, Web of Science and Cochrane Library. Gray relevant studies were manually searched. We set the searching time spanning from the creation date of electronic engines to February 2020. STATA version 12.0 was exerted to process the pooled data.

Results
A total of 9 literature included in the study, involving 2429 patients, hails from the Germany, USA, Canada, Italy, and France. Of these 2429 patients with vestibular schwannoma, there were 1628 cases from the translabyrinthine approach group versus 801 cases from the retrosigmoid approach group. The results demonstrated that the translabyrinthine approach group was associated with a lower rate of tinnitus (OR = 2.687; 95 %CI, 1.167−6.191; P = 0.02) and cranial nerve deficit (OR = 2.946; 95 %CI, 1.562−5.557; P = 0.001). And the translabyrinthine approach group was associated with a higher total resection rate (OR = 0.246; 95 %CI (0.071−0.848); P = 0.026). However, no statistic differences were found in the incidence of the near total (OR = 0.751; P = 0.351), subtotal resection (OR = 3.664; P = 0.109), postoperative facial nerve dysfunctions (OR, 0.763; P = 0.626), postoperative meningitis (OR = 2.7; P = 0.279), cerebrospinal fluid leak (OR = 1.225; P = 0.777), postoperative headache (OR = 1.412; P = 0.339), ophthalmic complications (OR = 0.87; P = 0.59), and vascular complications (OR = 2.501; P = 0.139).

Conclusion
Based on current evidence, the translabyrinthine approach was associated with a higher rate of total resection and a lower rate of the tinnitus and cranial nerve deficit. But the risk of cranial nerve deficit was clearly affected by the preoperative status. And a translabyrintine approach could imply a complete sensorineural hearing loss, which contribute to the lower rate of postoperative tinnitus. Consequently, more evidence-based researches are needed to supplement this opinion.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0303846720303371

 

[Frédéric]

Cochlear Implantation in Patients with intrameatal or intracochlear Schwannoma of the Vestibularcochlear nerve

Background
Up to 98% of patients with schwannoma of the 8th cranial nerve suffer from hearing loss at the time of diagnosis, or experience further hearing loss during treatment. CROS-Hearing aids cannot restore binaural hearing, which is often desired by the patients. This case series evaluates the audiological outcome of cochlear implantation after removal of intracochlear or intrameatal schwannoma of the vestibulocochlear nerve.

Methods
Within our group of 12 patients, 5 underwent cochlear implantation sequentially after tumor removal (3/5 retrosigmoidal, 1/5 middle-fossa approach) or radiotherapy (2/5). In 7 cases simultaneous transcochlear/ translabyrithine tumor removal and CI was performed. Intraoperative ECAP and/or E-ABR measurements were used to monitor nerve function.

Results
Only 2 patients did not regain usable hearing and were explanted later. Freiburg number recognition varied between 50-100% (mean 91,1%), monosyllabic word recognition between 0-90% (mean 45,3%). Four subjects with severe preoperative tinnitus additionally reported significant tinnitus reduction after surgery.

Conclusion
Cochlear implantation can be a viable option for hearing rehabilitation in patients suffering from vestibular schwannoma.

Source: https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0040-1711098

 

[Frédéric]

Gamma Knife Radiosurgery for Transmodiolar Schwannoma

Background
Rare and deep located tumors are surgical challenge with high morbidity. Minimal invasive techniques should be encouraged for a better outcome. Intralabyrinthine schwannoma (ILS) is a rare benign tumor that usually presents with hearing loss and tinnitus. Surgery is associated with high rate of facial paralysis and deafness. Radiosurgery is an option for tinnitus treatment, without the risk of facial paralysis.

Case Description
A young male patient presented with severe hearing loss and incapacitating tinnitus. Magnetic resonance revealed the presence of a small ILS. Radiosurgery was performed and obtained tinnitus control without complications and no further tumor growth.

Conclusions
Tumor control and symptoms relief could be safely achieved through a precisely plan using Gamma Knife radiosurgery, decreasing morbidity. This is the first radiosurgical description for a transmodiolar schwannoma.

Source: https://www.sciencedirect.com/science/article/abs/pii/S1878875020315424

 

[Frédéric]

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

Even if it is not mentioned in the abstract, tinnitus is studied.

Full article: https://link.springer.com/article/10.1007/s00701-020-04491-7

 

[Frédéric]

I posted this publication in this thread since Vestibular Schwannomas are the most common CPA Tumors.
This publication supports the need to ask practitioners for an MRI to rule out any kind of tumors.

The Added Value of MRI in Diagnosis of Cerebello-pontine Angle Tumors

Background
Cerebello pontine angel masses are the most common neoplasm in posterior fossa accounting for 5-10 % of intracranial tumors.

Aim
to evaluate the lesions that arise from this angle by using MRI sequences as T1 (with out and with contrast), T2, FLAIR, Diffusion Weighted and spectroscopy.

Methods
This study included 25 patients age ranged 25 -55 years, and were subjected to full history talking, Clinical examination, laboratory investigations and MRI for patient with suspected cerebello pontine angle lesions.

Results
Females are frequently involved by these lesions (19 patients) while males are less (6 patient). Among our patients , the most common presenting symptoms were hearing loss in 17 patients (68.0%) headache in 10 patients ( 40.0%), tinnitus in 9 patient ( 36.0 %) neuralgia in 5 patients ( 20.0 %), vertigo in 2 patients (8.0%), hemi facial spasm in one patient (4.0%) and wasting of mastication muscles (4.0%). Out of the studied patients , final diagnosis by MRI revealed acoustic schwannoma in 12 patients ( 48.0%) which was the most common pathology ,followed meningioma that were noted in 7 patients (28.0%), epidermoid cyst in one patient (4.0%),prominent AICA in one patient (4.0 %), paraganglioma in one patient (4.0%),cystic neurofibroma in one patient (4.0%), neurofibromatosis type 2 in one patient (4.0%) and arachnoid cyst in one patient (4.0 %).

Conclusion
MRI is the gold standard method to differentiate the lesions by anatomical site of origin, shape, signal intensity and behavior after contrast media injection.

 

[Frédéric]

Intralabyrinthine neurinoma: Management, exeresis and auditory restoration with cochlear implant

Introduction and Objective
Vestibular schwannoma is a benign tumour that originates in the eighth cranial nerve. It is termed intralabyrinthine schwannoma (ILS) when it develops in the inner ear, this being a rare origin. We present our experience in the management of three patients with ILS.

Material and Methods
The results of tumour excision and cochlear implantation were evaluated in three patients with ILS: two intracochlear schwannomas (ICS) and one intravestibular schwannoma (IVS).

Results
Prior to surgery, all patients presented progressive sensorineural hearing loss and tinnitus. Complete tumour resection and cochlear implantation was possible in all patients, with favourable hearing rehabilitation.

Conclusions
The therapeutic approach will depend on tumour size, growth rate, degree of hearing loss and presence of vestibular symptoms. Cochlear implantation (CI) in patients with ILS is possible when the cochlear nerve is present and functional. CI in patients, whether or not preceded by tumour excision, is an option with good hearing results in selected patients.

Source: https://europepmc.org/article/med/32867952

 

[Frédéric]

Useful Hearing Preservation Is Improved in Vestibular Schwannoma Patients Who Undergo Stereotactic Radiosurgery Before Further Hearing Deterioration Ensures

Introduction
The present study evaluates whether hearing deterioration during observation reduces serviceable hearing preservation rates after stereotactic radiosurgery (SRS) in vestibular schwannoma (VS) patients with useful hearing.

Methods
We retrospectively analyzed 1447 VS patients who underwent SRS between 1992 to 2017. We identied 100 VS patients who had Grade I Gardner- Robertson (GR) hearing at initial diagnosis but were observed without surgery or SRS. We compared hearing after SRS in 67 patients who retained GR Grade I hearing from initial diagnosis to SRS (the hearing maintenance or HM group) to 33 patients whose hearing worsened from GR grade I to grade II (the hearing deterioration or HD group). We also investigated whether a decline in pure tone average (PTA) or speech discrimination score (SDS) before SRS affected hearing preservation after SRS.

Results
The serviceable hearing (GR I and II) preservation in HM patients was 80%s, 63%, and 51% at 3, 5, and 10 years, respectively. The serviceable hearing preservation in HD patients was 40%, 33%, and 20% at 3, 5, and 10 years, respectively. In multivariate analysis, younger age (<55 years, p=0.012) and HM during observation (p<0.001) improved serviceable hearing preservation rates. Patients whose PTA increased >15 dB (p=0.011) or whose SDS declined >10% (p=0.024) had reduced serviceable hearing preservation rates.

Conclusions
Hearing deterioration during observation before SRS reduced long term hearing preservation rate in VS patients with GR grade I hearing at initial diagnosis. SRS before hearing deterioration was recommended for hearing preservation.

Full article: see attached file.