A Novel Imaging Grading Biomarker for Predicting Hearing Loss in Acoustic Neuromas

Zhou, Wenqiang; Wang, Yangyang; Ma, Shunchang; Yuan, Linhao; Wang, Xi; Peng, Jiayi; Zhang, Dainan; Guan, Xiudong; Li, Deling; Jia, Guijun; Jia, Wang

doi:10.1007/s00062-020-00938-7

Cited by 7 publications

(4 citation statements)

References 45 publications

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“…Classification by size was based on the Koos grading system from grades I to IV as follows: grade I, a small intracanalicular tumor; grade II, a small tumor with protrusion into the CPA cistern; grade III, a tumor occupying the CPA cistern with no brainstem displacement; and grade IV, a large tumor with brainstem and cranial nerve displacement. IAC invasion was classified by TFIAC (tumor filling inner auditory canal) as follows: grade I, 0% < TFIAC ≤ 25%; grade II, 25% < TFIAC ≤ 50%; grade III, 50% < TFIAC ≤ 75%; grade IV, 75% < TFIAC ≤ 100% ( 11 ).…”

Section: Methodsmentioning

confidence: 99%

Preservation of the integrity of facial nerve in vestibular schwannoma microsurgery: A consecutive study of 127 clinical cases focusing on nervus intermedius

Peng²,

Zhang³

et al. 2023

Front. Oncol.

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BackgroundNervus intermedius (NI) injuries are not given enough attention by neurosurgeons during vestibular schwannoma (VS) surgery. Preservation of NI function is essential for the integrity and continuity of the facial nerve, although this can be challenging. We identified the risk factors for NI injury and proposed our experience for optimizing NI preservation based on our cases.MethodsWe retrospectively analyzed clinical data from a consecutive series of 127 patients with VS who underwent microsurgery via the retrosigmoid approach from 2017 to 2021 at our institution. The baseline characteristics of the patients were collected from the medical records, and the incidence of NI dysfunction symptoms was obtained by outpatient and online video follow-up 6 months after surgery. The surgical procedures and techniques used were described in detail. The data were analyzed in relation to sex, age, tumor location (left or right), Koos grading scale, internal acoustic canal (IAC) invasion (TFIAC Classification), brainstem adhesion, tumor characteristics (cystic or solid), tumor necrosis, and preoperative House–Brackmann (HB) grading by univariate and multivariate analyses.ResultsGross tumor removal was achieved in 126 (99.21%) patients. Subtotal removal was performed on one patient (0.79%). Twenty-three of our cases exhibited facial nerve palsy preoperatively; 21 patients had HB grade II facial palsy, and two had HB grade III. Two months after surgery, 97 (76.38%) patients had normal function of the motor portion of the facial nerve; 25 (19.69%) patients had HB Grade II facial palsy, five had Grade III (3.94%), and zero (0%) had Grade IV. Postoperatively, 15 patients experienced newly gained dry eyes (11.81%), whereas 21 cases of lacrimal disturbances (16.54%), nine of taste disturbances (7.09%), seven of xerostomia (5.51%), five of nasal hypersecretions (3.94%), and seven of hypersalivation (5.51%) were identified in our cases. Univariate and multivariate analyses revealed that the Koos grading scale and tumor characteristics (solid or cystic) were correlated with NI injury (p <0.01).ConclusionThe data in this study demonstrate that although the motor function of the facial nerve is well preserved, NI disturbance is still common after VS surgery. Maintaining the integrity and continuity of the facial nerve is key to NI function. Performing bidirectional and subperineurium dissection based on even and adequate debulking is beneficial for NI preservation in VS surgery. Higher Koos grading and cystic characteristics of VS are associated with postoperative NI injuries. These two parameters can be used to guide the delineation of surgical strategy and predict the prognosis of NI function preservation.

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Section: Methodsmentioning

confidence: 99%

Preservation of the integrity of facial nerve in vestibular schwannoma microsurgery: A consecutive study of 127 clinical cases focusing on nervus intermedius

Peng²,

Zhang³

et al. 2023

Front. Oncol.

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“… 4 Affected/normal side of IAC was determined as distance from the nasal crest to the dorsal crest of the IAC at the affected/normal side. Expansion of affected side of IAC was determined as the ratio of distance of the affected side to distance of the healthy side and those above were measured on temporal bone CT. 10 …”

Section: Methodsmentioning

confidence: 99%

The value of radiographic features in predicting postoperative facial nerve function in vestibular schwannoma patients: A retrospective study and nomogram analysis

Shi,

Liu,

Zhang

et al. 2023

CNS Neurosci Ther

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ObjectiveThe purpose of this study was to identify significant prognostic factors associated with facial paralysis after vestibular schwannoma (VS) surgery and develop a novel nomogram for predicting facial nerve (FN) outcomes.MethodsRetrospective data were retrieved from 355 patients who underwent microsurgery via the retrosigmoid approach for VS between December 2017 and December 2022. Univariate and multivariate logistic regression analysis were used to construct a radiographic features‐based nomogram to predict the risk of facial paralysis after surgery.ResultsFollowing a thorough screening process, a total of 185 participants were included. The univariate and multivariate logistic regression analysis revealed that tumor size (p = 0.005), fundal fluid cap (FFC) sign (p = 0.014), cerebrospinal fluid cleft (CSFC) sign (p < 0.001), and expansion of affected side of internal auditory canal (IAC) (p = 0.033) were independent factors. A nomogram model was constructed based on these indicators. When applied to the validation cohort, the nomogram demonstrated good discrimination and favorable calibration. Then we generated a web‐based calculator to facilitate clinical application.ConclusionTumor size, FFC and CSFC sign, and the expansion of the IAC, serve as good predictors of postoperative FN outcomes. Based on these factors, the nomogram model demonstrates good predictive performance.

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“…As noted in a recent report, Zhou et al proposed a new MRI grading biomarker based on the percentage of tumor filling the inner auditory canal (TFIAC) to predict the hearing loss in SVS and defined the four grades accordingly with low TFIAC (<25%) in Grade I and high TFIAC in Grade IV (>75%). They found that the patients in TFIAC grade III experienced more significant hearing deterioration than Grade I patients, and TFIAC grade IV patients also had a higher rate of non-serviceable hearing (56). Besides, in another MRI study aiming to identify practical predictors of hearing loss in the conservatively managed SVS, the researchers considered the fundal cap as a candidate.…”

Section: Pressure and Tumor Filling Within Iacmentioning

confidence: 99%

Current Understanding of Hearing Loss in Sporadic Vestibular Schwannomas: A Systematic Review

Gan

Zhang

et al. 2021

Front. Oncol.

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ObjectiveHearing loss is the most common initial symptom in patients with sporadic vestibular schwannomas (SVS). Hearing preservation is an important goal of both conservative and surgical therapy. However, the mechanism of SVS-associated hearing loss remains unclear. Thus, we performed this systematic review to summarize the current understanding of hearing loss in the SVS and distill a testable hypothesis to further illuminate its underlying mechanism.MethodsA systematic review querying four databases (PubMed, Medline, Embase, and Web of Science) was performed to identify studies evaluating hearing loss in patients with SVS and exploring the potential mechanisms of hearing impairment.ResultsA total of 50 articles were eligible and included in this review. After analysis, the retrieved studies could be categorized into four types: (1) 29 studies explore the relationship between hearing loss and the growth pattern of the tumor (e.g., tumor size/volume, growth rate, tumor location, etc.); (2) ten studies investigate the potential role of cochlear dysfunction in hearing deterioration, including structural abnormality, protein elevation in perilymph, and cochlear malfunctioning; (3) two studies looked into SVS-induced impairment of auditory pathway and cortex; (4) in the rest nine studies, researchers explored the molecular mechanism underlying hearing loss in SVS, which involves molecular and genetic alterations, inflammatory response, growth factors, and other tumor-associated secretions.ConclusionsMultiple factors may contribute to the hearing impairment in SVS, including the growth pattern of tumor, cochlear dysfunction, impairment of auditory pathway and cortex, genetic and molecular changes. However, our current understanding is still limited, and future studies are needed to explore this multifactorial hypothesis and dig deeper into its underlying mechanism.

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A Novel Imaging Grading Biomarker for Predicting Hearing Loss in Acoustic Neuromas

Cited by 7 publications

References 45 publications

Preservation of the integrity of facial nerve in vestibular schwannoma microsurgery: A consecutive study of 127 clinical cases focusing on nervus intermedius

Preservation of the integrity of facial nerve in vestibular schwannoma microsurgery: A consecutive study of 127 clinical cases focusing on nervus intermedius

The value of radiographic features in predicting postoperative facial nerve function in vestibular schwannoma patients: A retrospective study and nomogram analysis

Current Understanding of Hearing Loss in Sporadic Vestibular Schwannomas: A Systematic Review

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