Change in hearing during ‘wait and scan’ management of patients with vestibular schwannoma

Se, Stangerup; Cayé‐Thomasen, Per; M, Tos; Thomsen, Jens

doi:10.1017/s0022215107001077

Cited by 128 publications

(77 citation statements)

References 41 publications

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“…Many physicians choose the conservative approach if patients have small tumors, 18 minimal or no symptoms, poor overall health status, or if they are elderly, 24,33,87 but this approach may still result in hearing loss over time. 35,41,65,70,91 Radiosurgery is often chosen for patients with tumors smaller than 2.5 cm or for the elderly. Patients harboring recurrent or residual tumors are also frequently referred for radiosurgery rather than an additional operation.…”

mentioning

confidence: 99%

Surgery for vestibular schwannomas: a systematic review of complications by approach

Ansari

Terry

Cohen-Gadol

2012

FOC

262

216

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Object Various studies report outcomes of vestibular schwannoma (VS) surgery, but few studies have compared outcomes across the various approaches. The authors conducted a systematic review of the available data on VS surgery, comparing the different approaches and their associated complications. Methods MEDLINE searches were conducted to collect studies that reported information on patients undergoing VS surgery. The authors set inclusion criteria for such studies, including the availability of follow-up data for at least 3 months, inclusion of preoperative and postoperative audiometric data, intraoperative monitoring, and reporting of results using established and standardized metrics. Data were collected on hearing loss, facial nerve dysfunction, persistent postoperative headache, CSF leak, operative mortality, residual tumor, tumor recurrence, cranial nerve (CN) dysfunction involving nerves other than CN VII or VIII, and other neurological complications. The authors reviewed data from 35 studies pertaining to 5064 patients who had undergone VS surgery. Results The analyses for hearing loss and facial nerve dysfunction were stratified into the following tumor categories: intracanalicular (IC), size (extrameatal diameter) < 1.5 cm, size 1.5–3.0 cm, and size > 3.0 cm. The middle cranial fossa approach was found to be superior to the retrosigmoid approach for hearing preservation in patients with tumors < 1.5 cm (hearing loss in 43.6% vs 64.3%, p < 0.001). All other size categories showed no significant difference between middle cranial fossa and retrosigmoid approaches with respect to hearing loss. The retrosigmoid approach was associated with significantly less facial nerve dysfunction in patients with IC tumors than the middle cranial fossa method was; however, neither differed significantly from the translabyrinthine corridor (4%, 16.7%, 0%, respectively, p < 0.001). The middle cranial fossa approach differed significantly from the translabyrinthine approach for patients with tumors < 1.5 cm, whereas neither differed from the retrosigmoid approach (3.3%, 11.5%, and 7.2%, respectively, p = 0.001). The retrosigmoid approach involved less facial nerve dysfunction than the middle cranial fossa or translabyrinthine approaches for tumors 1.5–3.0 cm (6.1%, 17.3%, and 15.8%, respectively; p < 0.001). The retrosigmoid approach was also superior to the translabyrinthine approach for tumors > 3.0 cm (30.2% vs 42.5%, respectively, p < 0.001). Postoperative headache was significantly more likely after the retrosigmoid approach than after the translabyrinthine approach, but neither differed significantly from the middle cranial fossa approach (17.3%, 0%, and 8%, respectively; p < 0.001). The incidence of CSF leak was significantly greater after the retrosigmoid approach than after either the middle cranial fossa or translabyrinthine approaches (10.3%, 5.3%, 7.1%; p = 0.001). The incidences of residual tumor, mortality, major non-CN complications, residual tumor, tumor recurrence, and dysfunction of other cranial nerves were not significantly different across the approaches. Conclusions The middle cranial fossa approach seems safest for hearing preservation in patients with smaller tumors. Based on the data, the retrosigmoid approach seems to be the most versatile corridor for facial nerve preservation for most tumor sizes, but it is associated with a higher risk of postoperative pain and CSF fistula. The translabyrinthine approach is associated with complete hearing loss but may be useful for patients with large tumors and poor preoperative hearing.

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mentioning

confidence: 99%

Surgery for vestibular schwannomas: a systematic review of complications by approach

Ansari

Terry

Cohen-Gadol

2012

FOC

262

216

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“…96,98,101 These inconsistencies are a major hindrance to the practice of evidence-based medicine. Meta-analyses of pooled data are fraught with considerable assumptions to simplify the nonuniform existent data and achieve statistical power and significance, which can greatly impact their conclusions.…”

Section: What Actually Creates the Treatment Dilemma?mentioning

confidence: 99%

“…57,81 The data, however, do not always show a linear correlation between the rate of tumor growth and deterioration of hearing. 38,39,82,96,104 …”

Section: Mechanism Of Hearing Loss In Vsmentioning

confidence: 99%

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An update on unilateral sporadic small vestibular schwannoma

Thakur¹,

Banerjee

Khan³

et al. 2012

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Advances in neuroimaging have increased the detection rate of small vestibular schwannomas (VSs, maximum diameter < 25 mm). Current management modalities include observation with serial imaging, stereotactic radiosurgery, and microsurgical resection. Selecting one approach over another invites speculation, and no standard management consensus has been established. Moreover, there is a distinct clinical heterogeneity among patients harboring small VSs, making standardization of management difficult. The aim of this article is to guide treating physicians toward the most plausible therapeutic option based on etiopathogenesis and the highest level of existing evidence specific to the different cohorts of hypothetical case scenarios. Hypothetical cases were created to represent 5 commonly encountered scenarios involving patients with sporadic unilateral small VSs, and the literature was reviewed with a focus on small VS. The authors extrapolated from the data to the hypothetical case scenarios, and based on the level of evidence, they discuss the most suitable patient-specific treatment strategies. They conclude that observation and imaging, stereotactic radiosurgery, and microsurgery are all important components of the management strategy. Each has unique advantages and disadvantages best suited to certain clinical scenarios. The treatment of small VS should always be tailored to the clinical, personal, and social requirements of an individual patient, and a rigid treatment protocol is not practical.

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“…Clinical observation through periodical MRIs is the treatment option that better exploits the spontaneous growth arrest of the majority of small neuromas [10]. Such attitude can be correct, but bears some important limitations: if hearing is yet not impaired, Hearing Preservation Surgery (HPS) has great chances of success [8], whilst clinical observation determines a progressive loss of hearing [11] even with no tumor growth [5], and reduces the possibilities of late HPS. Furthermore, if the tumor is larger than 10 mm at the cerebellopontine angle, surgical removal with preservation of the integrity of the 7th cranial nerve has some limitations, represented by a risk of 17-20 % of HB grade III palsy or worse [1], for lesions between 1.5 and 20 mm.…”

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confidence: 99%

Microsurgical endoscopy-assisted presigmoid retrolabyrinthine approach as a minimally invasive surgical option for the treatment of medium to large vestibular schwannoma

2013

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The paper from Iacoangeli and his colleagues from Ancona and Rome in this issue of Acta Neurochirurgica is timely given the continuing controversy on best treatment options for vestibular schwannomas.Their report is on the preliminary experience with an old approach integrated with the endoscope. The case material includes ten cases of small and medium sized sporadic acoustic neuromas (five cases of 8 and 10 mm, five cases of 11-25 mm), selected on the basis of a favourable anatomy of the temporal bone.It is noteworthy, and rather exceptional in comparison to other's experiences, that only three cases out of ten had a preoperative normal facial nerve function, while four cases of 11-25 mm had a House-Brackmann (HB) grade 3 and three cases of 10 and 20 mm had a HB grade 2, which makes 70 % of preoperative facial dysfunction in small and medium-size tumors.The surgical outcome was outstanding, with unchanged postoperative facial function (with the exception of the case with preoperative radiotherapy), only one case experiencing a hearing loss from AAORLHNS class B to C, and no instances of deafness. The removal of tumors from the internal auditory canal without a drill meatotomy in this series might have been favoured by a limited extension into the canal. The results on the hearing and facial nerve are superior to the results reported in the literature.We dare to say that we never had a group of ten consecutive cases with only one postop limited hearing loss in over 300 cases of hearing preservation surgery on smaller tumors [8].This revived approach, which was already dismissed by experienced surgeons, although now implemented by endoscopic assistance needs further validation in order to assess its performance versus the standard retrosigmoid approach.Notwithstanding, Iacoangeli and his colleagues have further contributed to the debate upon the treatment of acoustic neuroma. This has indeed been an active dispute over the last decades, and is nowadays even keener thanks to the further inputs brought by neurosurgeons, otosurgeons, endoscopists, and, last but not least, radiotherapists.It should be considered that early diagnosis results in a patient's population mainly (in 70 % of cases, according to accredited studies) made up of small tumors: the current debate and renewal of treatment options is therefore nowadays addressed to such lesions.

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Change in hearing during ‘wait and scan’ management of patients with vestibular schwannoma

Cited by 128 publications

References 41 publications

Surgery for vestibular schwannomas: a systematic review of complications by approach

Surgery for vestibular schwannomas: a systematic review of complications by approach

An update on unilateral sporadic small vestibular schwannoma

Microsurgical endoscopy-assisted presigmoid retrolabyrinthine approach as a minimally invasive surgical option for the treatment of medium to large vestibular schwannoma

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