Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Imaging in the Diagnosis and Management of Patients With Vestibular Schwannomas

Dunn, Ian F.; Bi, Wenya Linda; Mukundan, Srinivasan; Delman, Bradley N.; Parish, Jonathan; Atkins, Tyler; Asher, Anthony L.; Olson, Jeffrey J.

doi:10.1093/neuros/nyx510

Cited by 58 publications

(26 citation statements)

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“…An MRI-based tumor follow-up 5 years after VS resection is part of the CNC guidelines for VS treatment (24). Recent developments in CI magnets [bipolar diametrical magnets (Medel Synchrony), 3D magnets (Advanced Bionics 3D)], and surgical techniques (implant positioning) have had a significant impact on the relationship between CI and MRI, as this study shows.…”

Section: Discussionmentioning

confidence: 71%

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MRI Observation After Intralabyrinthine and Vestibular Schwannoma Resection and Cochlear Implantation

et al. 2020

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Objective: MRI observation is part of the regular follow-up after vestibular schwannoma (VS) or intralabyrinthine schwannoma (ILS) resection. Because cochlear implantation (CI) after resection is part of the audiological rehabilitation process, the magnet resonance imaging (MRI) behavior of CI systems needs to be considered. In light of recent developments in MRI artifact positioning and pain prevention, this study evaluates reproducible MRI observations after tumor resection and CI surgery as part of follow-up. Methods: In a retrospective study, we evaluated 9 patients with a T1 KM, T2 sequence MRI observation, and cone beam computed tomography (CBCT) after ILS/VS resection and CI. In all but one case, a CI with a diametrically bipolar magnet and a receiver positioned 8-9 cm behind the external auditory canal was performed. Results: In all but one case, MRI observation allowed for a pain-free visual assessment of the intralabyrinthine and internal auditory canal (IAC) regions. In one case, a painful dislodgement of the receiver magnet occurred. Conclusion: MRI follow-up after ILS and VS resection and CI is reproducibly possible. Implant choice and positioning should be considered before implantation to allow for a pain-free visual assessment afterward. This finding allows for the first time a widening of the indication into this patient group.

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Section: Discussionmentioning

confidence: 71%

“…An MRI-based tumor follow-up 5 years after VS resection is part of the CNC guidelines for VS treatment ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

MRI Observation After Intralabyrinthine and Vestibular Schwannoma Resection and Cochlear Implantation

et al. 2020

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“…Because of its location and relation to nearby vascular and neural structures, completely removing a large VS requires high-precision surgical techniques under high magnification, resolution, and bright deep-cavity illumination, which are traditionally offered by a binocular surgical microscope. [9][10][11][12] However, a binocular surgical microscope has a number of limitations: (1) the sizable head stage and counterbalance system dominants the surgical field and takes up the available space for surgery, (2) surgeons are often in uncomfortable positions with little freedom of motion for extended periods, increasing the level of operation fatigue, and (3) a regular surgical microscope is not optimal as an efficient training tool because trainees often have different view field from an operating surgeon. [13] An exoscope could overcome these limitations because it allows surgeons to operate through magnified video images on a high-resolution display, provides more flexible and ergonomically optional ways to operate, and offering an excellent training platform for trainees, who will have identical orientation and view as the surgeon has.…”

Section: Discussionmentioning

confidence: 99%

Use of a compact high-definition two-dimensional exoscope in surgical treatment of large vestibular schwannoma

Chen

Gao

Chai

et al. 2020

Chinese Medical Journal

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Background: Extra-corporeal video telescope operating monitor system provides a necessary instrument to perform high-precision neurosurgical procedures that could substitute or supplement the traditional surgical microscope. The present study was designed to evaluate a compact high-definition two-dimensional exoscope system for assisting in surgical removal of large vestibular schwannoma (VS), as an alternative to a binocular surgical microscope. Methods: Patients with Koos grade 3 and grade 4 VS undergoing surgery were enrolled in this prospective cohort study between January 2013 and June 2018. The demographics and tumor characteristics (size, Koos grade, composition [cystic or solid mass]) were matched between the two groups of patients. The following outcome measurements were compared between the two groups: duration of surgery, volume of blood loss, extent of tumor resection, number of operating field adjustments, pre-and post-operative facial and cochlear nerve function evaluated at 3 months post-surgery, complications and surgeons' comfortability. Results: A total of 81 patients received tumor resection through the retrosigmoid approach under either an exoscope (cases, n = 39) or a surgical microscope (control, n = 42). Patients in the two groups had comparable tumor location (P = 0.439), Koos grading (P = 0.867), and composition (P = 0.891). While no significant differences in the duration of surgery (P = 0.172), extent of tumor resection (P = 0.858), facial function (P = 0.838), and hearing ability (P = 1.000), patients operated on under an exoscope had less blood loss (P = 0.036) and a fewer field adjustments (P < 0.001). Both primary and assistant surgeons reported a high level of comfort operating under the exoscope (P = 0.001 and P < 0.001, respectively). Conclusions: The compact high-definition two-dimensional exoscope system provides a safe and efficient means to assist in removing large VSs, as compared to a surgical microscope. After the acquaintance with a visual perception through a dynamic hint and stereoscopically viewing corresponding to the motion parallax, the exoscope system provided a comfortable, high-resolution visualization without compromising operational efficiency and patient safety.

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“…Vestibular schwannoma with cystic component might be associated with rapid growth. 10) Factors that may predict tumor growth of above 4 mm/year are cystic and hemorrhagic features in the tumor. 11) The cystic formation of VSs has been attributed to repeated intratumoral hemorrhage, degenerative changes, and coalescence of microcysts in Antoni B tissue.…”

Section: Discussionmentioning

confidence: 99%

<i>De Novo</i> Vestibular Schwannoma: A Report of Three Cases

Kubota

Yamakami

Kubota

et al. 2019

NMC Case Report Journal

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The reported growth rate of vestibular schwannoma varied widely in the literature. However, emergence of vestibular schwannoma remains unsolved. We presented three patients who had undergone previous magnetic resonance imaging (MRI) confirming the absence of tumor and were diagnosed with a unilateral vestibular schwannoma with a diameter of 18–30 mm, 6–9 years after the initial MRI. One patient had solid tumor and experienced stereotactic radiosurgery. Following stereotactic radiosurgery, continuous tumor growth led to hydrocephalus and trigeminal dysfunction, resolved by surgical removal. Other two patients had the tumor with cystic component and experienced surgical removal as first treatment. All tumors were pathologically diagnosed as schwannomas without evidence of high potential of proliferation. This is the first report of three patients with de novo vestibular schwannoma, showing tumor emergence and rapid growth in a short period. Considering a de novo aspect, the “wait and scan” policy may not be appropriate for the subset of VS such as de novo VS.

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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Imaging in the Diagnosis and Management of Patients With Vestibular Schwannomas

Cited by 58 publications

References 0 publications

MRI Observation After Intralabyrinthine and Vestibular Schwannoma Resection and Cochlear Implantation

MRI Observation After Intralabyrinthine and Vestibular Schwannoma Resection and Cochlear Implantation

Use of a compact high-definition two-dimensional exoscope in surgical treatment of large vestibular schwannoma

<i>De Novo</i> Vestibular Schwannoma: A Report of Three Cases

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