New and Modified Reporting Systems from the Consensus Meeting on Systems for Reporting Results in Vestibular Schwannoma

Kanzaki, Jin; Tos, Mirko; Sanna, Mario; Moffat, David A.; Monsell, Edwin M.; Berliner, Karen I.

doi:10.1097/00129492-200307000-00019

Cited by 340 publications

(260 citation statements)

References 3 publications

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“…In the treatment group more moderately large, large-, and giant-sized (Koos Grades III and IV, 72.3%) than small-and medium-sized tumors (Koos Grade II, 27.7%; no Koos Grade I tumors) were observed. 10 In contrast, the relation of tumor sizes in the control group was 47.9% of Koos Grade I and II and 52.1% of Koos Grade III and IV tumors. Extent of resection was comparable with complete removal in 40 patients in both groups, capsule remnants (1-3 mm) in 4 patients in the treatment group and in 3 patients in the control group, and subtotal removal (3-10 mm) in 3 patients in the therapy group and in 5 patients in the control group, based on the evaluation of axial T1-weighted and contrast-enhanced MR images by a blinded neuroradiologist.…”

Section: Baseline Datamentioning

confidence: 83%

Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial

Scheller¹,

Wienke

Tatagiba

et al. 2016

JNS

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obJective A pilot study of prophylactic nimodipine and hydroxyethyl starch treatment showed a beneficial effect on facial and cochlear nerve preservation following vestibular schwannoma (VS) surgery. A prospective Phase III trial was undertaken to confirm these results. methods An open-label, 2-arm, randomized parallel group and multicenter Phase III trial with blinded expert review was performed and included 112 patients who underwent VS surgery between January 2010 and February 2013 at 7 departments of neurosurgery to investigate the efficacy and safety of the prophylaxis. The surgery was performed after the patients were randomly assigned to one of 2 groups using online randomization. The treatment group (n = 56) received parenteral nimodipine (1-2 mg/hr) and hydroxyethyl starch (hematocrit 30%-35%) from the day before surgery until the 7th postoperative day. The control group (n = 56) was not treated prophylactically. results Intent-to-treat analysis showed no statistically significant effects of the treatment on either preservation of facial nerve function (35 [ ]) (p = 0.530) 12 months after surgery. Since tumor sizes were significantly larger in the treatment group than in the control group, logistic regression analysis was required. The risk for deterioration of facial nerve function was adjusted nearly the same in both groups ], p = 0.91). In contrast, the risk for postoperative hearing loss was adjusted 2 times lower in the treatment group compared with the control group (OR 0.49 [95% CI 0.18-1.30], p = 0.15). Apart from dosedependent hypotension (p < 0.001), no clinically relevant adverse reactions were observed. coNclusioNs There were no statistically significant effects of the treatment. Despite the width of the confidence intervals, the odds ratios may suggest but do not prove a clinically relevant effect of the safe study medication on the preservation of cochlear nerve function after VS surgery. Further study is needed before prophylactic nimodipine can be recommended in VS surgery.Clinical trial registration no.: 2009-012088-32 (www.clinicaltrialsregister.eu)

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Section: Baseline Datamentioning

confidence: 83%

Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial

Scheller¹,

Wienke

Tatagiba

et al. 2016

JNS

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“…35 Hence, in a recent systematic review of large AN series it was shown that in vast majority of articles included (17 out of 19) various linear and not volume measurements techniques were used, including qualitative ANCSRR and Koos tumor size classification systems. 36,37 These systems, despite the fact that have been introduced for many years have not been commonly used since less than 20% of the papers identified had used them. 37 Moreover, even though volumetric measurements have been suggested since 1990s, still are not used in vast majority of relevant studies.…”

Section: Discussionmentioning

confidence: 99%

“…36,37 These systems, despite the fact that have been introduced for many years have not been commonly used since less than 20% of the papers identified had used them. 37 Moreover, even though volumetric measurements have been suggested since 1990s, still are not used in vast majority of relevant studies.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors of acoustic neuroma growth

Kikidis

Xenellis

Kyrodimos

et al. 2016

Int J Otorhinolaryngol Head Neck Surg

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Background:Since the use of magnetic resonance imaging (MRI) as the gold standard for acoustic neuroma diagnosis, the size of the majority of newly diagnosed acoustic neuromas has decreased. Management strategy is challenging, especially in young patients with small tumors. Therefore, prognostic factors for tumor growth may facilitate physicians to optimize treatment choice.Methods:Patients diagnosed with acoustic neuromas were recruited in this study. Gender, age, side, presence of hearing loss, tinnitus, vertigo, unsteadiness, other symptoms, hearing level in the affected ear and tumor growth at the first follow up MRI were recorded. Two primary endpoints were set: overall acoustic neuroma (AN) growth and growth correlated to treatment plan change (clinically significant growth). Multivariate and survival analysis were conducted to this end. Results:85 patients were finally included in the study. The most prevalent presenting symptoms were hearing loss (76%), tinnitus (56%) and unsteadiness (46%). The tumour grew in size in less than 50% of the cases during the observation period. Clinically significant growth was observed in 27% of the cases. Mean initial diameter was 10.41mm and mean final follow-up diameter (diameter at the end of the observation period) 12.73 mm. Following binary logistic regression analysis, tumour growth during the initial follow up visit was found to be correlated in a statistically significant level to overall tumour growth (p-value 0.023). Regarding clinically significant growth, three factors were found to be statistically significant: growth at the initial visit (p-value 0.02), initial diameter (p-value 0.045) and existence of unsteadiness at diagnosis (p-value 0.02).Conclusions:Acoustic neuroma overall growth is not identical to clinically significant growth. Growth at first visit is a significant prognostic factor and intervention potential should be considered under this perspective.

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“…We divided patients in five grades according to the extrameatal tumor size (0-10 mm, 11-20 mm, 21-30 mm, 31-40 mm and .40mm) 9 . Surgical results were evaluated based on the extension of resection, tumor relapse, and facial nerve function.…”

Section: Methodsmentioning

confidence: 99%

The extracisternal approach in vestibular schwannoma surgery and facial nerve preservation

Vellutini

Beer‐Furlan

Brock

et al. 2014

Arq. Neuro-Psiquiatr.

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The classical surgical technique for the resection of vestibular schwannomas (VS) has emphasized the microsurgical anatomy of cranial nerves. We believe that the focus on preservation of the arachnoid membrane may serve as a safe guide for tumor removal. Method: The extracisternal approach is described in detail. We reviewed charts from 120 patients treated with this technique between 2006 and 2012. Surgical results were evaluated based on the extension of resection, tumor relapse, and facial nerve function. Results: Overall gross total resection was achieved in 81% of the patients. The overall postoperative facial nerve function House-Brackmann grades I-II at one year was 93%. There was no recurrence in 4.2 years mean follow up. Conclusion: The extracisternal technique differs from other surgical descriptions on the treatment of VS by not requiring the identification of the facial nerve, as long as we preserve the arachnoid envelope in the total circumference of the tumor.Keywords: arachnoid membrane, facial nerve, surgery, vestibular schwannoma, acoustic neurinoma. RESUMOA técnica cirúrgica clássica para ressecção de schwannomas vestibulares enfatiza a anatomia microcirúrgica dos nervos cranianos. Acreditamos que o foco na preservação da membrana aracnóide pode servir como parâmetro seguro para a remoção do tumor. Método: A abordagem extracisternal é descrita em detalhe. Analisamos o prontuário de 120 pacientes tratados com esta técnica entre 2006 e 2012. Os resultados cirúrgicos foram baseados em extensão de ressecção, recorrência tumoral e função do nervo facial. Resultados: Ressecção total foi obtida em 81% dos pacientes. O resultado global da função do nervo facial (House-Brackmann graus I-II) após um ano da cirurgia foi de 93%. Não houve recidiva em um seguimento médio de 4,2 anos. Conclusão: A técnica extracisternal difere de outras descrições cirúrgicas no tratamento de schwannoma vestibular pois não requer a identificação do nervo facial, contanto que o plano de aracnóide seja preservado em toda circunferência do tumor.Palavras-chave: membrana aracnóide, nervo facial, cirurgia, schwannoma vestibular, neurinoma do acústico.Facial nerve injury is a common complication in the treatment of vestibular schwannomas (VS) and its associated facial muscle palsy has a great impact in patients' quality of life 1 . This is the reason why functional preservation of the facial nerve is sought when managing VS with either radiosurgery or microsurgery. Several factors have been correlated with worse facial nerve function outcomes, including older patients, large tumors, and preoperative facial nerve function 2,3,4 . Although careful facial nerve dissection is pursued, anatomical preservation of the facial nerve is not synonymous of normal function 5,6,7 . Intraoperative monitoring of the facial nerve is the key for optimal facial nerve preservation, even though not all patients' clinical courses correlate with their intraoperative electrophysiological result 6,8 . The classical descriptions of the surgical tech...

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New and Modified Reporting Systems from the Consensus Meeting on Systems for Reporting Results in Vestibular Schwannoma

Cited by 340 publications

References 3 publications

Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial

Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial

Predictive factors of acoustic neuroma growth

The extracisternal approach in vestibular schwannoma surgery and facial nerve preservation

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