Conservative management of vestibular schwannoma: Predictors of growth and hearing

Jethanamest, Daniel; Rivera, Andrew; Ji, Hongzhao; Chokkalingam, Venkatakarthikeyan; Telischi, Fred F.; Angeli, Simón I.

doi:10.1002/lary.25159

Cited by 54 publications

(40 citation statements)

References 27 publications

(54 reference statements)

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“…Not only do our results reinforce previously documented relationships between the maximum tumor diameter at presentation and disequilibrium with tumor growth, but lack of association between patient age(9,19,22,27), gender(9,19,27), hearing loss(9,27) and tinnitus(25) corroborate results from previously smaller studies. Nonetheless, our findings contradict a few previously reported statistically significant associations with VS growth; these include tinnitus(9,22) and aspirin use(28).…”

Section: Discussionsupporting

confidence: 92%

“…(24) Similarly, in another study, Jethanamest et al applied KM analyses to 94 patients to assess the risk of intervention, reporting that 69.1% of patients continued tumor observation at 5 years. (25) In our study, 50% of tumors had experienced growth or had undergone intervention by 22 months since the initial MRI. However, it is important to note that KM analyses are not adjusted for covariates.…”

Section: Discussionmentioning

confidence: 57%

“…This is in agreement with a number of other studies. (23,25,26) Beenstock et al performed a post hoc multivariable analysis and reported that symptoms of vertigo and unsteadiness were significantly related to tumor growth. (26) In addition, Jethanamest et al found that disequilibrium at presentation was also significantly associated with tumor growth, with an adjusted odds ratio of 2.96.…”

Section: Discussionmentioning

confidence: 99%

“…(26) In addition, Jethanamest et al found that disequilibrium at presentation was also significantly associated with tumor growth, with an adjusted odds ratio of 2.96. (25) And while Malhotra et al did not define disequilibrium, they also showed that patients presenting with disequilibrium had 3.42 greater odds of tumor growth. (23) However, while we calculated an adjusted hazard ratio of tumor growth of 1.70 in the present study in those patients presenting with disequilibrium, it is important to note that odds ratios are not directly comparable to the hazard ratios due to the underlying assumptions surrounding logistic regression models.…”

Section: Discussionmentioning

confidence: 99%

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Single Institutional Experience With Observing 564 Vestibular Schwannomas

Hunter

Francis

O’Connell

et al. 2016

Otology &Amp; Neurotology

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Objective To characterize the risk and predictors of growth during observation of vestibular schwannomas (VS). Study Design Retrospective case series. Setting Single academic, tertiary care center. Patients 564 consecutive VS patients who underwent at least two MRI studies prior to intervention. Intervention(s) Serial MRI studies Main outcome measure(s) Tumor growth, defined as a ≥2 mm increase in the maximum tumor diameter between consecutive MRI studies, or between the first and last study. Results A total of 1,296 patients (1995–2015) with VS were identified. Of those, 564 patients (median age 59.2 years; 53.5% female) were initially observed and underwent multiple MRI studies (median follow-up 22.9 months, interquartile range [IQR] 11.7 – 42.7). The median maximum tumor diameter at presentation was 1.00 cm (IQR 0.6 – 1.51 cm). In all, 40.8% of tumors demonstrated growth and 32.1% underwent intervention (21.5% microsurgery, 10.5% radiation) during the surveillance period. Multivariable Cox regression analysis showed that for each tumor, the risk of growth or intervention was significantly increased for larger initial VS diameters (HR=2.22; 95% CI: 1.90 – 2.61) and when disequilibrium was a presenting symptom (HR=1.70; 95% CI: 1.30 – 2.23). Patient age, gender, aspirin use and presenting symptoms of asymmetric hearing loss, tinnitus, and vertigo, were not associated with tumor growth. Conclusions To date, this is the largest series of observed VS reported in the literature. Risk of VS growth is significantly increased among patients who present with larger tumors and who have concomitant disequilibrium. IRB 151481 Define Professional Practice Gap & Educational Need No cohort with this sample size has assessed vestibular schwannoma growth rates in conjunction with this number of variables. Learning Objective To characterize vestibular schwannoma growth rates and predictors of growth.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Single Institutional Experience With Observing 564 Vestibular Schwannomas

Hunter

Francis

O’Connell

et al. 2016

Otology &Amp; Neurotology

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“…This is also consistent to a relevant study by Jethanamest et al 25 In this series, 22.3% of 94 patients observed for AN occurred clinically significant growth and underwent a change in management strategy to microsurgical excision or stereotactic radiotherapy. In the same study, disequilibrium and unsteadiness was identified as bad prognostic factor for tumor growth.…”

Section: Discussionsupporting

confidence: 79%

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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The Association of Vestibular Schwannoma Volume With Facial Nerve Outcomes After Surgical Resection

et al. 2020

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Objective: To explore the relationship between tumor size and facial nerve outcomes following vestibular schwannoma (VS) resection. Study Design: Single institutional retrospective chart review of all adult patients with untreated sporadic VS who underwent surgical resection from 2008 to 2018 with preoperative magnetic resonance imaging (MRI) and 1 year of follow-up. The primary outcome measure was facial nerve outcome as assessed by the House-Brackmann facial nerve grading system. Results: One hundred sixty-seven patients, 54.5% female, with a median age of 49 years (20-76 years), were identified who underwent VS resection. Surgical resection was performed by translabyrinthine (76.7%), middle cranial fossa (14.4%), retrosigmoid (7.2%), and transpromontorial (1.8%) approaches. The median tumor diameter and volume were 25.3 mm (range: 4.1-47.1 mm) and 3.17 cm 3 (range: 0.01-30.6 cm 3), respectively. The median follow-up was 24.2 months (range: 12-114.2 months). Gross total resection was performed in 79% of cases, with residual tumor identified on MRI in 17% of cases. For patients with tumors <3 cm 3 , 92.7% had grade 1 or 2 facial function after at least 1 year follow-up, compared to 81.2% for those with tumors >3 cm 3 (univariate logistic regression OR = 2.9, P = .03). Tumor volume >3 cm 3 was predictive of facial weakness on multivariate regression analysis (OR = 7.4, P = .02) when controlling for surgical approach, internal auditory canal extension, anterior extension, age, gender, and extent of resection. Conclusions: Tumor volume >3 cm 3 is associated with worse facial nerve outcomes 12 months following surgical resection.

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Conservative management of vestibular schwannoma: Predictors of growth and hearing

Abstract: 4.

Cited by 54 publications

References 27 publications

Single Institutional Experience With Observing 564 Vestibular Schwannomas

Single Institutional Experience With Observing 564 Vestibular Schwannomas

Predictive factors of acoustic neuroma growth

The Association of Vestibular Schwannoma Volume With Facial Nerve Outcomes After Surgical Resection

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