Cystic vestibular schwannomas: a possible role of matrix metalloproteinase–2 in cyst development and unfavorable surgical outcome

Moon, Kyung‐Sub; Jung, Shin; Seo, Sang-Beom; Jung, Tae‐Young; Kim, In-Young; Ryu, Hyang‐Hwa; Jin, Yongdong; Jin, Shu‐Guang; Jeong, Young‐Il; Kim, Kyung-keun; Kang, Su-Min

doi:10.3171/jns.2007.106.5.866

Cited by 54 publications

(84 citation statements)

References 31 publications

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“…As a crucial feature for surgery, the CVS usually means aggressive clinical features and worse postoperative outcomes. [10][11][12][13] The molecular mechanism underlying the cystic degeneration of VS, however, remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Depending on neuroradiological appearance, VS could be categorized as one of two subtypes: solid VS (SVS) and cystic VS (CVS). The more formidable subtype, CVS, accounts for 6.8 to 20.4% of VS based on several reports with larger series [6][7][8][9] and is notorious for aggressive clinical features, including rapid tumor growth (2-6 mm/year), 10 much more severe symptoms, 11,12 intensive adherence to the facial nerve, 13 and difficulty predicting its biological behavior. It often presents a dilemma for neurotologists to choose optimal management: the "wait and scan" policy may delay the optimal therapeutic time due to sudden or persistent fast growth.…”

Section: Introductionmentioning

confidence: 99%

“…13 Surgical resection rarely gets satisfactory postoperative functional outcomes in CVS. [6][7][8]11,14,15 The NF2 gene encodes a 595-amino-acid protein known as schwannomin or merlin, which is similar to a class of 4.1 superfamily of protein (moesin, ezrin, and radixin). 16 It is implicated in the cell and cell-cycle control processes such as adhesion, migration, cell-cell contact, spreading, proliferation, and signal transduction.…”

Section: Introductionmentioning

confidence: 99%

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Mutation spectrum and differential gene expression in cystic and solid vestibular schwannoma

Zhang

Wang

Sun

et al. 2014

Genetics in Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mutation spectrum and differential gene expression in cystic and solid vestibular schwannoma

Zhang

Wang

Sun

et al. 2014

Genetics in Medicine

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“…6,20 Matrix metalloproteinase-2 (MMP-2) has also been implicated in the genesis of cysts and may contribute to their adherence to the facial nerve. 19 The large size and hypervascularity of medial acoustic tumors may therefore predispose to cystic degeneration and consequent surgical risks.…”

Section: Cystic Prevalencementioning

confidence: 99%

Medial acoustic neuromas: clinical and surgical implications

Dunn

Erkmen³

et al. 2014

JNS

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Object Medial acoustic neuroma is a rare entity that confers a distinct clinical syndrome. It is scarcely discussed in the literature and is associated with adverse features. This study evaluates the clinical and imaging features, pertinent surgical challenges, and treatment outcome in a large series of this variant. The authors postulate that the particular pathological anatomy with its arachnoidal rearrangement has a profound implication on the surgical technique and outcome. Methods The authors conducted a retrospective analysis of 52 cases involving 33 women and 19 men who underwent resection of medial acoustic neuromas performed by the senior author (O.A.) over a 20-year period (1993–2013). Clinical, radiological, and operative records were reviewed, with a specific focus on the neurological outcomes and facial nerve function and hearing preservation. Intraoperative findings were analyzed with respect to the effect of arachnoidal arrangement on the surgeon's ability to resect the lesion and the impact on postoperative function. Results The average tumor size was 34.5 mm (maximum diameter), with over 90% of tumors being 25 mm or larger and 71% being cystic. Cerebellar, trigeminal nerve, and facial nerve dysfunction were common preoperative findings. Hydrocephalus was present in 11 patients. Distinguishing intraoperative findings included marked tumor adherence to the brainstem and frequent hypervascularity, which prompted intracapsular dissection resulting in enhancement on postoperative MRI in 18 cases, with only 3 demonstrating growth on follow-up. There was no mortality or major postoperative neurological deficit. Cerebrospinal fluid leak was encountered in 7 patients, with 4 requiring surgical repair. Among 45 patients who had intact preoperative facial function, only 1 had permanent facial nerve paralysis on extended follow-up. Of the patients with preoperative Grade I–II facial function, 87% continued to have Grade I–II function on follow-up. Of 10 patients who had Class A hearing preoperatively, 5 continued to have Class A or B hearing after surgery. Conclusions Medial acoustic neuromas represent a rare subgroup whose site of origin and growth patterns produce a distinct clinical presentation and present specific operative challenges. They reach giant size and are frequently cystic and hypervascular. Their origin and growth pattern lead to arachnoidal rearrangement with marked adherence against the brainstem, which is critical in the surgical management. Excellent surgical outcome is achievable with a high rate of facial nerve function and attainable hearing preservation. These results suggest that similar or better results may be achieved in less complex tumors.

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“…6 Apart from the large tumor size at diagnosis and the cystic component, sudden deterioration resulting from expansion of the cystic component or hemorrhage after radiosurgery does not support radiation therapy as a treatment option. 9,11 Regarding surgical treatment, cystic VS also has a worse prognosis because of the difficulty in preserving an adequate subarachnoid dissection plane, hypervascularity of the solid components, frequent engulfment of neurovascular structures, unusual cranial nerve displacement, substantially increased risk of accidental lesioning of the facial nerve, 2,21,27 and a greater tendency for postoperative bleeding 19,26 as compared with solid VSs. But the results of some recent studies have not supported these conclusions.…”

confidence: 99%

Fluid-fluid level in cystic vestibular schwannoma: a predictor of peritumoral adhesion

Xia¹,

Zhang²,

Yu³

et al. 2014

JNS

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Object. The aim of this study was to evaluate the clinical results and surgical outcomes of cystic vestibular schwannomas (VSs) with fluid-fluid levels.Methods. Forty-five patients with cystic VSs and 86 with solid VSs were enrolled in the study. The patients in the cystic VSs were further divided into those with and without fluid-fluid levels. The clinical and neuroimaging features, intraoperative findings, and surgical outcomes of the 3 groups were retrospectively compared.Results. Peritumoral adhesion was significantly greater in the fluid-level group (70.8%) than in the nonfluidlevel group (28.6%) and the solid group (25.6%; p < 0.0001). Complete removal of the VS occurred significantly less in the fluid-level group (45.8%, 11/24) than in the nonfluid-level group (76.2%, 16/21) and the solid group (75.6%, 65/86; p = 0.015). Postoperative facial nerve function in the fluid-level group was less favorable than in the other 2 groups; good/satisfactory facial nerve function 1 year after surgery was noted in 50.0% cases in the fluid-level group compared with 83.3% cases in the nonfluid-level group (p = 0.038).Conclusions. Cystic VSs with fluid-fluid levels more frequently adhered to surrounding neurovascular structures and had a less favorable surgical outcome. A possible mechanism of peritumoral adhesion is intratumoral hemorrhage and consequent inflammatory reactions that lead to destruction of the tumor-nerve barrier. These findings may be useful in predicting surgical outcome and planning surgical strategy preoperatively. 197Abbreviations used in this paper: DRIVE = driven equilibrium; PICA = posterior inferior cerebellar artery; TSE = turbo spin echo; VS = vestibular schwannoma.

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Cystic vestibular schwannomas: a possible role of matrix metalloproteinase–2 in cyst development and unfavorable surgical outcome

Cited by 54 publications

References 31 publications

Mutation spectrum and differential gene expression in cystic and solid vestibular schwannoma

Mutation spectrum and differential gene expression in cystic and solid vestibular schwannoma

Medial acoustic neuromas: clinical and surgical implications

Fluid-fluid level in cystic vestibular schwannoma: a predictor of peritumoral adhesion

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