Decision Making in the Wait-and-Scan Approach for Vestibular Schwannomas: Is There a Price to Pay in Terms of Hearing, Facial Nerve, and Overall Outcomes?

Prasad, Sampath Chandra; Patnaik, Uma; Grinblat, Golda; Giannuzzi, Annalisa; Piccirillo, Enrico; Taibah, Abdelkader; Sanna, Mario

doi:10.1093/neuros/nyx568

Cited by 30 publications

(23 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, VS may have major influences on the quality of life, with UHL as one of the consequences [20,21,22]. Different treatment options have been put forward and besides observation, surgery will be the typical treatment [23], separated into classical microsurgical interventions or radiotherapy, using gamma knife radiosurgery [24]. The choice of treatment depends on tumor size and patient symptoms, where microsurgery is considered the accepted treatment for larger tumors.…”

Section: Introductionmentioning

confidence: 99%

Reduced grey- and white matter volumes due to unilateral hearing loss following treatment for vestibular schwannoma

Heggdal

Larsen

Brännström

et al. 2020

Heliyon

View full text Add to dashboard Cite

Objective Previous studies of the consequences of unilateral hearing loss (UHL) on the functional-structural organization of the brain has included subjects with various degrees of UHL. We suggest that the consequences of a total loss of hearing in one ear might differ from those seen in subjects with residual hearing in the affected ear. Thus, the main aim of the present study was to compare the structural properties of auditory and non-auditory brain regions in persons with complete UHL to those of normal hearing controls. We hypothesize that the consequences of complete UHL following treatment for vestibular schwannoma will differ between ipsi- and contralateral structures, as well as between right- and left side deafness. Design A 3T Siemens Prisma MR-scanner was used. Anatomical images were acquired using a high-resolution T1-weighted sequence. Grey- and white matter volumes were assessed using voxel-based morphometry. Study sample Twenty-two patients with left- or right-side unilateral hearing loss. Fifty normal hearing controls. Results Reductions in grey- and white matter volumes were seen in cortical and sub-cortical regions, mainly in the right hemisphere including the auditory cortex, lingual gyrus, cuneus, middle temporal gyrus, occipital fusiform gyrus, middle cingulate gyrus and the superior temporal gyrus. Patients displayed reduced grey- and white matter volumes in cerebellar exterior structures ipsilateral to the tumor side. Conclusion When compared to controls, right side hearing loss yields more widespread reduction of grey matter volume than left side hearing loss. The findings of reduced grey- and white matter volumes in auditory and non-auditory brain regions could be related to problems with speech perception in adverse listening conditions, increased listening effort and reduced quality of life reported by persons with unilateral hearing loss despite normal hearing in the unaffected ear.

show abstract

Section: Introductionmentioning

confidence: 99%

Reduced grey- and white matter volumes due to unilateral hearing loss following treatment for vestibular schwannoma

Heggdal

Larsen

Brännström

et al. 2020

Heliyon

View full text Add to dashboard Cite

show abstract

“…16 The impact of the wait-and-scan approach on hearing in VS patients was evaluated by Prasad et al from Italy and included a cohort of patients with serviceable hearing followed for 5 years with hearing preservation maintained in 56.1%. 17 In addition, large and/or symptomatic tumors were generally not included in this analysis because of their predisposition toward early intervention.…”

Section: Discussionmentioning

confidence: 99%

Initial Observation among Patients with Vestibular Schwannoma

Ruiz‐Garcia

Peterson

Leon

et al. 2020

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

Introduction Vestibular schwannomas (VS) are slow growing tumors. Although there are a wide variety of available treatment options, these tumors are often initially observed. We aimed to establish the presenting symptoms and outcomes of patients treated with initial observation at our institution. Methods The medical records of patients with radiographically diagnosed VS were reviewed from 1989 to 2018. Actuarial estimates of radiographic tumor control and freedom of local therapy were calculated and compared using Cox regression analyses. Results A total of 360 patients were diagnosed with VS at our institution from 1989 through 2018 with a median age of 59.9 years. After radiographic diagnosis, 243 patients (67.5%) opted for initial observation. Local control at 1, 5, and 10 years was 91, 67, and 58%, respectively. On multivariable analysis, factors associated with shorter time to radiographic tumor progression included younger patient age (p = 0.016) and tumors with an extracanalicular component (p = 0.032). Regarding time until definitive treatment only larger baseline American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) tumor size predicted for earlier initiation of therapy (p < 0.001), although this was restricted to tumors with an extracanalicular component (p = 0.004), as opposed to purely internal auditory canal tumors (p = 0.839). Conclusions Many patients who were initially observed continued to have satisfactory local control rates at 10 years. In patients with extracanalicular tumors, larger AAO-HNS tumor measurements were associated with earlier radiographic tumor progression and shorter time to local therapy, with 7 mm serving as a potential threshold value for extracanalicular tumors. Younger patients and tumors with primarily an extracanalicular portion may warrant closer observation.

show abstract

“…Surgery was indicated in patients affected by disabling vertigo or a compromised facial nerve, according to our protocol 39 . Patients affected by anacusis (unmeasurable thresholds) were also given a surgical indication.…”

Section: Methodsmentioning

confidence: 99%

“…Surgery was indicated in patients affected by disabling vertigo or a compromised facial nerve, according to our protocol. 39 Patients affected by anacusis (unmeasurable thresholds) were also given a surgical indication. The rest of the patients presented were given the option to undergo a hearing preserving technique or a wait-and-scan follow-up.…”

Section: Methodsmentioning

confidence: 99%

Meningiomas of the Internal Auditory Canal

Sykopetrites¹,

Piras²,

Taibah³

et al. 2020

The Laryngoscope

Self Cite

View full text Add to dashboard Cite

Objective Identify and define specific preoperative and postoperative characteristics of intracanalicular meningiomas (ICMs) in order to improve their diagnosis and management, and to differentiate them from intrameatal vestibular schwannomas (IMVSs). Methods Preoperative symptomatology, magnetic resonance imaging (MRI), and postoperative outcomes of 28 ICMs were analyzed. The results were compared to the literature and IMVSs treated by our group. Results Anacusis and progressive hearing loss were more frequent in the present population than the cases reviewed (P = .0064 and P = .0001, respectively). Hearing loss affected more than 90% of the patients, with anacusis in 32.1% of the cases. Facial palsy affected 17.9% of the patients. In comparison to IMVSs, preoperative anacusis was more associated to meningiomas (P = .0037), and the facial nerve was more compromised in ICMs than IMVSs, both preoperatively (P = .0011) and at follow‐up (P < .0001). According to a re‐evaluation of preoperative MRIs and comparison with IMVSs, linear tumor borders, and linear morphology along the internal auditory canal wall, but not the presence of a dural tail, were significantly more present in ICMs (P = .0035, P = .0004, P = .1963, respectively). These characteristics could have led to a correct preoperative diagnosis in 61% of our cases. Conclusion Contrariwise to IMVSs, the frequent preoperative anacusis and facial palsy demonstrate the more aggressive nature of ICMs, which also carry a higher risk of postoperative facial palsy and difficulty to preserve hearing. An attentive evaluation of imaging should ease diagnosis, and asymptomatic or stable ICMs should be enrolled in a wait‐and‐scan protocol. Level of Evidence 4 Laryngoscope, 131:E413–E419, 2021

show abstract

Decision Making in the Wait-and-Scan Approach for Vestibular Schwannomas: Is There a Price to Pay in Terms of Hearing, Facial Nerve, and Overall Outcomes?

Abstract: While there may be no price to pay in wait-and-scan as far as hearing is concerned, this may not be the case for facial nerve outcomes, wherein the results may be better if the patients are taken earlier for surgery.

Cited by 30 publications

References 34 publications

Reduced grey- and white matter volumes due to unilateral hearing loss following treatment for vestibular schwannoma

Reduced grey- and white matter volumes due to unilateral hearing loss following treatment for vestibular schwannoma

Initial Observation among Patients with Vestibular Schwannoma

Meningiomas of the Internal Auditory Canal

Contact Info

Product

Resources

About