Gamma Knife radiosurgery for intravestibular and intracochlear schwannomas

Tuleasca, Constantin; George, Mercy; Schiappacasse, Luis; Patin, David; Fenu, Jacopo; Maire, Richard; Levivier, Marc

doi:10.1007/s00701-018-3762-y

Cited by 11 publications

(6 citation statements)

References 24 publications

(26 reference statements)

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“…Radiotherapy offers a treatment option for the ICS comorbid patient who has a progressively enlarging tumor but may not be eligible for surgery. In the specific case of ICS, experience with radiotherapy is still limited [17][18][19] and it remains difficult to respect the recommended cochlear tolerance doses of approximately 5 Gy in stereotactic radiosurgery (SRS) and 35 Gy in fractioned radiotherapy (FSRT), given that the required therapeutic doses are 12 Gy in SRS and 50.5-54Gy in FSRT. 20,21 It is however clear that the hearing damage after radiation is indirectly proportional to the cochlea total irradiation 21,22 and hearing deterioration increases in the follow-up on a multifactorial base.…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Hearing Outcome of Cochlear Implantation in Cases with Simultaneous Intracochlear Schwannoma Resection

Di Micco,

Salcher,

Lesinski‐Schiedat

et al. 2023

The Laryngoscope

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ObjectivesThe aim was to analyze the long‐term hearing results after simultaneous microsurgical extirpation via enlarged cochleostomy and cochlear implantation in intracochlear schwannoma as compared with non‐tumor single‐side deafness patients.MethodsMicrosurgical extirpation via enlarged cochleostomy with simultaneous cochlear implantation was performed in 15 cases of intracochlear schwannoma between 2014 and 2021. Speech recognition tests in German language and impedance performances were collected over 36 months of observation and compared with an internal cohort of 52 age matched non‐tumor single‐side deafness patients. Retrospective cohort study in a tertiary referral center.ResultsThe surgery proved feasible and uneventful in all cases. In the case of intracochlear schwannoma, the hearing rehabilitation results were highly satisfactory and comparable to those of the non‐tumor single‐side deafness cohort. The speech recognition performance improved steadily in the first 12 months; afterward, it remained stable, providing indirect evidence against tumor recurrence during the follow‐up. One patient required implant revision surgery related to device failure, but no recurrence was registered in the 36 months of observation.ConclusionsCochlear implantation is the strategy of choice for hearing rehabilitation in case of intracochlear schwannomas in the long term. In particular, the combination of tumor extirpation via cochleostomy with a cochlear implantation in the same surgical time offers a viable therapy for intracochlear schwannoma, granting a sufficient degree of radicality without compromising the cochlear integrity. This technique allows for revision surgery if required.Level of Evidence4 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 99%

Long‐Term Hearing Outcome of Cochlear Implantation in Cases with Simultaneous Intracochlear Schwannoma Resection

Di Micco,

Salcher,

Lesinski‐Schiedat

et al. 2023

The Laryngoscope

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“…Both our experiences and published data suggest that vertigo may resolve as a consequence of VS treatment. According to literature, up to 80% of patients subjected to gamma knife radiosurgery no longer presented with vertigo [6,7]. However, early and late vertigo remission rates after subtotal surgical resections of large VS are no greater than 30% and 14%, respectively [8].…”

Section: Discussionmentioning

confidence: 99%

Middle-ear cholesteatoma co-existing with labyrinthine fistula and vestibular schwannoma

Zwierz

Masna

Burduk

2020

Eur Arch Otorhinolaryngol

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Background Many conditions, among them vestibular schwannoma and middle ear cholesteatoma with lateral semicircular canal destruction, may be associated with asymmetrical sensorineural hearing loss (SNHL) and vertigo. However, the probability that these two distinct disease entities causing the same symptoms occur in a single patient is very low, approximately 1 per 28 billion per 1 year. Methods We present the case of a 40-year-old male admitted to our clinic because of chronic middle ear inflammation with concomitant tinnitus vertigo, and deafness in the right ear. The patient was diagnosed with lateral semicircular canal fistula caused by middle-ear cholesteatoma and concomitant vestibular schwannoma. Canal wall-down surgery was carried out to remove the cholesteatoma, followed by gamma knife radiosurgery for the vestibular schwannoma. Results Vertigo and tinnitus resolved within 3 days after the ear surgery, and gamma knife treatment resulted in the complete involution of the vestibular schwannoma. The patient presented with completely dry middle-ear cavity and no recurrence of the cholesteatoma was observed during a 3-year follow-up. Conclusion As the hereby reported condition is very rare, the results cannot be compared with any similar report published previously. Nevertheless, based on the outcome, the treatment strategy seems to be both reasonable and effective.

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“…In addition, it is possible to preserve semicircular canal function during cochleoectomy [263]. Reports on stereotactic ra-diotherapy of intralabyrinthine schwannomas are rare [269,270].…”

Section: Therapymentioning

confidence: 99%

“…In addition, it is possible to preserve semicircular canal function during cochleoectomy 263 . Reports on stereotactic radiotherapy of intralabyrinthine schwannomas are rare 269 270 . Here, it should be particularly noted that cochlear spiral ganglion neurons are located within the radiation field, which might result in their degeneration and subsequent neural deafness over the years 262 .…”

Section: Episodic Vestibular Syndromesmentioning

confidence: 99%

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Seltene Erkrankungen des vestibulären Labyrinths: von Zebras, Chamäleons und Wölfen im Schafspelz

Dlugaiczyk

2021

Laryngorhinootologie

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ZusammenfassungDie Differenzialdiagnose von Erkrankungen des vestibulären Labyrinths stellt eine grosse Herausforderung dar, da sich hinter dem sehr häufigen Leitsymptom «Schwindel» viele verschiedene und v. a. seltene Erkrankungen verbergen können. Der vorliegende Beitrag gibt einen Überblick über die für den HNO-Arzt wichtigen seltenen Erkrankungen des vestibulären Labyrinths ausgehend von ihrer klinischen Präsentation als akutes (AVS), episodisches (EVS) oder chronisches vestibuläres Syndrom (CVS). Der Schwerpunkt liegt dabei auf den EVS, sortiert nach ihrer Dauer und dem Vorhandensein von Triggern (Sekunden, ohne Trigger: Vestibularisparoxysmie, Tumarkin-Krise; Sekunden, lärm- und druckinduziert: Syndrome des «dritten Fensters»; Sekunden bis Minuten, positionsabhängig: seltene Varianten und Differenzialdiagnosen des benignen paroxysmalen Lagerungsschwindels; Stunden bis Tage, spontan: intralabyrinthäre Schwannome, Tumoren des endolymphatischen Sacks, Autoimmunerkrankungen des Innenohres). Des Weiteren werden seltene Differenzialdiagnosen eines AVS (Neuritis vestibularis inf., Otolithenfunktionsstörungen, vaskuläre Ursachen, akute bilaterale Vestibulopathie) und eines CVS (bilaterale Vestibulopathie) erläutert. Dabei werden insbesondere die entscheidenden diagnostischen Massnahmen für die Identifikation der einzelnen Krankheitsbilder und die Warnzeichen für potentiell gefährliche Ursachen (z. B. Labyrinthinfarkt/-blutung) dargelegt. Somit dient dieser Beitrag dem HNO-Arzt in Klinik und Praxis als eine Art «Vademecum» für die zügige Identifikation und zeitnahe Therapie seltener Erkrankungen des Gleichgewichtsorgans.

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Gamma Knife radiosurgery for intravestibular and intracochlear schwannomas

Cited by 11 publications

References 24 publications

Long‐Term Hearing Outcome of Cochlear Implantation in Cases with Simultaneous Intracochlear Schwannoma Resection

Long‐Term Hearing Outcome of Cochlear Implantation in Cases with Simultaneous Intracochlear Schwannoma Resection

Middle-ear cholesteatoma co-existing with labyrinthine fistula and vestibular schwannoma

Seltene Erkrankungen des vestibulären Labyrinths: von Zebras, Chamäleons und Wölfen im Schafspelz

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