Intracanalicular Vestibular Schwannomas: Initial Clinical Manifestation, Imaging Classification, and Risk Stratification for Management Proposal

Younes, Elias; Montava, Marion; Bachelard-Serra, Mathilde; Jaloux, L; Salburgo, Florent; Lavieille, J. P.

doi:10.1097/mao.0000000000001538

Cited by 16 publications

(18 citation statements)

References 23 publications

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“…Several authors have tried to identify features of VS that might predict future growth, growth rate and/or treatment. Most, however, looked at VS subgroups (eg VSs limited to the internal auditory canal 24,25 or non‐cystic VSs 26,27 ) used small sample sizes, 3,24,28‐33 used volume measurements to assess growth 30 or included growth rate in the first year of follow‐up in their analyses 32 . Based on findings of studies on the topic, including the current study, we might state that age and sex are no strong predictors for VS growth 4,24,29‐35 .…”

Section: Discussionmentioning

confidence: 99%

“…Most, however, looked at VS subgroups (eg VSs limited to the internal auditory canal 24,25 or non‐cystic VSs 26,27 ) used small sample sizes, 3,24,28‐33 used volume measurements to assess growth 30 or included growth rate in the first year of follow‐up in their analyses 32 . Based on findings of studies on the topic, including the current study, we might state that age and sex are no strong predictors for VS growth 4,24,29‐35 . Multiple authors did find an association between VS growth or treatment and VS size at time of diagnosis, 4,24,26,36,37 balance complaints 4,26,35 or extension in the CPA 26,33,38,39 …”

Section: Discussionmentioning

confidence: 99%

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Development of a model to predict vestibular schwannoma growth: An opportunity to introduce new wait and scan strategies

Hentschel¹,

Hannink²,

Steens

et al. 2020

Clinical Otolaryngology

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Objectives: To develop a prediction model to predict vestibular schwannoma (VS) growth for patients in a wait and scan (W&S) strategy. Design: Retrospective cohort study. Setting: Tertiary hospital (Radboud university medical center, Nijmegen, the Netherlands). Participants: Patients with unilateral VS, entering a W&S strategy and at least one follow-up MRI available. Data on demographics, symptoms, audiometry and MRI characteristics at time of diagnosis were collected from medical records. Main outcome measures: Following multiple imputation, a multivariable Cox regression model was used to select variables, using VS growth (≥2 mm) as outcome. Decision curve analyses (DCA) were performed to compare the model to the current strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Development of a model to predict vestibular schwannoma growth: An opportunity to introduce new wait and scan strategies

Hentschel¹,

Hannink²,

Steens

et al. 2020

Clinical Otolaryngology

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“…A striking 95% of VS patients develop SNHL; additional symptoms can include tinnitus, balance difficulties, and facial paralysis (2). The conventional hypothesis regarding the mechanism underlying VS-induced SNHL is that the tumor compresses the vestibulocochlear nerve, preventing neural signals carrying hearing and balance information from traveling from the inner ear to the brain; however, evidence from multisite, large cohort studies suggests that associations between tumor size and location and SNHL severity are weak (3)(4)(5)(6)(7), and that SNHL may (4,8,9) or may not (8,(10)(11)(12)(13) worsen with tumor growth over time in VS patients. Furthermore, (1) increased outer hair cell-generated distortion product otoacoustic emission (DPOAE) thresholds are observed in VS patients with minimal SNHL, indicating that outer hair cell damage may occur as a primary event, rather than secondary to neuronal damage (14), (2) 90% of human temporal bones from patients with ipsilateral VS show hair cell and neuronal damage that do not correlate with tumor size (15), and (3) biochemically-measured and radiologically-inferred intracochlear fluid protein levels are elevated in ears from poor-hearing VS tumor patients independent of tumor size (16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Intracochlear Perfusion of Tumor Necrosis Factor-Alpha Induces Sensorineural Hearing Loss and Synaptic Degeneration in Guinea Pigs

et al. 2020

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Tumor necrosis factor-alpha (TNF-α) is a proinflammatory cytokine that plays a prominent role in the nervous system, mediating a range of physiologic and pathologic functions. In the auditory system, elevated levels of TNF-α have been implicated in several types of sensorineural hearing loss, including sensorineural hearing loss induced by vestibular schwannoma, a potentially fatal intracranial tumor that originates from the eighth cranial nerve; however, the mechanisms underlying the tumor's deleterious effects on hearing are not well-understood. Here, we investigated the effect of acute elevations of TNF-α in the inner ear on cochlear function and morphology by perfusing the cochlea with TNF-α in vivo in guinea pigs. TNF-α perfusion did not significantly change thresholds for compound action potential (CAP) responses, which reflect cochlear nerve activity, or distortion product otoacoustic emissions, which reflect outer hair cell integrity. However, intracochlear TNF-α perfusion reduced CAP amplitudes and increased the number of inner hair cell synapses without paired post-synaptic terminals, suggesting a pattern of synaptic degeneration that resembles that observed in primary cochlear neuropathy. Additionally, etanercept, a TNF-α blocker, protected against TNF-α-induced synaptopathy when administered systemically prior to intracochlear TNF-α perfusion. Findings motivate further investigation into the harmful effects of chronically elevated intracochlear levels of TNF-α, and the potential for etanercept to counter these effects.

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“…Conversely, Younes et al. used 2 mm/year to identify the growing tumor, but no significant association was spotted between tumor growth and hearing loss ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that hearing impairment was related significantly to rapid tumor growth (≥0.10 cm 3 /year) (25). Conversely, Younes et al used 2 mm/year to identify the growing tumor, but no significant association was spotted between tumor growth and hearing loss (29).…”

Section: Tumor Growthmentioning

confidence: 99%

Current Understanding of Hearing Loss in Sporadic Vestibular Schwannomas: A Systematic Review

Gan

Zhang

et al. 2021

Front. Oncol.

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ObjectiveHearing loss is the most common initial symptom in patients with sporadic vestibular schwannomas (SVS). Hearing preservation is an important goal of both conservative and surgical therapy. However, the mechanism of SVS-associated hearing loss remains unclear. Thus, we performed this systematic review to summarize the current understanding of hearing loss in the SVS and distill a testable hypothesis to further illuminate its underlying mechanism.MethodsA systematic review querying four databases (PubMed, Medline, Embase, and Web of Science) was performed to identify studies evaluating hearing loss in patients with SVS and exploring the potential mechanisms of hearing impairment.ResultsA total of 50 articles were eligible and included in this review. After analysis, the retrieved studies could be categorized into four types: (1) 29 studies explore the relationship between hearing loss and the growth pattern of the tumor (e.g., tumor size/volume, growth rate, tumor location, etc.); (2) ten studies investigate the potential role of cochlear dysfunction in hearing deterioration, including structural abnormality, protein elevation in perilymph, and cochlear malfunctioning; (3) two studies looked into SVS-induced impairment of auditory pathway and cortex; (4) in the rest nine studies, researchers explored the molecular mechanism underlying hearing loss in SVS, which involves molecular and genetic alterations, inflammatory response, growth factors, and other tumor-associated secretions.ConclusionsMultiple factors may contribute to the hearing impairment in SVS, including the growth pattern of tumor, cochlear dysfunction, impairment of auditory pathway and cortex, genetic and molecular changes. However, our current understanding is still limited, and future studies are needed to explore this multifactorial hypothesis and dig deeper into its underlying mechanism.

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Intracanalicular Vestibular Schwannomas: Initial Clinical Manifestation, Imaging Classification, and Risk Stratification for Management Proposal

Abstract: We should consider observation a therapeutic modality. We valid the intrameatal staging as prognostic factor and propose a stratification of patients into low, moderate, or high risk for potential tumor growth to guide the initial management of ICVS.

Cited by 16 publications

References 23 publications

Development of a model to predict vestibular schwannoma growth: An opportunity to introduce new wait and scan strategies

Development of a model to predict vestibular schwannoma growth: An opportunity to introduce new wait and scan strategies

Intracochlear Perfusion of Tumor Necrosis Factor-Alpha Induces Sensorineural Hearing Loss and Synaptic Degeneration in Guinea Pigs

Current Understanding of Hearing Loss in Sporadic Vestibular Schwannomas: A Systematic Review

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