Multi-option therapy vs observation for small acoustic neuroma: hearing-focused management

Zanoletti, Elisabetta; Cazzador, Diego; Faccioli, Chiara; Gallo, Samanta; Denaro, Luca; D’Avella, Domenico; Mazzoni, Antonio

doi:10.14639/0392-100x-1756

Cited by 22 publications

(15 citation statements)

References 20 publications

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“…It seems reasonable to consider surgery with TLAB craniectomy for small growing tumors as a viable option to be submitted for further evaluation to the neurootologic community. With the current treatment options (1,3), the definitive cure achieved with surgery can be the main factor in favor of an early surgical indication in selected patients, as the alternatives involve lifelong surveillance and might carry the risk of surgery being needed, and less successfully, at a later date. Contributions from several centers show that TLAB surgery for tumors that have yet to exceed 10 mm in the CPA, in patients with poor hearing, can achieve excellent outcomes (3,9–11,14).…”

Section: Discussionmentioning

confidence: 99%

Early Translabyrinthine Surgery for Small- and Medium-Sized Vestibular Schwannomas: Consecutive Cohort Analysis of Outcomes

et al. 2022

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Objective: Reappraisal of the role of translabyrinthine (TLAB) surgery in small-and medium-sized vestibular schwannomas (VSs). Study Design: Retrospective study. Setting: Tertiary referral center. Patients: A total of 330 consecutive patients diagnosed between 1973 and 2019 with small-and medium-sized VS up to 20 mm in the extrameatal portion submitted to surgical treatment. Interventions: VS removal through microscopic TLAB approach. Main Outcome Measures: Facial nerve function according to the House-Brackmann scale at 12-month follow-up, postoperative complications and entity of tumor resection assessed with postoperative MRI. A comparative analysis of outcomes between two groups of patients was further conducted, according to tumor size: Group A, small-sized (intrameatal or ≤10 mm extrameatal tumors) and Group B, medium-sized VSs (extrameatal between 11 and 20 mm). Results: Complete tumor removal was achieved in all cases. The overall complication rate was 5.5%, being cerebrospinal fluid leak the most frequent. Patients with small-sized VS (n = 121) presented a significantly better facial nerve function than patients with medium-sized tumors (n = 209), showing House-Brackmann Grades I to II in 92.6% versus 73.6% of cases, respectively ( p < 0.001). A nearly 4.5-fold higher risk of poor facial nerve function at 12 months affects patients with medium-sized tumors (odds ratio, 4.473; 95% confidence interval, 2.122-9.430; p < 0.001). Conclusion:In the current scenario of multioptional VS management, when hearing preservation is not feasible, early TLAB approach as first-line treatment for small-sized VSs showed favorable results. Factors supporting such proactive surgical treatment include long-term definitive cure, no major complications, good facial nerve outcomes, and the possibility of simultaneous hearing rehabilitation with a cochlear implant.

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Section: Discussionmentioning

confidence: 99%

Early Translabyrinthine Surgery for Small- and Medium-Sized Vestibular Schwannomas: Consecutive Cohort Analysis of Outcomes

et al. 2022

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“…VS is also the most common cerebellopontine angle (CPA) tumor with a clinical incidence of about 1 per 100,000 persons (1,2). Currently, observation via serial magnetic resonance imaging (MRI), surgical resection, and stereotactic radiation stand as the three management options for patients with VS (3)(4)(5). While asymmetric SNHL is the most common presenting symptom of patients with a VS (6,7), the mechanisms of this SNHL remain incompletely understood.…”

Section: Introductionmentioning

confidence: 99%

Sporadic Vestibular Schwannoma Size and Location Do not Correlate With the Severity of Hearing Loss at Initial Presentation

et al. 2022

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Vestibular schwannoma (VS) is a non-malignant intracranial neoplasm arising from the vestibular branch of the 8th cranial nerve; sensorineural hearing loss (SNHL) is the most common associated symptom. Understanding whether VS imaging characteristics at the time of VS diagnosis can be associated with severity of VS-induced SNHL can impact patient counseling and define promising areas for future research. Patients diagnosed with VS at Massachusetts Eye and Ear (MEE) from 1994 through 2018 were analyzed if magnetic resonance imaging at VS presentation and sequential audiometry were available. Results were compared with original studies available in PubMed, written in English, on VS imaging characteristics and their impact on hearing in patients. A total of 477 patients with unilateral VS from the MEE database demonstrated no significant correlation between any features of tumor imaging at the time of VS diagnosis, such as VS size, impaction or location, and any hearing loss metric. Twenty-three published studies on the impact of VS imaging characteristics on patient hearing met inclusion criteria, with six solely involving NF2 patients and three including both sporadic and NF2-related VS patients. Fifteen studies reported a significant relationship between SNHL and at least one VS imaging characteristic; however, these trends were universally limited to NF2 patients or involved small patient populations, and were not reproduced in larger studies. Taken together, SNHL in sporadic VS patients is not readily associated solely with any tumor imaging characteristics. This finding motivates future studies to define how VS microenvironment and secreted molecules influence VS-induced SNHL.

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“…There has accordingly been a shift in the focus of treatment to preserving neurological function (including the facial nerve) and hearing. Observation (O), radiotherapy (RT), and surgery are the main options available for the treatment of AN, with similar outcomes in terms of preserving neurological function, while their effects on hearing function are still a matter of debate (1)(2)(3).…”

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confidence: 99%

Hearing Preservation Outcomes and Prognostic Factors in Acoustic Neuroma Surgery: Predicting Cutoffs

Zanoletti¹,

Mazzoni²,

Frigo³

et al. 2020

Otology &Amp; Neurotology

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Objective: To investigate the outcomes of hearing preservation surgery (HPS) for acoustic neuroma and quantify tumor and patient characteristics predictive of hearing preservation after surgery. Study Design: Retrospective study. Setting: Tertiary referral center. Patients: A total of 100 consecutive patients diagnosed with acoustic neuroma from 2000 to 2012. Intervention: Hearing preservation surgery through microscopic retrosigmoid approach combined with a retrolabyrinthine meatotomy. Main Outcome Measure: Pre-and postoperative hearing stratified according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Tokyo classifications. The most accurate cutoff was identified for each tumor and patients' variable affecting the outcome by calculating the Youden index. A multivariable analysis was undertaken at these cutoffs to identify prognostic factors for hearing preservation. Results: Preoperative hearing class was preserved after surgery in 31% (AAO-HNS), and 39% (Tokyo classification) of patients. According to the AAO-HNS classification, the tumor size in the cerebello-pontine angle, pure-tone average (PTA), and speech discrimination score cutoffs for predicting good postoperative hearing function were 7 mm, 21 dB, and 90%, respectively. With the Tokyo classification, only the PTA cutoff differed, with 27 dB. On multivariable analysis, tumor size and PTA were independent prognostic factors for postoperative hearing with high model's goodness of fit (area under the curve ¼ 0.784; 95% CI ¼ 0.68-0.88 and area under the curve ¼ 0.813; 95% CI ¼ 0.72-0.90), according to both the hearing classifications. Conclusions: The estimated cutoffs for tumor size and PTA were independently associated with HPS. These factors should be prospectively investigated before they are adopted as selection criteria for HPS.

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Multi-option therapy vs observation for small acoustic neuroma: hearing-focused management

Cited by 22 publications

References 20 publications

Early Translabyrinthine Surgery for Small- and Medium-Sized Vestibular Schwannomas: Consecutive Cohort Analysis of Outcomes

Early Translabyrinthine Surgery for Small- and Medium-Sized Vestibular Schwannomas: Consecutive Cohort Analysis of Outcomes

Sporadic Vestibular Schwannoma Size and Location Do not Correlate With the Severity of Hearing Loss at Initial Presentation

Hearing Preservation Outcomes and Prognostic Factors in Acoustic Neuroma Surgery: Predicting Cutoffs

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