The natural history of untreated sporadic vestibular schwannomas: a comprehensive review of hearing outcomes

Sughrue, Michael E.; Yang, Isaac; Aranda, Derick; Lobo, Khadja; Pitts, Lawrence H.; Cheung, Steven W.; Parsa, Andrew T.

doi:10.3171/2009.4.jns08895

Cited by 151 publications

(106 citation statements)

References 31 publications

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“…In conservatively managed patients with VS, tumor growth is reported to vary from 15 1 to 85%, 2 with hearing pres- ervation rates between 11 and 100%. 2,47 For the specific purpose of hearing outcome, the yearly growth rate seems also to be an important factor as outlined by Sughrue and colleagues 49 in a recent meta-analysis. Different patterns of growth have in fact been shown; some tumors exhibit no growth, whereas others tend to grow very quickly.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas

Franzin¹,

Spatola²,

Serra³

et al. 2009

FOC

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Object Due to technological advances in neuroradiology in recent years, incidental diagnoses of vestibular schwannomas (VSs) have increased. The aim of this study was to evaluate the hearing function after treatment with Gamma Knife surgery (GKS) for VSs in patients adequately selected with “good” or “useful” hearing before treatment and to assess the possible predictive factors for hearing function preservation. Methods Of all patients treated in the authors' hospital between 2001 and 2007, they retrospectively studied 50 patients with a unilateral VS in whom there was serviceable hearing (Gardner-Robertson [GR] Class I or II). Additional inclusion criteria were: no Type 2 neurofibromatosis, no previous treatment, and at least 6 months' follow-up of neuroradiological and audiological data. The median patient age was 54 years (range 24–78 years). The median tumor volume was 0.73 ml (range 0.03–6.6 ml), and the median radiation dose to the tumor margin was 13 Gy (range 12–16 Gy) with an isodose of 50%. Results Patient age, tumor volume, and presenting symptoms were found to correlate with hearing function. At a median of 36 months after radiosurgery, tumor growth control was 96% and no patient required any other additional treatment. Serviceable hearing was preserved in 34 patients (68%): 21 (62%) with GR Class I hearing and 13 (38%) with GR Class II hearing. The remaining 16 patients had poor hearing function:15 with GR Class III and 1 with GR Class IV hearing function. In 19 (58%) of 33 patients with GR Class I function before GKS the same class was maintained posttreatment; 29 (88%) maintained functional hearing (GR Class I or II). In all patients with an intracanalicular lesion, functional hearing was maintained. Significant prognostic factors for maintaining serviceable hearing were GR Class I function before treatment, symptoms at presentation, patient age younger than 54 years, and Koos Stage T1 disease. Conclusions The results of the study show that the probability of preserving functional hearing in patients undergoing GKS treatment for unilateral VSs is very high. Patients with GR Class I, age younger than 54 years, with presenting symptoms other than hearing loss, and a Koos Stage T1 tumor have better prognosis. The prescribed dose of 13 Gy appears to represent an excellent compromise between controlling the disease and preserving auditory function.

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Section: Discussionmentioning

confidence: 99%

Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas

Franzin¹,

Spatola²,

Serra³

et al. 2009

FOC

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“…The incidence rate of VS has been increased because of detection the small and early stage VS by routine use of MRI in approach to hearing disturbance [15,[31][32][33][34][35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Vestibular Schwannomas Microsurgery Assisted by Flexible Hand-Held 2 micro-Thulium-Fiber Laser

Mastronardi

Cacciotti

Roperto

et al. 2016

Caspian.J.Neurol.Sci

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Background: Vestibular Schwannoma (VS) is one of the skull base tumors originating from vestibular portion of eighth cranial nerve. Recently, 2 microThulium laser is used in the surgery of some intracranial tumors. Objectives: Assessing the efficacy of 2 micro-Thulium flexible hand-held laser fiber (Revolixjr ® ) in microsurgical removal of VS. Materials and Methods:This retrospective non-randomized study was carried out from July 2012 to November 2015. 39 patients with VS had been operated on with microsurgical technique via retro-sigmoid approach. 2 micro-Thuliumfiber hand-held flexible laser was used for tumor resection in 39 cases. Facial nerves function by House-Brackmann (HB) scale and hearing state were assessed preoperatively and 1 week and 6-month postoperatively. Results: Overall time of surgery changed only in proportion with the size of tumor (185-575 minutes) and was not affected by the use of laser. In 5out of 39cases, preoperative facial nerve palsy HB2, and in one case HB4 (permanent) was observed. On considering 38 cases, at 6-month follow-up facial nerve preservation rate (HB1) was 92.1% (from May 2015 all patients had not postoperative facial palsy). Hearing preservation rate was possible in 12 out of 15 cases with previously acceptable preoperative hearing state (AAO-HNS A and B classes). The mean surgeon satisfaction rate of usefulness of this technic was 2.7 in a 0-3-scale Conclusions: A good functional outcome including facial nerve preservation and hearing preservation was obtained by micro-Thulium-fiber hand-held flexible laser microsurgery.

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“…Combining the results of 6 previous meta-analyses shows that tumor growth occurred in 29% to 54% of patients (mean 44.6%). 4,9,89,95,101,113,118 A major drawback in the application of these results is that the mean follow-up time in these studies was only 3 years. A literature review of mostly Level 3 evidence yields impressive variability in growth rates (range 18%-73%).…”

Section: Hypothetical Casementioning

confidence: 99%

“…Meta-analyses of pooled data are fraught with considerable assumptions to simplify the nonuniform existent data and achieve statistical power and significance, which can greatly impact their conclusions. 100,101,111,115 These studies should thus be interpreted with caution.…”

Section: What Actually Creates the Treatment Dilemma?mentioning

confidence: 99%

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An update on unilateral sporadic small vestibular schwannoma

Thakur¹,

Banerjee

Khan³

et al. 2012

FOC

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Advances in neuroimaging have increased the detection rate of small vestibular schwannomas (VSs, maximum diameter < 25 mm). Current management modalities include observation with serial imaging, stereotactic radiosurgery, and microsurgical resection. Selecting one approach over another invites speculation, and no standard management consensus has been established. Moreover, there is a distinct clinical heterogeneity among patients harboring small VSs, making standardization of management difficult. The aim of this article is to guide treating physicians toward the most plausible therapeutic option based on etiopathogenesis and the highest level of existing evidence specific to the different cohorts of hypothetical case scenarios. Hypothetical cases were created to represent 5 commonly encountered scenarios involving patients with sporadic unilateral small VSs, and the literature was reviewed with a focus on small VS. The authors extrapolated from the data to the hypothetical case scenarios, and based on the level of evidence, they discuss the most suitable patient-specific treatment strategies. They conclude that observation and imaging, stereotactic radiosurgery, and microsurgery are all important components of the management strategy. Each has unique advantages and disadvantages best suited to certain clinical scenarios. The treatment of small VS should always be tailored to the clinical, personal, and social requirements of an individual patient, and a rigid treatment protocol is not practical.

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The natural history of untreated sporadic vestibular schwannomas: a comprehensive review of hearing outcomes

Abstract: These data suggest that a growth rate of > 2.5 mm/year is a better predictor of hearing loss than the initial tumor size for patients undergoing observation management of VSs < 25 mm in largest diameter.

Cited by 151 publications

References 31 publications

Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas

Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas

Vestibular Schwannomas Microsurgery Assisted by Flexible Hand-Held 2 micro-Thulium-Fiber Laser

An update on unilateral sporadic small vestibular schwannoma

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