Trends in Surgical Use and Associated Patient Outcomes in the Treatment of Acoustic Neuroma

Patel, S.H.; Nuño, Miriam A; Mukherjee, Debraj; Nosova, Kristin; Lad, Shivanand P.; Boakye, Maxwell; Black, Keith L.; Patil, Chirag G.

doi:10.1016/j.wneu.2012.06.029

Cited by 25 publications

(16 citation statements)

References 5 publications

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“…The most common postoperative complications following VS surgery have been reported as facial paralysis, hearing loss, neurologic and vascular complications, cerebrospinal fluid (CSF) leakage, meningitis, and wound infection. [4][5][6]19 The most common complication in this study was nervous system complications, not elsewhere specified, at 15.2%, followed by facial nerve paralysis, which occurred in 8.7% of patients. Nervous system complications, not elsewhere specified could indicate a number of conditions, including facial nerve paresis.…”

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confidence: 79%

Complications of Surgery for Sporadic Vestibular Schwannoma

Mahboubi

Ahmed

Yau

et al. 2013

Otolaryngol.--head neck surg.

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Objectives. We sought to investigate the postoperative complications of vestibular schwannoma excision and determine their significant clinical predictors.Study Design. Cross-sectional. Setting. California Hospital Inpatient Discharge Datasets 1997-2011.Subjects and Methods. Data for vestibular schwannoma excisions performed in California were extracted using the ICD-9-CM code ''04.01 excision of acoustic neuroma. '' Demographics, principal payer, state of residence, comorbidities, as well as hospital case volume were examined as possible predictors. Postoperative complications and patient disposition were examined as outcome variables. Comorbidities and complications were identified using ICD-9-CM diagnoses and procedures codes.Results. Overall, 6553 cases were examined. Comorbidities were present in 2539 (38.7%) patients. Postoperative complications occurred in 1846 (28.2%) patients; 1714 (26.2%) neurological and 337 (5.1%) medical complications. Patients' admission ended with death or further care (ie, skilled nursing facilities) in 260 (4.0%) cases. Mortality rate was 0.2%. No significant changes were observed over time. Multivariate analysis revealed that the odds of neurological complications were greater in the 2007-2011 period (OR = 1.51; 95% CI, 1.12-2.04), in patients with comorbidities (OR = 1.48; 95% CI, 1.16-1.88), and in hospitals with low case volume (OR = 1.69; 95% CI. 1.31-2.18). The odds of medical complications were also greater in the 2007-2011 period (OR = 1.69; 95%, CI 1.02-2.80). Female gender, non-Caucasian ethnicity, presence of comorbidities, and low hospital case volume were associated with greater odds of patients requiring further care.Conclusion. Comorbidities and low hospital case volume were major risk factors for complications. No significant changes in rates of complications from vestibular schwannoma surgery were observed over the 15-year period.

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confidence: 79%

Complications of Surgery for Sporadic Vestibular Schwannoma

Mahboubi

Ahmed

Yau

et al. 2013

Otolaryngol.--head neck surg.

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“…Estos resultados indujeron a Cushing a proponer la descompresión interna del tumor, desaconsejando la extirpación completa hasta tanto «los métodos quirúrgicos sean perfeccionados» 1 . El primero de estos perfeccionamientos fue la modificación del abordaje, desde una exposición completa de la fosa posterior y el cerebelo a la exposición unilateral propuesta por Dandy 41 . Estos autores atribuyeron el aumento en la tasa de complicaciones quirúrgicas al incremento del tamaño tumoral de los casos operados, o dicho de otra manera, un incremento de los tumores pequeños enviados para tratamiento radioquirúrgico.…”

Section: Mortalidadunclassified

Tratamiento del neurinoma acústico gigante

Samprón¹,

Altuna²,

Armendáriz³

et al. 2014

Neurocirugía

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“…More than 20% of surgical patients experience complications such as facial paralysis, neurologic damage, cerebrospinal fluid fistula, hematoma, hydrocephalus, and even death. 2 , 3 , 4 …”

Section: Resultsmentioning

confidence: 99%

“…Therefore, the long-term posttreatment toxicity must be heavily weighted for these patients. Although the complication rates are much lower than with surgery, 2 , 3 , 4 some patients experience radiation-induced side effects after treatment. Up to 40% of patients may experience middle ear side effects such as otitis media during treatment, 5 which can cause tinnitus, dizziness, and pain.…”

Section: Introductionmentioning

confidence: 97%

Cochlea-sparing acoustic neuroma treatment with 4π radiation therapy

Woods

Lee

Kaprealian

et al. 2018

Advances in Radiation Oncology

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PurposeThis study investigates whether 4π noncoplanar radiation therapy can spare the cochleae and consequently potentially improve hearing preservation in patients with acoustic neuroma who are treated with radiation therapy.Methods and materialsClinical radiation therapy plans for 30 patients with acoustic neuroma were included (14 stereotactic radiation surgery [SRS], 6 stereotactic radiation therapy [SRT], and 10 intensity modulated radiation therapy [IMRT]). The 4π plans were created for each patient with 20 optimal beams selected using a greedy column generation method and subsequently recalculated in Eclipse for comparison. Organ-at-risk (OAR) doses, homogeneity index, conformity, and tumor control probability (TCP) were compared. Normal tissue complication probability (NTCP) was calculated for sensorineural hearing loss (SNHL) at 3 and 5 years posttreatment. The dose for each plan was then escalated to achieve 99.5% TCP.Results4π significantly reduced the mean dose to both cochleae by 2.0 Gy (32%) for SRS, 3.2 Gy (29%) for SRT, and 10.0 Gy (32%) for IMRT. The maximum dose to both cochleae was also reduced with 4π by 1.6 Gy (20%), 2.2 Gy (15%), and 7.1 Gy (18%) for SRS, SRT, and IMRT plans, respectively. The reductions in mean/maximum brainstem dose with 4π were also statistically significant. Mean doses to other OARs were reduced by 19% to 56% on average. 4π plans had a similar CN and TCP, with a significantly higher average homogeneity index (0.93 vs 0.92) and significantly lower average NTCP for SNHL at both 3 years (30.8% vs 40.8%) and 5 years (43.3% vs 61.7%). An average dose escalation of approximately 116% of the prescription dose achieved 99.5% TCP, which resulted in 32.6% and 43.4% NTCP for SNHL at 3 years and 46.4% and 64.7% at 5 years for 4π and clinical plans, respectively.ConclusionsCompared with clinical planning methods, optimized 4π radiation therapy enables statistically significant sparing of the cochleae in acoustic neuroma treatment as well as lowering of other OAR doses, potentially reducing the risk of hearing loss.

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Trends in Surgical Use and Associated Patient Outcomes in the Treatment of Acoustic Neuroma

Cited by 25 publications

References 5 publications

Complications of Surgery for Sporadic Vestibular Schwannoma

Complications of Surgery for Sporadic Vestibular Schwannoma

Tratamiento del neurinoma acústico gigante

Cochlea-sparing acoustic neuroma treatment with 4π radiation therapy

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