Cost of Vestibular Schwannoma Treatment: A Systematic Review and Meta-Analysis.

Introduction Research furthering treatment efficacy for microsurgical resection and stereotactic radiosurgery for vestibular schwannoma (VS) is ever-growing; however, there remains a paucity of research addressing treatment costs. Our aim is to define the reported costs of different treatment modalities used for VS. Methods A systematic review of the literature for VS treatment cost was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed and Web of Science databases. Literature that presented cost of VS treatment specific to the modality was included. Articles from 1990 to present day in English were considered. Cost was corrected for inflation to April 2022 dollars using the US Bureau of Labor Statistics Inflation Calculator. Results A total of 407 articles were included in the analysis. After review, eight articles provided data on cost of treatment. In total, 687 patients were included across seven studies, with study dates ranging from 1997 to 2020. The average cost of resection was $54,321.99 (range = $10,243-95,590, n = 8), radiosurgery $27,837.92 (range = $6,281-51,676, n = 6), and observation $6,304.88 (range = $2,149-11,886, n = 3). Conclusion Our findings describe the limited and significant variability of data on published costs for the treatment of VS. Given the relative clinical equipoise between treatment modalities in some scenarios, better understanding of this end-point will help physicians make more responsible recommendations in the resource-constrained environment of modern healthcare and this analysis should serve as a starting point for more robust analysis into cost-effectiveness of treatment for VS.

Traumatic Ulceration of the Vestibular Mucous Membrane After Insertion of Four Mini-Implants in the Atrophied Mandible: A Case Report.

This clinical report describes how a decubital ulcer arose from the direct contact of the vestibular movable mucous membrane against mini-implant balled-type heads after the mini-implant insertion in the edentulous atrophic mandible of a 78-year-old patient who was not wearing a conventional mandibular complete denture for more than 10 years. Due to severe alveolar ridge atrophy, mini-implant insertion (2.0 mm wide) was an option without extensive surgical procedures. The patient signed the informed consent. A few days after the implant insertion, injury, inflammation, and induration of the vestibular movable mucous membrane were observed on the movable vestibular mucosa on the right side, opposing the mini-implants. The cause of inflammation was attributed to increased perioral muscle tonus which pushed the movable mucosa onto the mini-implant heads and caused mechanical trauma. During the period of edentulism, the perioral muscle tonus increased, directing the mucous membrane of the lips and cheeks against residual ridge to enable food comminution. To treat the persistent decubitus, a bulk of dental composite resin was placed around mini-implant heads and light-cured to protect the mucosa from further mechanical trauma, as the patient did not possess an old mandibular denture to cover the mini-implant heads. Vestibuloplastic surgery (disinsertion of movable attachments and deepening of the vestibulum) was also done. After the surgery, a silicone splint, resembling an occlusal rim, was made to protect the mucous membrane, keep medicaments for faster epitalization in place, to decrease perioral muscle tonus before the new dentures' delivery, and to prevent movable tissue relapse. The custom impression, jaw relationship determination, and try-in of the artificial teeth setup were made with sutures still in place. After the denture delivery and implant loading, the patient was instructed to sleep with the dentures to protect the movable mucous membrane. One year later, almost no peri-implant marginal bone loss was observed, attached and peri-implant mucosa were healthy, and the patient was delighted.

Soft and hard tissue evaluation for vestibular socket therapy of immediately placed implants in infected and non-infected sockets: a 1-year prospective cohort study.

BACKGROUND: Immediate implant placement using vestibular socket therapy (VST) proved to offer a successful treatment option in compromised sockets. However, the presence of active signs infection complicates immediate implants in sockets with defective labial plates, due to the possible contamination of the implant or the bone graft with existing infected tissues or oral environment via the fistula. This study, therefore, aims to explore the success of immediate implant placement using VST in managing infected compromised sockets. METHODS: We included 26 age- and sex-matched patients with 41 implants sites. Thirteen patients had 19 infected (group I) and 13 had 21 non-infected type 2 sockets (group N). Both groups were treated using vestibular socket therapy (VST) and a 6-day protocol. Implant survival, changes in facial bone thickness, and mid, mesial, and distal mucosal levels were evaluated 1 year after implant placement. The Mann-Whitney U test was used to compare both groups. Furthermore, the Wilcoxon signed-rank test was used to study changes with time within each group. The statistical significance level was set at P < 0.05. RESULTS: All implants survived; no significant difference was found between groups N and I regarding apical, mid, and crestal bone thickness and soft tissue level, except at the mesial papilla, where the recession was significantly more in group N than in group I. Changes over time were statistically significant in the apical, mid, and crestal bone thickness in both groups. The mean bone thickness gain ranged from 0.85 to 2.4 mm and 0.26-1.63 mm in groups I and N, respectively. Additionally, the mean mucosal recession ranged from 0.29 to 0.51 mm and 0.39-1.47 mm in groups I and N, respectively. CONCLUSION: Within the limitations of this study immediate implant placement in type II infected sockets using the 6-day protocol and VST achieved 100% implant survival, while maintaining the regenerated facial bone thickness with minimal mucosal recession. TRIAL REGISTRATION: The protocol for this study was registered on clinicaltrials.gov at 3/10/2021 (registration number NCT04787224).

A 5-week centrifuge-based G training with feedback on the magnitude of G force, does not improve the perception of roll tilt during simulated coordinated turns.

When entering a coordinated flight turn without visual references, the perception of roll-angular displacement is determined by vestibular cues, and/or probably by assessment of the G load (G magnitude) and its translation into the corresponding bank angle. Herein, we examined whether repeated exposures to hypergravity (G training) in a centrifuge, would advance, not only the ability to accurately assess the G load, but also the capacity to detect or estimate the corresponding roll inclination of the centrifuge gondola. To this end, in 9 men without piloting experience, the subjective estimation of G load and roll tilt were assessed, in complete darkness, during 5-min coordinated turns in the centrifuge, performed at 1.1G (25° roll-tilt angle) and 2.0G (60° roll tilt angle). These trials were conducted before and after 5-weeks of G training [3×40-min sessionsï½¥week-1; protocol: 20×1-min at G levels close to the individual relaxed G-level tolerance (range: ∼2.6G(~67°)-3.6G(74°)), separated by 1-min intervals at idle speed (1.4G)], while continual feedback to the subjects was limited to the G load. As expected, G training improved subjects' capacity to assess G load, especially at 2.0 G (P=0.006). The perception of roll tilt, however, was consistently underestimated (by ~70-80%), and not enhanced by G training (P≥0.51). The present findings demonstrate that prolonged repeated G-induced roll-tilts in a centrifuge gondola, while external feedback is restricted to graviception, enhance the capacity to perceive G load, but fail to advance the ability to detect or consciously estimate the magnitude of roll-angular displacement during a coordinated turn.

Cajal's contributions to vestibular research.

The Spanish neurohistologist Santiago Ramón y Cajal (1852-1934) is widely regarded as the father of modern Neuroscience. In addition to identifying the individuality of cells in the nervous system (the neuron theory) or the direction followed by nerve impulses (the principle of dynamic polarization), he described numerous details regarding the organization of the different structures of the nervous system. This task was compiled in his magnum opus, "Textura del Sistema Nervioso del Hombre y los Vertebrados," first published in Spanish between 1899 and 1904, and later revised and updated in French as "Histologie du système nerveux de l'homme et des vertébrés" between 1909 and 1911 for wider distribution among the international scientific community. Some of Cajal's findings are fundamental to our understanding of the anatomy and histology of the vestibular system. He depicted the nerve endings in the sensory epithelia, the structure of the vestibular nerve and Scarpa ganglion, afferent vestibular fibers, vestibular nuclei, lateral vestibulospinal tract, vestibulocerebellar connections, and the fine structure of the cerebellum. However, most of these pioneering descriptions were published years earlier in Spanish journals with limited circulation. Our study aimed to gather Cajal's findings on the vestibular system and identify his original publications. After this endeavor, we claim a place for Cajal among the founders of anatomy and histology of the vestibular system.

Masseteric Vestibular Evoked Myogenic Potentials in Wallenberg Syndrome: A Case Report.

We report the clinical findings of mVEMP responses in conjunction with cVEMPs and oVEMPs in an individual with Wallenberg syndrome. The results indicated that the degree of abnormality in mVEMP was comparatively higher than in cVEMPs and oVEMPs. mVEMPs can offer valuable insights into the Wallenberg syndrome's brainstem pathophysiology.

Phenotyping vestibulocochlear manifestations in Susac syndrome: a cohort study.

PURPOSE: To characterize vestibulocochlear involvement in patients with Susac syndrome (SuS), a rare immune-mediated endotheliopathy of cerebral, retinal and inner ear microvasculature causing a triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. METHODS: The electronic patient files of 21 patients with SuS are reviewed for data on demography, clinical presentation, disease course and audiovestibular testing. RESULTS: All 21 patients experienced some form of audiovestibular complaints during the disease course, with vertigo and instability being most frequently reported, followed by hearing loss, tinnitus and aural fullness. These audiovestibular symptoms did not always coincide. Fifteen patients had objectified predominant low- to midfrequency sensorineural hearing loss and 8 out of 18 patients showed abnormalities on vestibular testing, most frequently vestibular evoked myogenic potential-abnormalities, indicating otolith dysfunction. Treatment protocols consisted of uniformly extensive immunosuppressive therapy and hearing loss remained mostly mild. CONCLUSION: Audiovestibular involvement is very common in patients with SuS. Characteristic findings include a "reverse-slope" configuration on audiological testing and otolith dysfunction on vestibular testing. Aggressive immunosuppression may prevent severe audiovestibular dysfunction. Symptoms as aural fullness and otolith dysfunction may indicate an underlying hydrops. Further investigations are necessary to elucidate the histopathological mechanisms underlying these preferentially involved cochleovestibular areas. Early recognition and treatment of SuS are important to stabilize or decrease disease activity and might also have beneficial effects on inner ear outcome. THE SUBMITTED MANUSCRIPT REPORTS DATA DERIVED FROM CLINICAL OBSERVATIONS IN HUMANS: Consent for the research was provided by the Ethics Committee of Ghent University hospital (application number 2019/1443, registration date 31/12/2021, principal investigator Guy Laureys).

Congenital deafness and vestibular disorders: a systematic literature review.

Introduction: Congenital deafness is a pathological entity that represents an economical and social burden, affecting up to 0.2% of newborns in Europe. Sensorineural hearing loss (SHL) is caused by a variety of factors, including congenital abnormalities, perinatal infectious diseases and genetic syndromes. The inner ear's vestibular system, nestled alongside the auditory organs, is crucial for balance maintenance. Its close connection with the auditory system means that disturbances in one often coincide with disturbances in the other, highlighting their intertwined functions. With this review we aim to describe objective vestibular tests found in literature and to study their use for diagnosis of vestibular disturbances in patients affected by congenital deafness. Methods: The review is conducted with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. The search string used was: [(congenital deafness) OR (congenital hearing loss) OR (congenital hypoacusia)] AND [(vestibular disorders) OR (vertigo)]. An initial abstract reading selection was made, and a subsequent comprehensive full-text reading. For each article, we identified the type of vestibular test utilized and its corresponding outcome. Results: Out of the initial-papers identified through the search string-articles met the eligibility criteria for further analysis through abstract and full-text reading. After further selection-articles were chosen for detailed examination, focusing on the data of patients. Conclusion: Congenital hearing loss profoundly affects a child's development, especially in language and communication skills, and it is frequently associated with a pathological vestibular system. Early identification allows timely intervention with personalized therapies. In current literature, there is still no gold standard test to identify balance disorders in patients with congenital hearing loss. There is considerable variability on the subject due to the inclusion of diverse patients with various diagnoses, alongside a wide range of available technologies. Managing such conditions necessitates collaboration among healthcare providers, ensuring comprehensive care through prompt diagnosis and personalized treatment plans. Ongoing research aims to further improve screening methods and develop precision medicine approaches tailored to individual needs.

Central tendency and serial dependence in vestibular path integration.

Path integration, the process of updating one's position using successive self-motion signals, has previously been studied using visual distance reproduction tasks in which optic flow patterns provide information about traveled distance. These studies have reported that reproduced distances show two types of systematic biases: central tendency and serial dependence. In the present study, we investigated whether these biases are also present in vestibular path integration. Participants were seated on a linear motion platform and performed a distance reproduction task in total darkness. The platform first passively moved the participant a pre-defined stimulus distance which they then actively reproduced by steering the platform back the same distance. Stimulus distances were sampled from short- and long-distance probability distributions and presented in either a randomized order or in separate blocks to study the effect of presentation context. Similar to the effects observed in visual path integration, we found that reproduced distances showed an overall positive central tendency effect as well as a positive, attractive serial dependence effect. Furthermore, reproduction behavior was affected by presentation context. These results were mostly consistent with predictions of a Bayesian Kalman-filter model, originally proposed for visual path integration.

The effect of head orientation on vestibular signal-based modulation of paraspinal muscle activity during walking.

BACKGROUND: Vestibulospinal reflexes play a role in maintaining the upright posture of the trunk. Head orientation has been shown to modify the vestibulospinal reflexes during standing. This study investigated how vestibular signals affect paraspinal muscle activity during walking, and whether head orientation changes these effects. METHODS: Sixteen participants were instructed to walk on a treadmill for 8 min at 78 steps/min and 2.8 km/h in four conditions defined by the presence of electrical vestibular stimulation (EVS) and by head orientation (facing forward and facing leftward), while bipolar electromyography (EMG) was recorded bilaterally from the paraspinal muscles from cervical to lumbar levels. RESULTS: In both head orientations, significant phasic EVS-EMG coherence in the paraspinal muscles was observed at ipsilateral and/or contralateral heel strikes. Compared to walking with the head forward, a significant decrease was found in EVS-evoked responses (i.e., EVS-EMG coherence and gain) when participants walked with the leftward head orientation, with which EVS induced disturbance in the sagittal plane. This overall decrease can be explained by less need of feedback control for walking stabilization in the sagittal plane compared to in the frontal plane. The decrease in coherence was only significant at the left lower vertebral levels and at the right upper vertebral levels around left heel strikes. CONCLUSION: These findings confirm the contribution of the vestibular afferent signals to the control of paraspinal muscle activity during walking and indicate that this control is changed in response to different head orientations.

Transiently worse postural effects after vestibulo-ocular reflex gain-down adaptation in healthy adults.

Suffering an acute asymmetry in vestibular function (i.e., vestibular neuritis) causes increased sway. Non-causal studies report associations between lateral semicircular canal function and balance ability, but direct links remain controversial. We investigate the immediate effect on body sway after unilateral vestibulo-ocular reflex (VOR) gain down adaptation simulating acute peripheral vestibular hypofunction. Eighteen healthy adults, mean age 27.4 (± 12.4), stood wearing an inertial measurement device with their eyes closed on foam before and after incremental VOR gain down adaptation to simulate mild unilateral vestibular neuritis. Active head impulse VOR gain was measured before and after the adaptation to ensure VOR gain adaptation. Percentage change for VOR gain was determined. Sway area was compared before and after VOR adaptation. VOR gain decreased unilaterally exceeding meaningful change values. Sway area was significantly greater immediately after VOR gain down adaptation, but quickly returned to baseline. In a subset of subjects VOR gain was re-assessed and found to remain adapted despite sway normalization. These results indicate that oculomotor adaptation targeting the lateral semicircular canal VOR pathway has an immediate, albeit transient increase in body sway. Rapid return of body sway to baseline levels suggests dynamic sensory reweighting between vestibular and somatosensory inputs to resolve the undesirable increased body sway.

[Evaluation of e-NIHSS scale combined with HINTS for posterior circulation ischemic stroke with vestibular symptoms].

Objective:To explore the predictive value of HINTS bedside examination and e-NIHSS scale for posterior circulation ischemia with vestibular symptoms. Methods:136 cases in total patients with acute vestibular syndrome（AVS） hospitalized in our hospital from April 2021 to April 2023 were selected as the study subjects, According to the classification of AVS etiology, patients with central AVS, namely posterior circulation ischemia（PCI）, were divided into case group（68 cases） and peripheral AVS patients were control group（68 cases）, Collect data and perform head impulse test-nystagmus-test of skew deviation test beside the bed, two doctors evaluated the NIHSS and e-NIHSS scales for PCI patients with vestibular symptoms respecb tively, and recorded the results after they were consistent, and improved the head MRI examination. Results:The positive rate of head pulse test in PCI patients with vestibular symptoms was 3 cases（4.41%）, and 60 cases（88.24%） with peripheral symptoms; The positive rate of nystagmus test in PCI group was 64 cases（94.12%） and peripheral 21 cases（30.88%）; The positive rate of eye deviation test in PCI group was 55 cases（80.88%） and peripheral 8 cases（11.76%）. Comparing the data with the consistency of the final diagnosis, the sensitivity was 97.0%, the specificity was 95.7%, and the accuracy was 0.963. It passed the Kappa consistency test Kappa=0.926（P<0.01）. The patients in PCI group were scored, in which the NIHSS score of brainstem group was 1.51±0.59, and the e-NIHSS score was 4.05±1.71（P<0.05）; The NIHSS score of cerebellar group was 1.42±0.62, and the e-NIHSS score was 3.86±1.59（P<0.05）; NIHSS score of thalamus group was 1.31±0.73, e-NIHSS score was 3.56±1.27 （P<0.05）; NIHSS score of non-focus group was 1.11±0.43, e-NIHSS score was 3.06±1.20 （P<0.01）. The difference between e-NIHSS score and NIHSS score in each group was statistically significant. Conclusion:HINTS examination is highly consistent with the final diagnosis of the gold standard. The e-NIHSS scoring scale has a higher detection rate than the NIHSS scoring scale for patients with posterior circulation ischemia mainly characterize〓by vestibular symptoms.

[Reference ranges and test-retest reliability of subject visual horizontal from different head-tilt angles in young healthy adults].

Objective:To establish the normal values of subjective visual horizontal（SVH） under different head tilt angles, analyze the test-retest reliability, and provide a normal value reference for the refined diagnosis and functional assessment of SVH in clinical vestibular disorders. Methods:Thirty-one healthy young people were selected to wear visual reality glasses to test SVH data in five different head tilt angles: upright head position 0°, head tilted 45°to the left（L45°ï¼‰, head tilted 45° to the right（R45°ï¼‰, head tilted 90° to the left（L90°ï¼‰, and head tilted 90° to the right（R90°ï¼‰, and were re-tested 2 weeks later. Results:①The normal values of SVH at 0°, L45°, R45°, L90°, and R90°were 0.30±1.32, 5.94±5.54, -11.44±5.32, -0.87±8.63, -2.70±8.02, respectively. ②The 95% confidence intervals of SVH at 0°, L45°, R45°, L90°, and R90° were: （-2.34,2.94）,（-5.14,17.02）,（-22.08,-0.80）,（-18.13,16.39）,（-18.74，13.34）, respectively. The ratio of asymmetry in the absolute value of bilateral 45° deviation was 26.4% and the ratio of asymmetry in the absolute value of bilateral 90° deviation was 1.3%. ③The intra-class correlation coefficient（ICC） for 0°, L45°, R45°, L90° and R90° was 0.625, 0.641, 0.564, 0.769, 0.656, respectively. Conclusion:SVH has good test-retest reliability and high clinical test stability and stability. The data on normal values of SVH at different head tilt angles established in this study can provide clinical references for the refined diagnosis and functional assessment of vestibular system disorders.

Development and application of explainable artificial intelligence using machine learning classification for long-term facial nerve function after vestibular schwannoma surgery.

PURPOSE: Vestibular schwannomas (VSs) represent the most common cerebellopontine angle tumors, posing a challenge in preserving facial nerve (FN) function during surgery. We employed the Extreme Gradient Boosting machine learning classifier to predict long-term FN outcomes (classified as House-Brackmann grades 1-2 for good outcomes and 3-6 for bad outcomes) after VS surgery. METHODS: In a retrospective analysis of 256 patients, comprehensive pre-, intra-, and post-operative factors were examined. We applied the machine learning (ML) classifier Extreme Gradient Boosting (XGBoost) for the following binary classification: long-term good and bad FN outcome after VS surgery To enhance the interpretability of our model, we utilized an explainable artificial intelligence approach. RESULTS: Short-term FN function (tau = 0.6) correlated with long-term FN function. The model exhibited an average accuracy of 0.83, a ROC AUC score of 0.91, and Matthew's correlation coefficient score of 0.62. The most influential feature, identified through SHapley Additive exPlanations (SHAP), was short-term FN function. Conversely, large tumor volume and absence of preoperative auditory brainstem responses were associated with unfavorable outcomes. CONCLUSIONS: We introduce an effective ML model for classifying long-term FN outcomes following VS surgery. Short-term FN function was identified as the key predictor of long-term function. This model's excellent ability to differentiate bad and good outcomes makes it useful for evaluating patients and providing recommendations regarding FN dysfunction management.

Intraoperative monitoring and early recognition of facial nerve root in vestibular schwannoma surgery.

The removal of vestibular schwannomas carries a risk of facial palsy. This study aims to evaluate the usefulness and technical aspects of intraoperative monitoring (IOM) for the facial nerve. A total of 96 patients who underwent surgery for vestibular schwannoma were retrospectively investigated. The cohort was divided into two groups: those with intraoperative facial nerve monitoring (IOM group) and those without IOM (non-IOM group). Preoperative and postoperative facial nerve functions were assessed using the House-Brackmann (HB) scale immediately after surgery, at discharge, and at the 1-year follow-up. HB grade I and II were classified as satisfactory outcomes, HB grade III and IV as intermediate, and HB grade V and VI as poor. Facial nerve functions were compared between the groups. Additionally, the ratio of satisfactory results was investigated in the IOM group, focusing on whether the root exit zone (REZ) was identified at an early or late stage of surgery. Among the 65 (67%) patients in the IOM group and 31 (32%) patients in the non-IOM group, there were no differences in demographic and tumor characteristics. The extent of resection varied from subtotal to gross total removal, with no statistical differences between the groups. Although facial nerve function was more favorably preserved in the non-IOM group immediately after surgery, this trend reversed at discharge and the 1-year follow-up, showing significant statistical differences. In the IOM group, more patients achieved satisfactory outcomes when the REZ was identified early compared to late during tumor resection. Intraoperative facial nerve monitoring provides more satisfactory outcomes in preserving nerve function in vestibular schwannoma surgery. Early recognition of the REZ may contribute to improved surgical outcomes.

Test-Retest Reliability of Dynamic Subjective Visual Vertical and Visual Dependency in Older Adults Using Virtual Reality Methods.

The perception of verticality is formed through the integration of multisensory gravitational information, including somatosensory, visual, and vestibular inputs. Older adults exhibit visual dependency (VD) as they rely more on visual information to compensate for reduced somatosensory and vertical perception. Increased VD is associated with falls, and the dynamic subjective visual vertical (SVV) is used to assess VD. However, the measurement reliability of dynamic SVV and VD using virtual reality (VR), which has garnered considerable attention in recent years, remains unclear. Therefore, our purpose in this study was to assess the test-retest reliability of dynamic SVVs and VDs using a VR method. We evaluated static and dynamic SVV of 40 older adults using a smartphone-based VR system (SVR-SVV). Dynamic SVV consisted of numerous spheres on the background rotating clockwise (CW-SVV) or counterclockwise (CCW-SVV). Each SVV measurement consisted of one set of 10 trials. VD was calculated as the mean value of dynamic SVV minus the mean values of static SVV. A re-test was conducted after one week. Reliability was analyzed using Bland-Altman plots and intraclass correlation coefficients (ICC 2, k) for each SVV measure. We observed no systematic bias in any of the SVV values, which were 0.1° (SD = 2.8°), 13.3° (SD = 8.3°), -12.8° (SD = 6.9°), and 15.7° (SD = 8.1°) for static SVV, CW-SVV, CCW-SVV, and VD, respectively. Test-retest reliability was good for static SVV (ICC = .817, p < .001), CW-SVV (ICC = .896, p < .001) and excellent for CCW-SVV (ICC = .914, p < .001), VD (ICC = .937, p < .001). The dynamic SVV and VD measurements using SVR-SVV demonstrated good test-retest reliability. Moreover, the SVR-SVV is more portable than conventional methods, making it highly useful in clinical practice.

Effectiveness of CI as an alternative to ABI for hearing loss in patients with vestibular schwannomas: A multicenter study in Japan.

OBJECTIVE: NF2-related schwannomatosis (NF2) is characterized by bilateral vestibular schwannomas (VS), often causing severe damage to the bilateral auditory function. Auditory brainstem implantation (ABI) provides hearing-impaired patients with an opportunity to reacquire auditory sensation through electrical stimulation of auditory neurons in the cochlear nucleus. However, ABI is not covered by public health insurance in Japan, leading to a large difference in financial burden compared to cochlear implantation (CI). The aim of the present study was to demonstrate the effectiveness of CI as an alternative to ABI for hearing reacquisition in patients with profound hearing loss caused by VS. METHODS: To investigate the current situation of ABI and CI for hearing reconstruction in VS patients, we conducted a questionnaire survey of 102 facilities in Japan. Based on the responses to the questionnaire, a multicenter research group consisting of otolaryngologists and neurosurgeons was established. We collected detailed data on patients with VS who underwent ABI (n = 7, all NF2) and CI (n = 14 [nine NF2, and five non-NF2]). RESULTS: Some sense of hearing was obtained in all patients but one with CI indicating the efficacy of CI and ABI for profound hearing loss caused by VS. The mean hearing levels were 45.4 dB HL in the ABI patients and 32.7 dB HL in the CI patients, indicating that CI was effective as an alternative to ABI. CONCLUSION: The results of the present study suggest the effectiveness of CI as an alternative to ABI for hearing reacquisition in patients with profound hearing loss caused by VS.

Stereotactic Radiosurgery in Primary Treatment of Sporadic Small to Medium (<3 cm) Vestibular Schwannomas: A Systematic Review and Meta-Analysis.

PURPOSE: To analyze the current literature regarding use of SRS as primary treatment of VS to further evaluate efficacy and treatment-related neurologic deficits. METHODS: Online databases were queried to identify relevant publications from January 2001-December 2020. Full text, English articles for sporadic VS treated primarily with radiosurgery and documented hearing preservation data were reviewed. Papers that had a minimum follow-up period of less than 36 months, did not utilize radiosurgery for primary treatment, or included patients with Neurofibromatosis II were excluded. RESULTS: A total of 33 studies involving 4286 patients with an average follow-up of 62.5 months were included in the final analysis. All 33 studies included eligible hearing data; overall preservation of serviceable hearing was found to be 58.27%. 27 studies with 3822 eligible patients were analyzed for tumor control rates; overall, tumor control was reported in 92.98% of cases. 27 studies were analyzed for post-treatment facial nerve dysfunction which was reported in 1.53% of cases. CONCLUSIONS: SRS is a safe and effective primary treatment modality for sporadic vestibular schwannoma as evidenced by the present analysis. Radiosurgery is effective with regard to tumor control and hearing preservation while offering a low rate of post-treatment facial nerve dysfunction.

A critical appraisal of the International Classification of Headache Disorders migraine diagnostic criteria based on a retrospective multicenter cross-sectional headache registry study in youth.

OBJECTIVES: We used Cluster Analysis of Migraine-associated Symptoms (CAMS) to critically evaluate current International Classification of Headache Disorders-Third Edition (ICHD-3) migraine-associated symptoms criteria. BACKGROUND: Diagnostic criteria play a central role in guiding clinical trial inclusion, and therefore available treatments. Migraine and tension-type headaches (TTH) are differentiated in ICHD-3 by many headache characteristics, including associated symptoms. A diagnosis of probable migraine indicates some but not all features of migraine are met. Photophobia and phonophobia, or nausea and/or vomiting, are required to meet a diagnosis of migraine; however, CAMS-a model that describes associated symptoms across youth with headache-indicates that a broader range of symptoms contain information about migraine burden. METHODS: In this multisite retrospective cross-sectional study, we evaluated ICHD-3 migraine criteria. Youth aged 6-17 years with migraine (including probable migraine) or TTH were included in the analysis. We used CAMS to evaluate the migraine-associated symptom criterion. With CAMS as a guide, we evaluated how changes to the migraine-associated symptom criterion altered who met the diagnosis of migraine. RESULTS: Of the 9017 participants included in this study, 66.7% were female and had a median (interquartile range) age of 13 (10-15) years. Most participants had migraine or probable migraine (99.0%), and the remainder had TTH (1.0%). A sizable percentage (10.1%) of youth under the umbrella diagnosis of migraine were diagnosed with probable migraine because they did not meet migraine-associated symptom criterion D; however, many in this group reported several non-ICHD migraine-associated symptoms. We explored alterations to criterion D based on CAMS. Allowing for photophobia or phonophobia re-categorized 55.6% of youth as having migraine, though some only had one symptom. Including lightheadedness or lightheadedness and spinning re-categorized 19.7% and 25.8% of youth with migraine, respectively, but all of those who were re-categorized had at least two migraine-associated symptoms. CONCLUSION: The ICHD-3 captures the most prevalent migraine-associated symptoms; however, many youths with probable migraine who do not meet full criteria due to insufficient associated symptoms nonetheless experience multiple non-ICHD migraine-associated symptoms. Changes to criterion D should be considered for the ICHD-4.

Cluster Analysis of Migraine-associated Symptoms (CAMS) in youth: A retrospective cross-sectional multicenter study.

OBJECTIVE: To conduct a retrospective cross-sectional multicenter study to validate the relationships between migraine-associated symptoms. BACKGROUND: Symptoms associated with headache-photophobia and phonophobia, nausea, and/or vomiting-are required criteria for migraine diagnosis based on the International Classification of Headache Disorders-Third Edition (ICHD-3). However, individuals with migraine report high rates of other symptoms (e.g., lightheadedness, difficulty thinking). We recently completed a single-center study assessing the relationships between an expanded set of migraine-associated symptoms. METHODS: A pre-registered cross-sectional multicenter retrospective analysis was conducted on standardized questionnaire data of youth ages 6-17 years from two headache registries at pediatric tertiary care centers. Cluster Analysis of Migraine-associated Symptoms (CAMS) was implemented to assess associations between 11 migraine-associated symptoms. We explored differences between the two centers, and how CAMS was associated with demographics, including sex and age, and headache burden. RESULTS: There were 10,721 participants who were 66.5% female and had a median (interquartile range) age of 13 (10-15) years. The first three CAMS dimensions accounted for 46.5% of the variance and were consistent across sites. The first dimension indicated those reporting any migraine-associated symptoms were likely to report multiple. The second dimension separated symptoms into those included in ICHD-3 migraine diagnostic criteria and non-ICHD symptoms (e.g., lightheadedness, difficulty thinking). The third dimension separated sensory hypersensitivity and vestibular symptoms. An abundance of migraine-associated symptoms correlated with greater headache severity (Spearman's ρ = 0.18, 95% confidence interval [CI] 0.17-0.20; small effect size) and disability (ρ = 0.26, 95% CI 0.25-0.28; small effect size). We also observed differences in associated symptoms across age and sex. DISCUSSION: Associations between an expanded set of migraine-associated symptoms are informative for headache burden and reveal intriguing changes across child development and sex. We were able to replicate findings across two centers, indicating that these symptom clusters are inherent to migraine.