Quality of life related to symptomatic outcomes in patients with vestibular schwannomas: A Canadian Centre perspective.

Patients with vestibular schwannomas (VS) typically present with hearing loss and tinnitus as well as variable cranial nerve dysfunctions. Surgical resection, stereotactic radiotherapy and/or conservative management employing serial magnetic resonance or computed tomography imaging serve as the main treatment options. Quality of life (QoL) may be impacted by the extent of tumour burden and exacerbated or relieved by treatment. Subjective assessment and quality of life inventories provide valuable information in client centered approaches with important implications for treatment. The intention of QoL measurements affecting VS patients within a clinical setting is to facilitate discussions regarding treatment options and objectively evaluate patient- centered clinical outcomes in a naturalistic setting.

Quality of life among acoustic neuroma patients managed by microsurgery, radiation, or observation.

OBJECTIVE: The main aim of this study was to examine differences in quality of life (QoL) among acoustic neuroma patients across the management options of microsurgery, radiation, and observation. Additional aims were to describe QoL and investigate management, medical, and demographic factors that predicted QoL in this patient group. STUDY DESIGN: Cross-sectional design, using a postal questionnaire. SETTING: Tertiary referral centers. PATIENTS: Participants included 180 adults diagnosed with, or treated for, a unilateral acoustic neuroma within 5 years of questionnaire distribution. The mean age of participants was 56.5 years, and 107 (59.4%) were female. INTERVENTION(S): Patients' acoustic neuromas were managed with microsurgery, radiation, or observation. MAIN OUTCOME MEASURE(S): Current QoL was measured using the Short Form 12 Version 2 (SF-12), and postmanagement changes in QoL were assessed with the Glasgow Benefit Inventory (GBI). RESULTS: No significant differences in SF-12 scores were found across microsurgery, radiation, and observation patients. However, microsurgery patients reported more deterioration on the GBI general well-being subscale than radiation patients and more improvement in the GBI social support scale than observation patients. Number of symptoms was a consistent predictor of SF-12 and GBI scores. CONCLUSION: This is only the second study to use multivariate statistical techniques and a large sample to examine QoL across the acoustic neuroma management options of microsurgery, radiation, and observation. There were few differences in QoL outcomes across management groups. Number of symptoms was an important factor in current QoL and postmanagement changes in QoL.

Pathological laughter in trigeminal schwannoma: case report and review of the literature.

Pathological laughter is an uncommon manifestation of neurosurgical diseases. Very few cases of trigeminal schwannoma have been reported in the literature presenting with pathological laughter as a predominant symptom. We are reporting on a case of multi-compartmental trigeminal schwannoma presenting as pathological laughter and discuss a review of the literature. A 23-year-old lady presented with pathological laughter, along with symptoms pertaining to other cranial nerves and cerebellar dysfunction. Magnetic resonance imaging (MRI) of the brain was suggestive of a dumbbell-shaped mass in the middle and posterior cranial fossa on the left side, causing significant compression of the pons. She was investigated and operated for multi-compartmental trigeminal schwannoma. Following surgery, abnormal laughter disappeared immediately and no recurrence of symptoms was -present for a follow-up of 16 months. This case supports the role of the brainstem, especially the pons, in the control of laughter and, perhaps, of the medial temporal lobe too.

Trigeminal schwannoma associated with pathological laughter and crying.

A 46 year old man with trigeminal schwannoma displayed symptoms of ataxia with pathological laughter and crying. The tumour developed in the cerebellopontine angle, compressing the pontomesencephalic structures backward, extending in the posterior parasellar region and Meckel's cave. No recurrence of laughter and crying attacks were noted after total removal of the tumour. Theories of mechanism of pathological laughter and crying reported in the literature are reviewed.

[Site-dependent psychopathologic symptoms in brain tumors exemplified by olfactory meningioma]. / Lokalisationsbezogene psychopathologische Symptome bei Hirntumoren am Beispiel der Olfaktoriusmeningeome.

Despite the propagation of imaging techniques in recent years, brain neoplasms are still identified too late in many cases, not least because of a disregard or misinterpretation of early psychiatric symptoms. By means of a detailed report of a case of olfactorius meningioma, together with a summary of 13 other cases from the same hospital over the past 15 years, it is demonstrated that a specious psychodynamic "understanding" may delay the correct diagnosis. Possible reasons for the initial false diagnosis are considered in detail.

Modulation detection by patients with eighth-nerve tumors.

Detection thresholds for sinusoidally amplitude-modulated broad-band noise were measured as a function of modulation frequency for 4 normally hearing listeners and for 6 patients suffering eighth-nerve tumors. Measurements were obtained using a method-of-adjustment (MOA) procedure. On average, the threshold values revealed that more modulation was needed across all modulation frequencies for the patients' affected ears relative to either the normally hearing listeners or the patients' better ears. The cutoff frequency derived from the average modulation-threshhold function (MTF) for the affected ears was about half the normal value. For a simple lowpass-filter model of the process, the latter result suggested a doubling of the auditory time constant in the affected ears. These patients, on average, exhibited the characteristic high-frequency audiometric hearing loss most often associated with eighth-nerve tumors. Their MTFs closely resembled MTFs described previously for high-frequency audiometric hearing loss. The results of statistical analyses suggested that high frequency audiometric hearing loss, irrespective of other influences, is the most parsimonious explanation for the increased modulation thresholds measured for the eighth-nerve tumor patients.

[Neuro-ophthalmology and psychopathology of meningiomas of the tuberculum sellae (syndrome of the anterior chiasma angle)]. / Beitrag zu Neuro-Ophthalmologie und Psychopathologie der Meningeome des Tuberculum sellae (Syndrom des vorderen Chiasmawinkels).

Seventeen cases of meningiomas of the Tuberculum sellae (the anterior chiasma angle) are analysed according to neuro-ophthalmological and psychopathological aspects. Although they also develop in the so-called suprasellar space, they are not characterised by heteronymous bitemporal hemianopsia, but it is in most cases the primary, bilateral optic atrophy that is predominant. Six of 17 cases showed--as the case reported by E. Lange in 1963 ("hysterical" amaurosis)--psychopathological initial and leading symptoms and with these a psychopathological complex which is called a medio-basal hypothalamic-limbic brain-localised psychosyndrome.