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2.
Otolaryngol Head Neck Surg ; 162(4): 530-537, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31986971

RESUMO

OBJECTIVE: To ascertain the relationship among vestibular schwannoma (VS) tumor volume, growth, and hearing loss. STUDY DESIGN: Retrospective cohort study. SETTING: Single tertiary center. SUBJECTS AND METHODS: Adults with observed VS and serviceable hearing at diagnosis were included. The primary outcome was the development of nonserviceable hearing as estimated using the Kaplan-Meier method. Associations of tumor volume with baseline hearing were assessed using Spearman rank correlation coefficients. Associations of volume and growth with the development of nonserviceable hearing over time were assessed using Cox proportional hazards models and summarized with hazard ratios (HRs). RESULTS: Of 230 patients with VS and serviceable hearing at diagnosis, 213 had serial volumetric tumor data for analysis. Larger tumor volume at diagnosis was associated with increased pure-tone average (PTA) (P < .001) and decreased word recognition score (WRS) (P = .014). Estimated rates of maintaining serviceable hearing at 6 and 10 years following diagnosis were 67% and 49%, respectively. Larger initial tumor volume was associated with development of nonserviceable hearing in a univariable setting (HR for 1-cm3 increase: 1.36, P = .040) but not after adjusting for PTA and WRS. Tumor growth was not significantly associated with time to nonserviceable hearing (HR, 1.57; P = .14), although estimated rates of maintaining serviceable hearing during observation were poorer in the group that experienced growth. CONCLUSION: Larger initial VS tumor volume was associated with poorer hearing at baseline. Larger initial tumor volume was also associated with the development of nonserviceable hearing during observation in a univariable setting; however, this association was not statistically significant after adjusting for baseline hearing status.


Assuntos
Perda Auditiva/etiologia , Neuroma Acústico/complicações , Neuroma Acústico/patologia , Carga Tumoral , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
HNO ; 68(Suppl 1): 60-64, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31598774

RESUMO

Schwannomas of the eighth cranial nerve are benign tumours commonly found in the internal auditory meatus or in the cerebellopontine angle. In most cases, they arise from the inferior or vestibular portion of the vestibular nerve. Rarely, these tumours present in the inner ear and are then called intralabyrinthine schwannomas. Bilateral schwannomas are known in neurofibromatosis type 2 (NF2). Bilateral and ipsilateral, multilocular sporadic schwannomas of the eighth cranial nerve have been described as extremely rare findings. This report describes the first case of bilateral sporadic intracochlear schwannomas in a patient with no genetic or clinical features of NF2.


Assuntos
Neurilemoma , Neurofibromatose 2 , Neuroma Acústico , Feminino , Humanos , Pessoa de Meia-Idade , Neurilemoma/complicações , Neurofibromatose 2/complicações , Neuroma Acústico/complicações , Nervo Vestibular
4.
Otolaryngol Head Neck Surg ; 162(2): 211-214, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31842677

RESUMO

Vestibular schwannomas (VSs) were proposed to arise from the glial-Schwann cell junction within the internal auditory canal (IAC). However, otopathology studies indicate that VS may arise anywhere along the course of the vestibular nerve. Recent studies suggested that the majority of tumors are located centrally within the IAC with an equal distribution near the porus acusticus and the fundus. However, these studies analyzed tumors of all sizes, obscuring their precise origin. Herein, we aim to quantify the position of small intracanalicular tumors (<5 mm), assessing hearing outcomes and growth patterns in relation to tumor position. Of the 38 small intracanalicular tumors analyzed, 61% originated closest to the fundus, 34% at the midpoint, and only 5% closest to the porus acusticus. Tumors were observed with serial magnetic resonance imaging for 3.37 ± 2.65 years (mean ± SD) without intervention. Our findings indicate a lateral predominance of small VS within the IAC, an independence between tumor location and hearing outcomes, and further support the slow natural progression of VS.


Assuntos
Perda Auditiva/diagnóstico , Audição/fisiologia , Imagem por Ressonância Magnética/métodos , Neuroma Acústico/diagnóstico , Nervo Vestibular/patologia , Idoso , Audiometria de Tons Puros , Feminino , Perda Auditiva/etiologia , Perda Auditiva/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/complicações , Neuroma Acústico/fisiopatologia , Estudos Retrospectivos , Nervo Vestibular/fisiopatologia
5.
World Neurosurg ; 135: e488-e493, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31843724

RESUMO

BACKGROUND: Vestibular schwannoma (VS) is the most common benign tumor originating in the cerebellopontine angle. In most cases, tumors tend to grow and deserve proper treatment. Sometimes they stabilize, and rarely they decrease in size spontaneously. METHODS: We evaluated retrospectively the images of patients with spontaneous tumor regression. We describe the common neuroimage findings of patients with spontaneous tumoral regression. RESULTS: Four patients with diagnosis of VS were followed with magnetic resonance imaging (MRI). There were some relevant features in MRI: a heterogeneous contrast enhancement in the outer layer of the tumor and presence of a cerebrospinal fluid column between the tumor and the entrance of the internal auditory canal. The percentage of tumor diameter reduction ranged from 20% to 40%. CONCLUSIONS: Some MRI features may demonstrate a spontaneous involution of VS and may be closely followed in asymptomatic or oligosymptomatic patients.


Assuntos
Neoplasias Cerebelares/patologia , Ângulo Cerebelopontino/patologia , Neuroma Acústico/patologia , Adulto , Idoso , Neoplasias Cerebelares/complicações , Feminino , Perda Auditiva/etiologia , Perda Auditiva/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Regressão Neoplásica Espontânea/patologia , Neuroma Acústico/complicações , Estudos Retrospectivos , Zumbido/etiologia , Zumbido/patologia
6.
Ugeskr Laeger ; 181(46)2019 Nov 11.
Artigo em Dinamarquês | MEDLINE | ID: mdl-31791465

RESUMO

In this case report, a female patient with schizophrenia was diagnosed with a cystic vestibular schwannoma, at the age of 28 years. Since her teenage years, the patient had been showing psychiatric symptoms and had suffered from vertigo and auditory hallucinations, and since adulthood the symptoms were unilateral perceptive hearing loss, tinnitus and vertigo. In patients with psychiatric disorders, clinicians should be especially aware of changes in persistent symptoms or onset of new symptoms not to overlook any organic disease.


Assuntos
Alucinações , Neuroma Acústico , Esquizofrenia , Zumbido , Adulto , Feminino , Alucinações/etiologia , Humanos , Neuroma Acústico/complicações , Vertigem
7.
Rev. Hosp. Ital. B. Aires (2004) ; 39(4): 115-127, dic. 2019. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1099709

RESUMO

La neurofibromatosis (NF) comprende un grupo de enfermedades genéticas de herencia autosómica dominante, que se clasifican de la siguiente manera: neurofibromatosis tipo 1 (NF1), neurofibromatosis tipo 2 (NF2) y schwannomatosis (también conocida como neurofibromatosis tipo 3). Esta última es una enfermedad muy infrecuente, con una prevalencia aproximada de 1/126 000 personas, por lo que solo profundizaremos las dos primeras. La NF1, también conocida como la enfermedad de Von Recklinghausen, es la más frecuente de las tres y afecta principalmente la piel y el sistema nervioso periférico. Se caracteriza por la presencia de máculas "café con leche", pecas axilares o inguinales, nódulos de Lisch (hamartomas en el iris) y neurofibromas (tumores de la vaina de nervios periféricos). Otras manifestaciones menos frecuentes, aunque de mayor gravedad, incluyen gliomas del nervio óptico, meningiomas, neurofibromas malignos, escoliosis y displasia de la tibia. Su diagnóstico se suele realizar al nacimiento o durante los primeros años de vida, y se estima que un 50% de quienes la padecen presenta dificultades cognitivas. No hay datos concluyentes sobre la mortalidad en los pacientes con NF1, aunque se sabe que la expectativa de vida es menor que en la población general. La NF2 tiene una prevalencia considerablemente menor que la NF1 y su inicio es más tardío, afectando principalmente a adultos jóvenes. La presentación clínica típica se caracteriza por acúfenos, hipoacusia y ataxia en contexto de la presencia de schwannomas vestibulares bilaterales. Otros hallazgos menos frecuentes incluyen schwannomas de nervios periféricos, meningiomas, ependimomas o astrocitomas. La esperanza de vida es de unos 36 años, con una supervivencia media desde el momento del diagnóstico de 15 años. (AU)


Neurofibromatosis (NF) includes a group of genetic diseases with an autosomal-dominant inheritance pattern, and they are classified as follows: Neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2) and Schwannomatosis (also known as neurofibromatosis type 3). This last one is a very rare disease, with an approximate prevalence of 1/126000, so we will only deepen in the first two. NF1, also known as von Recklinghausen disease, is the most frequent, and mainly affects the skin and peripheral nervous system. Its typical manifestations are the presence of café-au-lait macules, axillary or inguinal freckles, Lisch nodules (hamartomas in the iris) and neurofibromas (peripheral nerve sheath tumors). Less frequent manifestations, although more serious, include optic nerve gliomas, meningiomas, malignant neurofibromas, scoliosis and tibial dysplasia. The diagnosis is usually made at birth or during the first years of life, and approximately 50% of patients present cognitive difficulties. There is no conclusive data on mortality in patients with NF1, although it is known that life expectancy is lower than in general population. NF2 has a considerably lower prevalence than NF1, and its onset is later in life, mainly affecting young adults. Its typical clinical presentation is characterized by tinnitus, hearing loss and ataxia in the context in the presence of bilateral vestibular schwannomas. Less frequent findings include peripheral nerve schwannomas, meningiomas, ependymomas or astrocytomas. Life expectancy is about 36 years old, with a median survival from the moment of diagnosis of 15 years. (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Adulto , Adulto Jovem , Neurofibromatose 2/etiologia , Neurofibromatose 1/etiologia , Neurofibromatoses/classificação , Astrocitoma/fisiopatologia , Ataxia , Escoliose/fisiopatologia , Tíbia/anormalidades , Zumbido , Doenças do Desenvolvimento Ósseo/fisiopatologia , Neuroma Acústico/complicações , Expectativa de Vida , Neurofibromatose 2/epidemiologia , Neurofibromatose 1/fisiopatologia , Neurofibromatose 1/mortalidade , Neurofibromatose 1/epidemiologia , Neurofibromatoses/diagnóstico , Glioma do Nervo Óptico/fisiopatologia , Ependimoma/fisiopatologia , Perda Auditiva , Doenças da Íris/fisiopatologia , Melanose/fisiopatologia , Meningioma/fisiopatologia , Neurilemoma/etiologia , Neurilemoma/fisiopatologia , Neurofibroma/fisiopatologia , Neurofibroma/patologia
8.
BMJ Case Rep ; 12(11)2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31690691

RESUMO

Acoustic neuroma (AN) usually manifests with asymmetric hearing loss, tinnitus, dizziness and sense of disequilibrium. About 10% of patients complain of atypical symptoms, which include facial numbness or pain and sudden onset of hearing loss. Patients with atypical symptoms also tend to have larger tumours due to the delay in investigation. We report a particularly interesting case of a patient presented to us with numbness over her right hemifacial region after a dental procedure without significant acoustic and vestibular symptoms. Physical examination and pure tone audiometry revealed no significant findings but further imaging revealed a cerebellopontine angle mass. The changing trends with easier access to further imaging indicate that the presentation of patients with AN are also changing. Atypical symptoms which are persistent should raise clinical suspicion of this pathology among clinicians.


Assuntos
Neoplasias Cerebelares/patologia , Ângulo Cerebelopontino/patologia , Dor Facial/fisiopatologia , Perda Auditiva/fisiopatologia , Neuroma Acústico/patologia , Audiometria de Tons Puros , Neoplasias Cerebelares/complicações , Neoplasias Cerebelares/cirurgia , Dor Facial/etiologia , Feminino , Perda Auditiva/etiologia , Humanos , Pessoa de Meia-Idade , Neuroma Acústico/complicações , Neuroma Acústico/cirurgia , Período Pós-Operatório , Resultado do Tratamento
9.
Otolaryngol Head Neck Surg ; 161(6): 1027-1030, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31570055

RESUMO

OBJECTIVE: Unilateral vestibular weakness has considerable potential etiologies. One source is a vestibular schwannoma. This article evaluates, in the absence of other symptoms and signs, if unilateral vestibular weakness is an analogue to asymmetric sensorineural hearing loss and serves as an indication for lateral skull base imaging. STUDY DESIGN: Retrospective chart review. SETTING: Academic tertiary center. SUBJECTS AND METHODS: All patients undergoing caloric assessment between January 1, 2012, and June 30, 2018, were investigated. Patients with unilateral vestibular weakness (a left-right difference >25% on electronystagmography) were included in the study. A provincial encompassing image library was surveyed for potential adequate imaging (computed tomography internal auditory canal infused, magnetic resonance imaging [MRI] brain, MRI internal auditory canal) of the target population within the preceding 5 years. Presence/absence of vestibular schwannoma on imaging was determined. RESULTS: Of the 3531 electronystagmography reports reviewed during the period, 864 patients were identified with unilateral vestibular weakness. Of these, 542 had sufficient imaging, and 14 vestibular schwannomas were identified. Only 1 individual had a vestibular weakness in isolation, while the remaining 13 patients also suffered from documented sensorineural hearing loss that would have mandated MRI scanning. CONCLUSION: The results of our study suggest that, in isolation, vestibular weakness is an insufficient indicator for lateral skull base imaging.


Assuntos
Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Neurossensorial/etiologia , Neuroma Acústico/diagnóstico por imagem , Vestíbulo do Labirinto/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Testes Calóricos , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/complicações , Seleção de Pacientes , Estudos Retrospectivos
10.
Acta Neurochir (Wien) ; 161(9): 1809-1816, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31321539

RESUMO

BACKGROUND: Patients with vestibular schwannoma (VS) often complain about tiredness, exhaustion, lack of energy, and strength, but such symptoms of fatigue have scarcely been objectified and analyzed in a VS population. We aimed to characterize fatigue in a cohort of patients with VS and compare such symptoms with a control group. METHODS: All patients who attended an educational course for patients with VS were surveyed with validated tools for assessment of fatigue (fatigue severity scale), anxiety and depression (hospital anxiety and depression scale), sleepiness (Epworth sleepiness scale), and apathy (Starkstein apathy scale). Quality of Life was assessed with the disease-specific Penn Acoustic Neuroma Quality of Life (PANQOL). Symptom severity was estimated with a visual analog scale (VAS). The results have been compared to a control group consisting of patient companions. RESULTS: Data from 88 VS patients and 49 controls were analyzed. The controls had similar age and sex distribution as patients. Fifty-seven percent of VS patients had significant fatigue, compared to 25% in the control group. The mean fatigue score was 4.1 for the patients, and 2.8 for controls. Patients with fatigue were more likely to have depression, anxiety, sleepiness, and apathy. No correlation of fatigue was found with age, gender, or treatment modality. Regression analyses revealed depression, apathy, and vertigo to be predictors of fatigue. Fatigue was strongly correlated to QoL. CONCLUSION: Almost six out of ten VS patients had fatigue, significantly higher than the control group. Interest and focus on fatigue in VS patients can improve the patient's QoL.


Assuntos
Fadiga/epidemiologia , Neuroma Acústico/complicações , Adulto , Idoso , Fadiga/complicações , Fadiga/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Inquéritos e Questionários
11.
Audiol Neurootol ; 24(3): 117-126, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31266017

RESUMO

OBJECTIVE: To evaluate the audiological aspects of vestibular schwannoma (VS) patients with normal hearing. STUDY DESIGN: Retrospective study. SETTING: Quaternary referral center for skull base pathologies. PATIENTS: The records on 4,000 patients who had been diagnosed with VS between 1986 and December 2017 were retrospectively reviewed. The patients included in the study were the ones who complied with the strict audiological normality criteria, as follows: a pure tone hearing threshold (at the 6-octave-spaced frequencies from 250 to 8,000 Hz) ≤25 dBHL; a word recognition score >90%; and interaural differences ≤10 dB at each frequency. INTERVENTIONS: Auditory brainstem response (ABR) testing and radiological imaging. MAIN OUTCOME MEASURES: The incidence of normal objective hearing among VS patients, and the diagnostic utility of the ABR and the effect of tumor size and site on the response. RESULTS: The incidence of normal hearing among VS patients was 4.2%. Tinnitus and vertigo were the most common symptoms across tumor grades; 5.6% of the tumors were large and giant tumors. The ABR yielded a sensitivity of 73.6%, with a false negative rate of 26.3% using a cutoff point of 0.2 ms for interaural latency differences. CONCLUSIONS: The diagnosis of VS should not be based on audiometric thresholds alone. Alarming signs of VS should be clear to the physician in order not to miss or delay the diagnosis of the disease. The ABR is useful in the diagnosis of VS, but normal results do not exclude the occurrence of the disease in patients with normal hearing.


Assuntos
Limiar Auditivo/fisiologia , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Audição/fisiologia , Neuroma Acústico/fisiopatologia , Audiometria de Tons Puros , Bases de Dados Factuais , Humanos , Neuroma Acústico/complicações , Estudos Retrospectivos , Zumbido/etiologia , Zumbido/fisiopatologia , Vertigem/etiologia , Vertigem/fisiopatologia
12.
Otolaryngol Head Neck Surg ; 161(5): 846-851, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31310582

RESUMO

OBJECTIVES: To study the development of dizziness, caloric function, and postural sway during long-term observation of untreated vestibular schwannoma patients. STUDY DESIGN: Retrospective review of a prospectively maintained longitudinal cohort. SETTING: Tertiary referral hospital. SUBJECTS AND METHODS: Patients with vestibular schwannoma undergoing wait-and-scan management were included-specifically, those who did not require treatment during a minimum radiologic follow-up of 1 year. Baseline data and follow-up included magnetic resonance imaging, posturography, bithermal caloric tests, and a dizziness questionnaire. Main outcomes were prevalence of moderate to severe dizziness, canal paresis, and postural instability at baseline and follow-up, as compared with McNemar's test. RESULTS: Out of 433 consecutive patients with vestibular schwannoma, 114 did not require treatment during follow-up and were included. Median radiologic follow-up was 10.2 years (interquartile range, 4.5 years). Age ranged from 31 to 78 years (mean, 59 years; SD, 10 years; 62% women). Median tumor volume at baseline was 139 mm3 (interquartile range, 314 mm3). This did not change during follow-up (P = .446). Moderate to severe dizziness was present in 27% at baseline and 19% at follow-up (P = .077). Postural unsteadiness was present in 17% at baseline and 21% at follow-up (P = .424). Canal paresis was present in 51% at baseline and 56% at follow-up (P = .664). CONCLUSIONS: There was no significant change in the prevalence of dizziness, postural sway, or canal paresis during conservative management of vestibular schwannoma, while tumor volume remained unchanged. This indicates a favorable prognosis in these patients with regard to vestibular symptoms.


Assuntos
Tratamento Conservador , Tontura/epidemiologia , Neuroma Acústico/complicações , Neuroma Acústico/diagnóstico , Equilíbrio Postural , Vestíbulo do Labirinto/fisiopatologia , Adulto , Idoso , Testes Calóricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/terapia , Prognóstico , Estudos Retrospectivos , Inquéritos e Questionários , Avaliação de Sintomas , Fatores de Tempo , Conduta Expectante
13.
Clin Nucl Med ; 44(11): 883-885, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31306195

RESUMO

A 77-year-old man with newly diagnosed prostate adenocarcinoma with a total prostate-specific antigen level of 6.4 ng/mL and Gleason score 7 (4 + 3) was referred to Ga-prostate-specific membrane antigen-11 (PSMA) PET/CT for initial staging. An intense focal PSMA uptake was shown in the right peripheral zone of the prostate gland consistent with the primary tumor. Additionally, PET/CT demonstrated a PSMA-avid soft tissue mass in the left cerebellopontine angle. The patient had a history of left-sided sensorineural hearing loss.


Assuntos
Ácido Edético/análogos & derivados , Achados Incidentais , Neuroma Acústico/diagnóstico por imagem , Oligopeptídeos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Humanos , Masculino , Estadiamento de Neoplasias , Neuroma Acústico/complicações , Neoplasias da Próstata/complicações , Neoplasias da Próstata/patologia
14.
Otol Neurotol ; 40(5S Suppl 1): S59-S66, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31225824

RESUMO

INTRODUCTION: Vestibular schwannomas (VS) are a rare cause of asymmetrical hearing loss, and routine screening with magnetic resonance imaging (MRI) can be costly. At present, no consensus exists on what qualifies as "asymmetrical sensorineural hearing loss" (ASNHL) and when a patient should be referred for screening. OBJECTIVES: 1) Evaluation of published audiometric protocols on the basis of sensitivity and specificity when applied to local clinical cohort of patients with ASNHL; 2) determination of clinical risks of missing VS and potential wastes in screening "radiologically normal" cases; 3) assessment of the cost of MRI screening. METHODS: Cross-sectional study with chart review in a 2-year (2015-2016) cohort of 1059 patients who underwent MRI screening and audiometry indicating sensorineural hearing loss. Fourteen previously published audiometric protocols were assessed for their sensitivity and specificity in guiding radiological diagnosis of VS, and cost analysis was performed. RESULTS: 6/14 audiometric protocols had a sensitivity greater than 85%. Diagnostic specificity ranged from 22.91 to 82.76%, clinical risks from 0 to 50%, and potential wastes from 17.24 to 77.09%. Average annual cost of screening was £64,069. Application of proposed local screening protocol had a projected cost saving of 32.19%. Cost of screening patients that benefit from treatment was compared with a utility function that quantified expected benefit. CONCLUSIONS: Development of an easy-to-apply algorithm incorporating high-sensitivity audiometric protocols may result in significant cost saving, with minimal clinical risk of missing cases. There was disparity between screening costs and monetary "benefit" of hearing.


Assuntos
Algoritmos , Perda Auditiva Neurossensorial/etiologia , Programas de Rastreamento/métodos , Neuroma Acústico/diagnóstico , Adulto , Audiometria/economia , Audiometria/métodos , Análise Custo-Benefício , Estudos Transversais , Feminino , Humanos , Imagem por Ressonância Magnética/economia , Imagem por Ressonância Magnética/métodos , Masculino , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Neuroma Acústico/complicações , Sensibilidade e Especificidade , Resultado do Tratamento
15.
World Neurosurg ; 122: e561-e568, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31108072

RESUMO

OBJECTIVE: We tested the hypothesis that cerebellopontine angle (CPA) tumors are associated with a greater incidence of unruptured intracranial aneurysms (IAs). METHODS: Patients with intracranial tumors (ITs) undergoing computed tomography angiography and magnetic resonance imaging were enrolled in an observational cohort study that prospectively collected age, sex, hypertension, diabetes, cerebral arteriosclerosis, tumor type, tumor location, hydrocephalus, smoking, alcohol intake, CPA tumor size, cerebral aneurysms, and cerebral arteriosclerosis. Patients with the coexistence of IA and ITwere classified as group II, whereas the others with IT as group I. RESULTS: We included 1218 patients with IT for analysis. The incidence of IA was 7.1% (86/1218). A total of 31% of patients with aneurysms had CPA tumors. In a multivariate logistic regression model, a greater incidence of IA was found in female patients (odds ratio [OR] 1.726, 95% confidence interval [CI] 1.050-2.836, P=0.031) and in patients with CPA tumors (OR 3.002, 95% CI 1.822-4.947, P=0.000) after adjustment for tumor type, cerebral arteriosclerosis, and age. In female patients, CPA tumors were a unique independent risk factor of a greater incidence of IA (OR 2.270, 95% CI 1.194-4.317, P=0.012). Furthermore, cerebral arteriosclerosis was a unique independent risk factor of IA in patients with CPA tumors (OR 7.626, 95% CI 2.928-19.860, P=0.000). CONCLUSIONS: These data support the hypothesis that CPA tumors are associated with a greater incidence of unruptured IAs, especially in female patients. Cerebral arteriosclerosis contributed to elevated risk of IA in patients with CPA tumors.


Assuntos
Neoplasias Encefálicas/complicações , Aneurisma Intracraniano/etiologia , Neuroma Acústico/complicações , Adenoma/complicações , Angiografia por Tomografia Computadorizada , Feminino , Glioma/complicações , Humanos , Arteriosclerose Intracraniana/complicações , Angiografia por Ressonância Magnética , Masculino , Neoplasias Meníngeas/complicações , Meningioma/complicações , Pessoa de Meia-Idade , Imagem Multimodal , Neoplasias Hipofisárias/complicações , Estudos Prospectivos , Fatores de Risco
16.
Prog Neurol Surg ; 34: 82-90, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096208

RESUMO

Vestibular schwannomas (VS) are benign tumors predominantly originating from the balance portion of cranial nerve VIII. These tumors have an incidence of 1-2 per 100,000 people. The growth of these tumors is approximately 1-2 mm per year. A VS can result in significant neurologic dysfunction from continued growth or the management paradigms designed to control this predominantly benign tumor. The impacts on the critical space within the auditory canal and cerebellopontine angle can lead to hearing deficits, tinnitus, vestibular dysfunction, facial nerve deficits, and brain stem compression.


Assuntos
Neuroma Acústico/radioterapia , Radiocirurgia/métodos , Humanos , Neuroma Acústico/complicações , Neuroma Acústico/fisiopatologia , Neuroma Acústico/cirurgia
17.
World Neurosurg ; 129: 157-163, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31103763

RESUMO

BACKGROUND: Vestibular schwannomas (VS) are common slow-growing tumors that typically present with the insidious progression of unilateral hearing loss, tinnitus, vertigo, and gait imbalance. Clinically significant intratumoral acute hemorrhage is exceedingly rare and can present with the acute onset of symptoms, neurologic deterioration, and significant dysfunction of cranial nerves VII and VIII. We discuss a 40-year-old man who developed mild hearing loss and headaches over the course of a month before presenting with a large acutely hemorrhagic vestibular schwannoma. In addition, we review the current literature pertaining to this pathology. CASE PRESENTATION: A previously healthy 40-year-old man with a 1-month history of mild headaches, dizziness, and left-sided hearing loss, tinnitus, and facial numbness presented with the acute onset of severe headache, vomiting, complete left-sided hearing loss, and left-sided facial weakness. Computed tomography and magnetic resonance imaging revealed a 4.1 × 2.7 cm hemorrhagic mass in the left cerebellopontine angle most consistent with VS. The patient subsequently underwent a retrosigmoid craniotomy and resection of the tumor. Pathology was consistent with hemorrhagic VS. Imaging at 1-year follow-up demonstrated no residual or recurrent disease, and facial motor function had completely recovered. CONCLUSIONS: Histologically, vascular abnormalities and microhemorrhages are nearly ubiquitous across vestibular schwannomas and may contribute to cystic degeneration and rapid tumor growth. However, clinically significant hemorrhage is rarely encountered and is more commonly associated with more profound neurologic sequelae and cranial nerve VII dysfunction. Surgical resection at the time of presentation should be strongly considered to remove the risk of repeat hemorrhage and further deterioration. Our case represents a typical presentation and clinical course for a patient presenting with this rarely encountered pathology.


Assuntos
Hemorragia/etiologia , Neuroma Acústico/complicações , Neuroma Acústico/patologia , Adulto , Ângulo Cerebelopontino/patologia , Humanos , Masculino
18.
World Neurosurg ; 128: e669-e682, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31059859

RESUMO

BACKGROUND: Patients with neurofibromatosis type 2 develop bilateral vestibular schwannomas with progressive hearing loss. Auditory brainstem implants (ABIs) stimulate hearing in the cochlear nuclei and show promise in improving hearing. Here, we assess the impact of ABI on hearing over time by systematically reviewing the literature and re-analyzing available individual patient data. METHODS: A multidatabase search identified 3 studies with individual patient data of longitudinal hearing outcomes after ABI insertion in adults. Data were collected on hearing outcomes of different sound complexities from sound to speech using an ABI ± lip reading ability plus demographic data. Because of heterogeneity each study was analyzed separately using random effects multilevel mixed linear modeling. RESULTS: Across all 3 studies (n = 111 total) there were significant improvements in hearing over time from ABI placement (P < 0.000 in all). Improvements in comprehension of sounds, words, sentences, and speech occurred over time with ABI use + lip reading but lip reading ability did not improve over time. All categories of hearing complexity had over 50% comprehension after over 1 year of ABI use and some subsets had over 75% or near 100% comprehension. Vowel comprehension was greater than consonant, and word comprehension was greater than sentence comprehension (P < 0.0001 in both). Age and sex did not predict outcomes. CONCLUSIONS: ABIs improve hearing beyond lip reading alone, which represents baseline patient function prior to treatment, and the benefits continue to improve with time. These findings may be used to guide patient counseling regarding ABI insertion, rehabilitation course after insertion, and future studies.


Assuntos
Implante Auditivo de Tronco Encefálico , Perda Auditiva Bilateral/reabilitação , Perda Auditiva Neurossensorial/reabilitação , Leitura Labial , Neurofibromatose 2/complicações , Neuroma Acústico/complicações , Percepção da Fala , Percepção Auditiva , Perda Auditiva Bilateral/etiologia , Perda Auditiva Neurossensorial/etiologia , Humanos , Estatística como Assunto , Resultado do Tratamento
19.
Otol Neurotol ; 40(5): 674-680, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31083098

RESUMO

OBJECTIVE: There is a common misconception that improvement in sudden sensorineural hearing loss (SSNHL) after treatment with steroid therapy effectively excludes the diagnosis of a vestibular schwannoma (VS) and such cases do not warrant an MRI. Paralleling this, steroids are commonly withheld for SSNHL in patients with an existing diagnosis of VS, believing that this condition is not steroid-responsive. This study seeks to underscore that improvement or recovery of SSNHL with steroid therapy does not exclude the diagnosis of VS and does not preclude the need for magnetic resonance imaging. METHODS: A retrospective chart review was performed (2002-2017) of patients with previously untreated sporadic VS who developed SSNHL that improved after steroid treatment. A clinically significant audiometric improvement was defined as an increase of more than or equal to 15% in word recognition score (WRS) and/or decrease of more than or equal to 15 dB in 4-frequency pure-tone average (PTA). To supplement these data, a separate population of patients with incomplete or missing audiometric data, who reported unequivocal subjective improvement in hearing after steroid treatment, were also described to reinforce the study objective. Patient demographics, tumor characteristics, steroid regimen, and data regarding treatment response were recorded. RESULTS: A total of 29 patients (55% women; median age of 47 yr) met inclusion criteria. Fourteen (48%) cases had objective audiometric documentation of SSNHL, while 15 (52%) had either subjective report only or incomplete audiometric data available. Eighteen (62%) had a single event, while 11 (38%) had more than one episode of SSNHL that was treated with steroids. For all patients, the median time between SSNHL and diagnosis of VS was 1.3 months (range, 0.13-148.4 mo). At the time of diagnosis, 15 tumors were purely intracanalicular, while 15 tumors had cerebellopontine angle extension. Of the latter, the median cisternal tumor size was 15.9 mm (range, 5.3-33). Twenty-six (90%) cases received oral steroid therapy alone, two (9%) had intratympanic steroid therapy alone, and one (3%) required combination therapy. The median PTA improvement with steroid therapy was 21 dB HL (range, -10-101.2) and the median WRS improvement was 40% (range, 4-100%). CONCLUSION: A therapeutic response to steroid therapy for SSNHL does not exclude the diagnosis of VS. All patients with SSNHL should undergo appropriate diagnostic imaging to prevent delays in diagnosis and potential treatment.


Assuntos
Glucocorticoides/uso terapêutico , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Neurossensorial/etiologia , Neuroma Acústico/complicações , Neuroma Acústico/diagnóstico , Adulto , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Súbita/tratamento farmacológico , Perda Auditiva Súbita/etiologia , Humanos , Injeção Intratimpânica , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/tratamento farmacológico , Estudos Retrospectivos
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