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1.
Pediatr Blood Cancer ; 67(5): e28228, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32124552

RESUMO

Seventeen children at six institutions with neurofibromatosis type 2 (NF2)-related vestibular schwannomas received bevacizumab. Eight of the 13 patients with initial hearing loss (61%) showed objective hearing improvement within six months of treatment. No patients showed hearing deterioration during therapy; however, only two patients showed objective radiological response. Seven of eight patients had tumor progression or worsening hearing loss upon cessation of treatment. Bevacizumab was well tolerated with no patients discontinuing therapy. Bevacizumab appears to postpone hearing loss in childhood NF2-associated vestibular schwannomas, but responses are not durable, suggesting that either longer maintenance therapy or new strategies are required.


Assuntos
Bevacizumab/administração & dosagem , Neurofibromina 2/metabolismo , Neuroma Acústico/tratamento farmacológico , Neuroma Acústico/metabolismo , Adolescente , Criança , Feminino , Humanos , Masculino , Neuroma Acústico/patologia , Neuroma Acústico/fisiopatologia
2.
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
3.
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
4.
Handb Clin Neurol ; 160: 451-464, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277868

RESUMO

The auditory brainstem response (ABR), consisting of five to six vertex-positive peaks with separation of about 0.8ms, is very sensitive to factors that affect conduction velocity and hence ABR wave latencies in the brainstem auditory pathways. In addition, disorders causing dissynchronization of neural activity result in an amplitude decrease or disappearance of ABR peaks. The opposite effects occur in the maturation process, which takes about 2 years postterm; here conduction velocity increases quickly to its adult value, but synaptic delays being sensitive to synchronous release of transmitter substance take considerably longer. In neurological disorders, those that cause dissynchrony, such as auditory neuropathy and vestibular schwannoma, Gaucher disease, and Krabbe disease, the (longer latency) ABR peaks are reduced or absent. Effects on neural conduction, resulting in increased ABR interwave latencies, are found in vestibular schwannomas, Bell's palsy, Duane retraction syndrome, Marcus Gunn ptosis, and various encephalomyopathies. These measures allow an assessment of the parts of the brainstem that are involved.


Assuntos
Tronco Encefálico/fisiologia , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Doenças do Sistema Nervoso/fisiopatologia , Estimulação Acústica/métodos , Potenciais de Ação/fisiologia , Tronco Encefálico/fisiopatologia , Humanos , Doenças do Sistema Nervoso/diagnóstico , Neuroma Acústico/diagnóstico , Neuroma Acústico/fisiopatologia
5.
PLoS One ; 14(6): e0217752, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163048

RESUMO

BACKGROUND: The natural history of sporadic vestibular schwannoma is unpredictable, with tumors growing, non-growing and even showing spontaneous regression in some rare cases. OBJECTIVE: This retrospective study aims to describe the radiologic signs characterizing and identifying the shrinking vestibular schwannoma. METHODS: Involution was considered to have occurred if tumor size had decreased by 2 mm or more on its largest diameter. All magnetic resonance imaging scans were reviewed for tumor size, internal auditory meatus size, and tumor characteristics. Volumetric measurements were performed on the first and last scan. Audiometric data were collected at the first and last visit. RESULTS: Fourteen patients with a confirmed spontaneous regression were included, with a mean follow-up of 5 ± 2.6 years. The mean shrinkage rate was 0.9 ± 0.59 mm/year on 2D measurements, and 0.2 ± 0.17 cm3/year on volumetric measurements, with a relative shrinkage of 40 ± 16.9%. Two remarkable radiologic features were observed: First, a festooned aspect, defined by multiple curves in the tumor outline, noticed in 12 cases (86%); second, the appearance of cerebrospinal fluid filling the internal auditory meatus, associated with an enlargement of the internal auditory meatus compared to the contralateral side, and observed in 10 out of 13 cases with internal auditory meatus invasion (77%). Those two aspects were associated in 64% of cases. CONCLUSION: These two newly reported radiologic features could help neurosurgeons, oto-neurosurgeons and neuroradiologists to identify a spontaneous vestibular schwannoma involution at first visit. This could allow any treatment to be postponed, monitoring to be more widely spaced, and patients to be reassured.


Assuntos
Regressão Neoplásica Espontânea/patologia , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/diagnóstico , Cóclea/diagnóstico por imagem , Cóclea/patologia , Cóclea/fisiopatologia , Audição/fisiologia , Humanos , Imagem por Ressonância Magnética , Regressão Neoplásica Espontânea/fisiopatologia , Neuroma Acústico/patologia , Neuroma Acústico/fisiopatologia
6.
Neurosurgery ; 85(6): E1078-E1083, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31215628

RESUMO

BACKGROUND: Fractionated stereotactic radiosurgery (SRS) for vestibular schwannomas (VS) has been theorized to allow for tumor control with higher rates of hearing preservation in selected patients with useful hearing. However, there is a paucity of literature with formal audiologic measures of hearing preservation to support the standard use of fractionated SRS in VS. We hypothesized that fractionation would diminish the amount of hearing damage. OBJECTIVE: To evaluate the relationship between audiologic performance and SRS fractionation scheme. METHODS: We performed an IRB-approved retrospective review of patients treated with 1, 3, or 5 fraction SRS for VS at our institution from 1998 to 2016. Pre- and post-SRS audiograms with speech awareness threshold (SAT) in treated and contralateral ears were obtained. Contralateral ear measurements were used for hearing normalization to account for presbycusis. RESULTS: Fifty-six patients with median audiologic follow-up 2.0 yr (mean 2.66 yr, min-max 0.50-9.45 yr) were included. Patients treated with single fractionation had a significantly worsened SAT (dB) compared to patients treated with 5 fractions (P = .008) and compared to all multifraction patients (P = .009) at 12 to 24 mo follow-up. CONCLUSION: This retrospective analysis supports the use of fractionated SRS to preserve hearing in patients with VS. SAT can be used as an objective metric of hearing response to radiosurgery.


Assuntos
Audiometria/tendências , Fracionamento da Dose de Radiação , Audição/efeitos da radiação , Neuroma Acústico/radioterapia , Radiocirurgia/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Audição/fisiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico , Neuroma Acústico/fisiopatologia , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
7.
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
9.
Otolaryngol Head Neck Surg ; 161(2): 324-329, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30909803

RESUMO

OBJECTIVE: To determine relationships between caloric testing (CT) and video head impulse testing (vHIT) among patients with unilateral vestibular schwannoma (VS). To describe the distribution of CT and vHIT measurements and assess associations with tumor size and self-perceived handicapping effects. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral hospital. SUBJECTS AND METHODS: Subjects were adults with presumed unilateral VS between 2014 and 2017. Interventions were CT and vHIT. Primary outcomes were vHIT value (abnormal <0.8) and CT value (abnormal >25%). Secondary outcomes were tumor size and Dizziness Handicap Inventory scores. RESULTS: Fifty-one individuals had complete data for CT and vHIT. The odds of abnormal gain increases by 2.18 for every 10% increase in unilateral weakness on CT (range, 1.44-3.34; P < .001). A significant negative correlation between CT and gain exists (rs = -0.64, P < .001). Odds of observing saccades increased by 2.68 for every 10% increase in unilateral weakness (range, 1.48-4.85; P = .001). This association was larger in magnitude for overt than covert saccades (odds ratios, 2.48 and 1.59, respectively). Tumor size was significantly associated with an increase in caloric weakness (ß = 0.135, P < .001). With every 10-mm increase of tumor size, odds of abnormal gain on vHIT increased 4.13 (range, 1.46-11.66; P = .007). Mean Dizziness Handicap Inventory score was 19.7 (σ = 22), without association to caloric weakness, gain, or tumor size. CONCLUSION: CT and vHIT both effectively assess vestibular function for patients with VS and correlate to tumor size. These findings are important as vHIT has a lower overall cost, improved patient tolerance, and demonstrated reliability.


Assuntos
Testes Calóricos , Teste do Impulso da Cabeça , Neuroma Acústico/diagnóstico , Neuroma Acústico/fisiopatologia , Adulto , Idoso , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Carga Tumoral
10.
Otol Neurotol ; 40(4): 511-516, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870368

RESUMO

OBJECTIVES: Tumor factors that influence vestibular function in vestibular schwannoma (VS) have not been properly described. We evaluated whether cystic VSs have different vestibular function than solid VS. Tumor size on vestibular function was also evaluated. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary referral center. PATIENTS: Forty-one cases of sporadic, untreated VS. INTERVENTION: Evaluation with video head impulse test and MRI. MAIN OUTCOME MEASURES: Tumors were classified as solid, heterogeneous, or cystic and by size using the Hannover classification. Vestibulo-ocular reflex (VOR) gain was correlated to tumor size and cystic status. RESULTS: Large VS had worse VOR gain than small lesions (p < 0.001). Cystic lesions had lower VOR gain than all other tumors (p = 0.001), Hannover T3 and T4 (p = 0.014), Hannover T4 (p = 0.015), solid tumors (p < 0.001), solid Hannover T3 and T4 (p = 0.003), and solid Hannover T4 (p = 0.008). Heterogeneous VSs had lower VOR gain compared to solid tumors (p = 0.02), solid Hannover T3 and T4 (p = 0.08), and solid Hannover T4 (p = 0.14). Heterogeneous and cystic VSs had lower VOR gain than solid tumors (p < 0.001), solid Hannover T3 and T4 (p = 0.004), and solid Hannover T4 (p = 0.02). VOR gain of solid T4 lesions was not significantly lower than solid Hannover T1-T3 (p = 0.33). CONCLUSION: Cystic status is directly associated with a worse vestibular dysfunction. Size did not significantly impact vestibular function in solid VS.


Assuntos
Teste do Impulso da Cabeça , Neuroma Acústico/fisiopatologia , Vestíbulo do Labirinto/fisiopatologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reflexo Vestíbulo-Ocular/fisiologia , Adulto Jovem
11.
Clin Neurophysiol ; 130(5): 722-726, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30901633

RESUMO

OBJECTIVE: EMG "A-train" activity correlates with postoperative facial palsy after vestibular schwannoma (VS) surgery. An intermedius nerve separate from the facial nerve increases A-trains without significant impact on function. We investigate occurrence of A-train "clusters", A-trains over a majority of channels within a short time frame. METHODS: Data from 217 patients with first surgery for VS were evaluated retrospectively. Continuous EMG recorded with 9 channels was evaluated for A-train patterns. "Clusters" of A-trains were identified, i.e. A-trains within 3 seconds over a majority of channels. Relation to a separate intermedius, tumor size and facial palsy was evaluated. RESULTS: Correlations between A-trains and postoperative facial palsy were higher in patients without separate intermedius (r = 0.562 versus r = 0.194). Clusters were identified in 107 patients (49.3%), separate intermedius in 109 (50.2%), with significant association of both (p < 0.001, Chi-Square test). Excluding clusters slightly increased correlation of A-trains to facial nerve function. CONCLUSIONS: A-train clusters have limited relevance for predicting postoperative paresis. However, they should be regarded as warning signs, suggesting the presence of a separate intermedius nerve. SIGNIFICANCE: A-train "clusters" are a sign of hyperactivity of the facial nerve due to a separate intermedius nerve and may confound intraoperative monitoring during VS surgery.


Assuntos
Eletromiografia , Traumatismos do Nervo Facial/diagnóstico , Nervo Facial/fisiopatologia , Paralisia Facial/etiologia , Neuroma Acústico/fisiopatologia , Procedimentos Neurocirúrgicos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Nervo Facial/fisiopatologia , Paralisia Facial/fisiopatologia , Feminino , Humanos , Monitorização Neurofisiológica Intraoperatória , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Adulto Jovem
12.
Br J Neurosurg ; 33(4): 402-408, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30829548

RESUMO

Background: Papilloedema and visual failure can occur as a consequence of vestibular schwannoma without evidence of hydrocephalus on imaging. Conventional treatment usually includes CSF diversion procedures. We describe here the novel use of optic nerve sheath fenestration in these patients. Methods: A case series of three patients who underwent optic nerve sheath fenestration for visual complications of vestibular schwannoma. Results: Patients A and B were both 23 year old females, with visual symptoms and papilloedema at the time of presentation with a large vestibular schwannoma. Patient A had progressive, severe visual failure despite treatment with an external ventricular drain and tumour resection. She therefore went on to have bilateral optic nerve sheath fenestration surgery, which restored central vision, improved peripheral vision and resolved papilloedema. Patient B underwent optic nerve sheath fenestration as first line surgical management for visual symptoms from a large vestibular schwannoma. This resulted in resolution of visual symptoms and papilloedema and she went on to have the lesion resected at a later date. Patient C was a 54 year old male who developed visual symptoms and papilloedema following the resection of a vestibular schwannoma. This was found to be secondary to a transverse venous sinus thrombosis and he underwent an optic nerve sheath fenestration to treat the complications of this. He also had restored vision and resolution of papilloedema. Conclusion: We demonstrate, with 3 differing cases, that optic nerve sheath fenestration can be a useful and safe treatment choice for patients with visual failure and papilloedema secondary to vestibular schwannoma.


Assuntos
Cegueira/cirurgia , Neuroma Acústico/cirurgia , Nervo Óptico/cirurgia , Cegueira/etiologia , Cegueira/fisiopatologia , Feminino , Humanos , Hidrocefalia/complicações , Hidrocefalia/cirurgia , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/complicações , Neuroma Acústico/fisiopatologia , Papiledema/etiologia , Papiledema/cirurgia , Campos Visuais/fisiologia , Adulto Jovem
13.
Nat Protoc ; 14(2): 541-555, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30617350

RESUMO

Neurofibromatosis type II (NF2) is a disease that lacks effective therapies. NF2 is characterized by bilateral vestibular schwannomas (VSs) that cause progressive and debilitating hearing loss, leading to social isolation and increased rates of depression. A major limitation in NF2 basic and translational research is the lack of animal models that allow the full spectrum of research into the biology and molecular mechanisms of NF2 tumor progression, as well as the effects on neurological function. In this protocol, we describe how to inject schwannoma cells into the mouse brain cerebellopontine angle (CPA) region. We also describe how to apply state-of-the-art intravital imaging and hearing assessment techniques to study tumor growth and hearing loss. In addition, ataxia, angiogenesis, and tumor-stroma interaction assays can be applied, and the model can be used to test the efficacy of novel therapeutic approaches. By studying the disease from every angle, this model offers the potential to unravel the basic biological underpinnings of NF2 and to develop novel therapeutics to control this devastating disease. Our protocol can be adapted to study other diseases within the CPA, including meningiomas, lipomas, vascular malformations, hemangiomas, epidermoid cysts, cerebellar astrocytomas, and metastatic lesions. The entire surgical procedure takes ~45 min per mouse and allows for subsequent longitudinal imaging, as well as neurological and hearing assessment, for up to 2 months.


Assuntos
Ângulo Cerebelopontino/patologia , Diagnóstico por Imagem/métodos , Modelos Animais de Doenças , Perda Auditiva/patologia , Neurofibromatose 2/patologia , Neuroma Acústico/patologia , Animais , Linhagem Celular Tumoral , Ângulo Cerebelopontino/metabolismo , Ângulo Cerebelopontino/cirurgia , Expressão Gênica , Genes Reporter , Audição/fisiologia , Perda Auditiva/genética , Perda Auditiva/fisiopatologia , Testes Auditivos , Humanos , Injeções Intraventriculares , Luciferases/genética , Luciferases/metabolismo , Camundongos , Camundongos Knockout , Neurofibromatose 2/genética , Neurofibromatose 2/fisiopatologia , Neurofibromina 2/deficiência , Neurofibromina 2/genética , Neuroma Acústico/genética , Neuroma Acústico/fisiopatologia , Técnicas Estereotáxicas
14.
Laryngoscope ; 129(10): 2378-2383, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30623429

RESUMO

BACKGROUND: The management of small- to medium-size (< 20 mm) sporadic vestibular schwannomas (VSs) continues to inspire debate. Preoperative pure tone thresholds and tumor size are recognized prognostic features of hearing preservation after surgery. OBJECTIVE: To investigate what preoperative characteristics were associated with nonserviceable hearing after surgery for VSs. METHODS: We retrospectively reviewed the audiological results of 92 patients treated with the middle cranial fossa (MCF) approach for resection of VSs (< 20 mm). Sex, age, symptoms, tumor site, tumor size, growth rate, and hearing class according to American Academy of Otolaryngology-Head and Neck Surgery guidelines were evaluated. Negative outcome was progression after surgery to nonserviceable hearing according to Gardner-Robertson classification. We included only patients with preoperative serviceable hearing. RESULTS: After surgery, 48 patients (52.2%) had nonserviceable hearing. At univariate analysis, sex age, symptoms, tumor site, and size were not associated to hearing outcome. Tumor growth rate ≥ 2.16 mm/year (P = 0.02, odds ratio 8.5) and preoperative hearing class B (P = 0.03, OR 5.89) were statistically associated to nonserviceable hearing after VSs resection. Tumor growth rate ≥ 2.16 mm/year was also significantly associated to preoperative hearing class B (P = 0.01). At multivariate analysis, the only independent prognostic factor of progression to nonserviceable hearing in operated VSs was tumor growth rate ≥ 2.16 mm/year (P = 0.01, OR = 4.15). CONCLUSION: We found a new prognostic indicator of hearing preservation after VS surgery with the MCF approach: the tumor growth rate. This feature should be further investigated before being considered in the decision-making process of VS treatment. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:2378-2383, 2019.


Assuntos
Fossa Craniana Média/cirurgia , Audição/fisiologia , Neuroma Acústico/patologia , Neuroma Acústico/fisiopatologia , Carga Tumoral , Adulto , Audiometria de Tons Puros , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/cirurgia , Período Pós-Operatório , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
15.
Ann Otol Rhinol Laryngol ; 128(2): 113-120, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30360640

RESUMO

OBJECTIVES:: The aim of this study was to investigate vertical semicircular canal function in patients with vestibular schwannoma (VS) by video head impulse test (vHIT). METHODS:: Fifteen patients with VS who had not received any treatment, including surgery or stereotactic radiotherapy, before vHIT examination were enrolled. Vestibulo-ocular reflex gain and catch-up saccade in vHIT were evaluated. RESULTS:: Dysfunction of anterior and posterior semicircular canals was detected by vHIT in 26.7% and 60.0%, respectively. Six patients (40.0%) demonstrated abnormalities referable to both vestibular nerve divisions. Abnormalities referable to the superior vestibular nerve were identified in 3 patients (20.0%), while 3 patients (20.0%) demonstrated a pattern indicative of inferior vestibular nerve involvement. Anterior semicircular canal vHIT produced fewer abnormalities than did either horizontal or posterior semicircular canal vHIT. CONCLUSIONS:: Dysfunction of the semicircular canals, including the vertical canals, in patients with VS was detected by vHIT. The anterior semicircular canal was less frequently involved than the horizontal or posterior semicircular canal. The examination of the vertical canals by vHIT is useful in the evaluation of vestibular function in patients with VS.


Assuntos
Teste do Impulso da Cabeça/métodos , Neuroma Acústico/fisiopatologia , Canais Semicirculares/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reflexo Vestíbulo-Ocular , Estudos Retrospectivos , Nervo Vestibular/fisiopatologia , Gravação em Vídeo
16.
J Back Musculoskelet Rehabil ; 32(1): 93-99, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30248037

RESUMO

BACKGROUND: The origin of about 10% of tumors located in the intracranial region is the cerebellopontine angle. Therefore Cerebellopontine Angle (CPA) tumors affect patients' balance. OBJECTIVE: The aim of this study was to compare the balance in individuals who underwent surgery for CPA tumors with healthy individuals. METHODS: Thirty patients who were being followed-up by the Department of Neurosurgery and had been operated on CPA tumor and 31 healthy individuals were included in the study as group 1 and group 2, respectively. The participants were evaluated using Romberg Test, Sharpened Romberg Test, One-leg Stance (OLS), Tandem Walking, Walk Across, Berg Balance Scale (BBS), Dizziness Handicap Inventory (DHI) and Short Form 36 (SF-36). RESULTS: In comparison of the groups, OLS tests (p< 0.001), BBS (p< 0.05) and DHI (p< 0.05) were significantly different in favor of healthy group. SF-36 results revealed a significant difference between the groups, except for Bodily Pain and Vitality (p< 0.05). CONCLUSIONS: The results of this study demonstrated a decrease in balance parameters and quality of life in individuals who underwent CPA tumor surgery in comparison to healthy individuals. Evaluation of balance in the preoperative and postoperative period should not be ignored in these patients and they are suggested to start rehabilitation in the early postoperative period.


Assuntos
Neuroma Acústico/fisiopatologia , Equilíbrio Postural/fisiologia , Adulto , Estudos de Casos e Controles , Avaliação da Deficiência , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/cirurgia
17.
Braz J Otorhinolaryngol ; 85(1): 111-120, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29980446

RESUMO

INTRODUCTION: Intralabyrinthine schwannoma is a rare, benign tumor that affects the most terminal portions of the vestibular and cochlear nerves. This tumor can be classified into 10 subtypes, according to its inner ear location. OBJECTIVE: To carry out a comprehensive review of the most frequent auditory manifestations secondary to the intralabyrinthine schwannoma, describing the possible underlying pathophysiological mechanisms. METHODS: Systematic review of the literature until October 2017 using the PubMed, Web of Science and Scopus databases. The inclusion criteria were clinical manifestations of the intralabyrinthine schwannoma. Three researchers independently assessed the articles and extracted relevant information. The description of a case of an intravestibular subtype intralabyrinthine schwannoma with multiple forms of clinical presentations was used as an example. RESULTS: Twenty-seven studies met our inclusion criteria. The most common intralabyrinthine schwannoma subtype was the intracochlear, followed by the intravestibular type. All the cases demonstrated hearing loss, usually progressive hearing loss. CONCLUSION: The diagnosis of intralabyrinthine schwannomas is based on high-resolution magnetic resonance imaging and should be included in the differential diagnosis of patients with vestibulocochlear complaints. Although there are approximately 600 cases in the literature, we still lack a detailed description of the clinical evolution of the patients, correlating it with MRI findings of temporal bones and tumor subtype.


Assuntos
Perda Auditiva/etiologia , Doenças do Labirinto/complicações , Neuroma Acústico/complicações , Adulto , Audiometria , Progressão da Doença , Feminino , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/fisiopatologia , Humanos , Doenças do Labirinto/diagnóstico por imagem , Doenças do Labirinto/fisiopatologia , Imagem por Ressonância Magnética , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/fisiopatologia
18.
Am J Otolaryngol ; 40(2): 236-246, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30554886

RESUMO

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.


Assuntos
Neoplasias dos Nervos Cranianos/fisiopatologia , Neoplasias dos Nervos Cranianos/terapia , Neuroma Acústico/fisiopatologia , Neuroma Acústico/terapia , Qualidade de Vida , Doenças do Nervo Vestibulococlear/fisiopatologia , Doenças do Nervo Vestibulococlear/terapia , Adulto , Tratamento Conservador , Neoplasias dos Nervos Cranianos/diagnóstico , Neoplasias dos Nervos Cranianos/psicologia , Feminino , Audição , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico , Neuroma Acústico/psicologia , Procedimentos Cirúrgicos Otológicos , Radiocirurgia , Estudos Retrospectivos , Inquéritos e Questionários , Tomografia Computadorizada por Raios X , Vestíbulo do Labirinto , Doenças do Nervo Vestibulococlear/diagnóstico , Doenças do Nervo Vestibulococlear/psicologia
19.
Otolaryngol Clin North Am ; 51(6): 1193-1212, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30390772

RESUMO

Current consensus on optimal treatment of vestibular schwannoma remains poorly established; treatment options include observation, stereotactic radiosurgery, microsurgical resection, medical therapy, or a combination of these. Treatment should be individualized and incorporate the multitude of patient- and tumor-specific characteristics known to affect outcome. Treatment paradigms for sporadic and neurofibromatosis type 2-related tumors are distinct and decision-making in neurofibromatosis type 2 is uniquely challenging. In all cases, treatment should maximize tumor control and minimize functional deficit.


Assuntos
Nervo Facial/cirurgia , Neuroma Acústico/terapia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Perda Auditiva/etiologia , Humanos , Microcirurgia , Neuroma Acústico/fisiopatologia , Radiocirurgia , Resultado do Tratamento
20.
Clin Neurophysiol ; 129(11): 2350-2360, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30248625

RESUMO

OBJECTIVES: We determined if eye movements evoked by Electrical Vestibular Stimulation (EVS) can be used to detect vestibular dysfunction in patients with unilateral vestibular schwannoma (VS). METHODS: Ocular torsion responses to monaural sinusoidal EVS currents (±2 mA, 2 Hz) were measured in 25 patients with tumours ranging in size from Koos grade 1-3. For comparative purposes we also measured postural sway response to EVS, and additionally assessed vestibular function with the lateral Head Impulse Test (HIT). Patient responses were compared to age-matched healthy control subjects. RESULTS: Patients exhibited smaller ocular responses to ipsilesional versus contralesional EVS, and showed a larger asymmetry ratio (AR) than control subjects (19.4 vs. 3.3%, p < 0.05). EVS-evoked sway responses were also smaller in ipsilesional ear, but exhibited slightly more variability than the eye movement response, along with marginally lower discriminatory power (patients vs. controls: AR = 16.6 vs 2.6%, p < 0.05). The HIT test exhibited no significant difference between groups. CONCLUSIONS: These results demonstrate significant deficits in the ocular torsion response to EVS in VS patients. SIGNIFICANCE: The fast, convenient and non-invasive nature of the test are well suited to clinical use.


Assuntos
Neuroma Acústico/fisiopatologia , Potenciais Evocados Miogênicos Vestibulares , Idoso , Movimentos Oculares , Feminino , Movimentos da Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico , Postura
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