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1.
J Laryngol Otol ; 134(6): 519-525, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32613920

RESUMO

OBJECTIVE: To present our data evaluating the feasibility of simultaneous cochlear implantation with resection of acoustic neuroma. METHODS: This paper describes a case series of eight adult patients with a radiologically suspected acoustic neuroma, treated at a tertiary referral centre in Newcastle, Australia, between 2012 and 2015. Patients underwent cochlear implantation concurrently with removal of an acoustic neuroma. The approach was translabyrinthine, with facial nerve monitoring and electrically evoked auditory brainstem response testing. Standard post-implant rehabilitation was employed, with three and six months' follow-up data collected. The main outcome measures were: hearing, subjective benefit of implant, operative complications and tumour recurrence. RESULTS: Eight patients underwent simultaneous cochlear implantation with resection of acoustic neuroma over a 3-year period, and had 25-63 months' follow up. There were no major complications. All patients except one gained usable hearing and were daily implant users. CONCLUSION: Simultaneous cochlear implantation with resection of acoustic neuroma has been shown to be a safe treatment option, which will be applicable in a wide range of clinical scenarios as the indications for cochlear implantation continue to expand.


Assuntos
Implante Coclear/métodos , Terapia Combinada/métodos , Audição/fisiologia , Neuroma Acústico/cirurgia , Adolescente , Idoso , Austrália/epidemiologia , Terapia Combinada/estatística & dados numéricos , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Nervo Facial/cirurgia , Estudos de Viabilidade , Seguimentos , Testes Auditivos/métodos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Neuroma Acústico/reabilitação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento
2.
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
3.
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
4.
PLoS One ; 15(1): e0225638, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923229

RESUMO

INTRODUCTION: This study explores the possibility of a relationship between the sphericity degree of a target volume with the dose distribution. This relationship is evaluated based on the ratio isodose volume / target volume (IV/TV) and the metrics coverage, i.e., selectivity, gradient index, conformity index and mean dose when planning radiosurgery for vestibular schwannoma. METHODS: Sphericity degree (φ) was calculated for each target volume (TV) of 64 patients who underwent stereotactic radiosurgery (SRS) for vestibular schwannoma. The calculation of this parameter was developed using the theoretical definition for operational sphericity φ = VP/VCS. The values found are evaluated considering the following metrics:-Coverage (C), selectivity (S), gradient index (GI), Paddick conformity index (CIPaddick) and dose distribution (IV/TV). The planning was also carried out considering a spherical target volume defined in a spherical phantom. The spherical volume is the same as the target used in the treatment plan. The planning of the spherical target was considered as a reference plan to evaluate the dose distribution inside and outside the volume. RESULTS: It was possible to observe that the majority of target volumes has (ϕ) around 0,66-0,77, corresponding to 54,7% of the total. Considering the mean values for metrics, the results are: C = 0,98, S = 0,78, GI = 3,11 and CI = 0,81. The dose distribution was equivalent for treatment plans and reference plans. Quantitative analysis for IV/TV shows that these values are higher than 30% for treatment plans where shot density is large. CONCLUSION: This study demonstrates that de sphericity degree (φ) can be related to the dose distribution (IV/TV). Therefore the sphericity degree is a good parameter to evaluate the dose distribution of a plan for vestibular schwannoma treatment, considering the reference plan as being a spherical target using a leksell gamma knife® perfexion (LGKP). This study shows that the sphericity degree offers important information of the dose distribution outside and inside the target volume. This is not evaluated by the other parameters already implemented as metric to analyzing the GKP plans.


Assuntos
Neoplasias Encefálicas/radioterapia , Neuroma Acústico/radioterapia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Neoplasias Encefálicas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/patologia , Radiocirurgia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador
5.
World Neurosurg ; 136: e440-e446, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931234

RESUMO

OBJECTIVE: To explore patient demographics as to predicting vestibular schwannoma (VS) size and treatment plan within a single institution. METHODS: Using a large tertiary referral skull base center database, all patients with sporadic VS who presented to the center between 2009 and 2018 were reviewed. RESULTS: A total of 816 patients with VS over 18 years of age were included. The median age was 56.8 years (range: 18.6-90.9 years). The median tumor diameter at diagnosis was 11.9 mm (range: 0.6-51.1 mm). With multivariate analysis, older age was associated with decreased tumor size (0.23 mm, 95% confidence interval [CI]: 0.17-0.29), whereas married patients had larger tumors (2.5 mm, 95% CI: 0.92-4.09). When comparing observation, radiation, or surgery, older patients are more likely to pursue observation as compared with surgery and radiation (odds ratio [OR]: 1.08, 95% CI: 1.06-1.10 and OR: 1.20, 95% CI: 1.08-1.33), respectively. Married patients were less likely to pursue observation as compared with surgery (OR: 0.49, 95% CI: 0.29-0.82). Each additional mile a patient lives farther from the center increases his or her odds of pursuing treatment (OR: 1.002, 95% CI: 1.001-1.003). CONCLUSIONS: Older age is associated with smaller tumors, whereas married patients have larger tumors at diagnosis as compared with nonmarried patients. Furthermore, married patients are more likely to pursue treatment, specifically surgery, as compared with nonmarried patients, whereas patients who live farther from the center are more likely to pursue treatment.


Assuntos
Neuroma Acústico/patologia , Carga Tumoral , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Estado Civil , Pessoa de Meia-Idade , Neuroma Acústico/terapia , Planejamento de Assistência ao Paciente , Características de Residência/estatística & dados numéricos , Fatores de Risco , Adulto Jovem
6.
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
7.
World Neurosurg ; 135: e686-e694, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31884127

RESUMO

OBJECTIVE: To describe the morphology and anatomical relationship of the jugular process (JP) and to elucidate its utility as a surgical landmark in the lateraland posterior lateral approaches to the jugular foramen. MATERIALS AND METHODS: Eight dry adult skulls and 10 silicon-injected cadaver heads were used for this study. The distances to selected structures and the thickness of the JP at 3 selected sites were measured. We also included the data of 20 thin-sliced 3-dimensional computed tomography scans. The radiology data of these patients were transferred to a workstation for 3-dimensional reconstruction. RESULTS: The JP, an irregular trapezoid structure, is an important surgical landmark when approaching the jugular foramen. Laterally the JP is rough with 1 or 2 prominences to which the rectus capitis lateralis is attached. The JP is relatively flat medially. The condylar part of the occipital bone could be conceived as a "3-story building." The JP, hypoglossal canal, and lateral and posterior condylar emissary veins are located on the middle floor. The stylomastoid foramen is found constantly in the triangle formed by the styloid process, JP, and the base of the mastoid process. CONCLUSIONS: The JP is an important surgical landmark in the identification of jugular foramen, especially in the lateral and posterior approaches. A better understanding of its morphology and its relationship with the surrounding structures is a prerequisite for accurate surgical planning and intraoperative orientation.


Assuntos
Pontos de Referência Anatômicos , Forâmen Jugular/anatomia & histologia , Osso Occipital/anatomia & histologia , Adulto , Neoplasias Encefálicas/patologia , Cadáver , Feminino , Perda Auditiva/etiologia , Humanos , Imageamento Tridimensional , Forâmen Jugular/diagnóstico por imagem , Imagem por Ressonância Magnética , Microcirurgia/métodos , Neuroma Acústico/patologia , Osso Occipital/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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.
Neurol India ; 67(5): 1274-1278, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31744957

RESUMO

Objectives: Microsurgery of vestibular schwannoma (VS) after radiosurgery is not common. In this study, we analyze nerve functional outcomes and technical challenges associated with the microsurgery following radiosurgery of VS. Materials and Methods: Sixteen patients underwent microsurgery at an average of 37 months (range 3-96 months) after radiosurgery. Indications of surgery included tumour progression or clinical worsening. Twelve of them had never undergone microsurgery before radiosurgery, and three had partial excision before radiosurgery. Maximum tumour diameter of all patients ranged from 23 to 51 mm, of which four were giant tumours. Operative findings and post-microsurgery clinical course, imaging and outcome were analysed. Results: The tumours found at surgery were firmer, with an avascular core but increased vascularity near the surface. There were thickened arachnoid and often adhesions with surrounding structures making total excision difficult. Near total excision was employed in such cases. Eleven patients underwent gross total/near total resection. No major morbidity or death was reported. Post-surgery, eight patients had grade I/II HB facial function, four had grades III and three had grades IV/V. Of the last three, two had the same deficit preoperatively. At the last follow-up (average 50 months), all patients had a stable facial function. None of the patients have undergone any further radiosurgery/microsurgery since the last intervention. Conclusion: For the few patients who require microsurgery after radiosurgery, excellent tumour resection with an acceptable outcome can be achieved with proper techniques and neuromonitoring. Leaving tiny residue attached to critical structures is the key to an optimal outcome.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Neuroma Acústico/radioterapia , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Neuroma Acústico/patologia , Radiocirurgia , Estudos Retrospectivos
10.
World Neurosurg ; 132: e34-e39, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520763

RESUMO

OBJECTIVE: Vestibular schwannomas (VSs) can either be solid or contain variable amounts of cystic components. It has been established that gamma knife radiosurgery (GKRS) is an effective treatment modality for solid VSs. However, in the case of cystic VS, given the somewhat unpredictable growth of the cystic portion of these tumors, microsurgery has often been preferred to GKRS in the management of cystic VS. However, to date, a relative paucity of data evaluating the outcomes after GKRS for cystic VS has been available. In the present study, we reviewed our experience treating cystic VSs with GKRS and evaluated the results. METHODS: The data from patients with a diagnosis of cystic VS who had undergone GKRS from 1999 to 2018 were analyzed. Only those patients who had undergone GKRS as the initial treatment of cystic VSs were included in the present study. Patients who had undergone previous surgical treatment were excluded. The cystic VSs were divided into intratumoral and peritumoral cysts. RESULTS: A total of 24 patients were enrolled in the present study. The mean age was 60.8 ± 2.4 years (range, 38-82 years). The mean follow-up period was 55.8 ± 8.1 months (range, 8-145 months). Of the 24 patients, 11 were men. The control rate after GKRS for cystic VSs was 75%. The 5-year progression-free rate was 70%. Six patients had presented with an increasing lesion size after GKS. Of these 6 patients, 2 underwent surgical treatment and 1 underwent repeat GKRS. No statistically significant differences were found between the control rate and cystic type (P = 0.093). CONCLUSION: The results from the present study have demonstrated that GKRS is an effective treatment modality for cystic VSs.


Assuntos
Neuroma Acústico/cirurgia , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos/patologia , Cistos/cirurgia , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos , Resultado do Tratamento
11.
World Neurosurg ; 132: e223-e227, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493598

RESUMO

OBJECTIVE: This study focused on the changes in the internal acoustic canal (IAC) caused by vestibular schwannomas (VSs) and their prognostic significance for postoperative hearing outcome. METHODS: A total of 125 consecutive cases of VS were included. We used a neuronavigation software to perform the following measurements on both the tumor side and healthy side: volume of the IAC (VIAC), maximal diameter of the IAC (DIAC), and length of the IAC (LIAC). A statistical analysis was realized using Spearman correlation to test the correlation of the morphometric measure of the IAC and postoperative hearing. Multivariate analysis was performed to test the impact of measurements of the IAC and preoperative hearing on postoperative hearing. RESULTS: The mean VIAC on the tumor side and on the healthy side was 0.271 and 0.169 cm3, respectively. The mean DIAC was 9.438 mm on the tumor side and 7.034 mm contralateral. The correlations tests showed significant correlations of both postoperative hearing deficit and degree of hearing loss with 1) VIAC on the tumor side, 2) difference between VIAC on the tumor side and healthy side, 3) DIAC on the tumor side, and 4) difference between the DIAC on the tumor side and healthy side. The multivariate analysis showed significant impact of the DIAC (P = 0.01) and preoperative hearing status (P = 0.02) on postoperative hearing. CONCLUSIONS: Enlargement of the VIAC and DIAC are negative prognostic factors for hearing preservation. Reasons may be long-standing compression of the auditory nerve and an increased vulnerability of the inner ear structures during the drilling of the IAC.


Assuntos
Orelha Interna/patologia , Perda Auditiva/etiologia , Neuroma Acústico/patologia , Neuroma Acústico/cirurgia , Adulto , Idoso , Orelha Interna/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuronavegação , Prognóstico , Adulto Jovem
12.
World Neurosurg ; 132: e228-e234, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493607

RESUMO

PURPOSE: To search for texture features of routine magnetic resonance imaging to predict tumor volume reduction and transient versus permanent tumor progression of vestibular schwannomas treated by Gamma Knife stereotactic radiosurgery. MATERIALS AND METHODS: Included were 23 patients with vestibular schwannomas treated in our center and followed over a period of 23.7-80.3 months (mean 42.7). Magnetic resonance imaging was performed on a 3-Tesla scanner and included T1-weighted images with and without contrast enhancement, T2-weighted, and fluid-attenuated inversion recovery images. Volumetric results were followed longitudinally over time and correlated to texture features as mean, minimum, maximum, standard deviation, skewness, and kurtosis of normalized signals taken from regions of interest covering the total tumor volume. RESULTS: In total, 14 tumors showed early progression during the first 5-18 months (2 cases permanent, 12 cases transient), whereas 9 tumors regressed immediately after SRS. Kurtosis of T2-weighted image intensity values turned out to predict progression best with a sensitivity and specificity of 71% and 78%. From all texture feature parameters, only the minimum of the normalized T2-weighted image intensity values correlated significantly to the final reduction of tumor volume per month (correlation coefficient = -0.634, P < 0.05, corrected for false discovery rate). CONCLUSIONS: Texture feature analysis helps to predict permanent versus transient enlargement and final volume reduction of schwannomas after SRS. Thus, alternative treatment strategies might be considered, mainly in large tumors, where further clinical deterioration cannot be excluded. To confirm these results, a prospective study including more cases and a longer follow-up period is necessary.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Neuroimagem/métodos , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Neuroma Acústico/cirurgia , Adolescente , Adulto , Idoso , Criança , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Radiocirurgia , Adulto Jovem
13.
World Neurosurg ; 130: 378-379, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31306840

RESUMO

Vestibular schwannomas (VSs) are rare in children and, when present, are usually part of neurofibromatosis 2 and bilateral. Sporadic unilateral VSs in the pediatric age group itself are rare in medical literature and giant sporadic unilateral pediatric VSs (>4 cm) are extremely rare. Herein, we describe the largest reported case of giant sporadic left-sided VS in a 10-year-old boy.


Assuntos
Neoplasias Cerebelares/patologia , Neuroma Acústico/patologia , Ângulo Cerebelopontino/patologia , Criança , Humanos , Masculino , Tratamentos com Preservação do Órgão/métodos , Resultado do Tratamento , Carga Tumoral
14.
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
15.
Otol Neurotol ; 40(5S Suppl 1): S67-S71, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31225825

RESUMO

OBJECTIVE: To compare linear and volumetric vestibular schwannoma (VS) measurements between different magnetic resonance imaging (MRI) sequences. STUDY DESIGN: Retrospective case series. SETTING: Tertiary care university hospital. PATIENTS: Those with VS that had at least two separate MRI studies containing both T1-weighted contrast (T1C) and high-resolution T2-weighted (HRT2) images. INTERVENTION: Two neurotologists measured the greatest linear axial dimension and segmentation volumes of VS. MAIN OUTCOME MEASURE: 1) Correlation between T1C and HRT2 VS linear and volumetric measurements. 2) Comparing the interpretation of VS growth between T1C and HRT2 sequences and reviewers, defined as an increase in tumor diameter of more than or equal to 2 mm or a volume increase of more than or equal to 20%. RESULTS: Twenty-three patients met inclusion criteria. Imaging studies encompassed a median of 25.2 months. At the initial imaging study, inter-observer measurements between reviewers, analyzed with intraclass correlation coefficients, for T1C diameters, T1C volumes, HRT2 diameters, and HRT2 volumes were 0.983 (95% confidence interval [CI] 0.972-0.989), 0.989 (95% CI 0.982-0.993), 0.992 (95% CI 0.988-0.995), and 0.998 (95% CI 0.995-0.999), respectively. The Cohen's kappa for growth rates between T1C diameters, T1C volumes, HRT2 diameters, and HRT2 volumes was 0.564 (95% CI 0.284-0.844), 0.704 (95% CI 0.514-0.894), 0.605 (95% CI 0.319-0.891), and 0.475 (95% CI 0.242-0.708), respectively. CONCLUSIONS: There are significant differences in VS volume measurements when utilizing T1C versus HRT2 images. However, there is "excellent" interobserver agreement between T1C and HRT2 diameters and volumes. T1C VS volumes may be more reliable than HRT2 volumes to determine growth.


Assuntos
Imagem por Ressonância Magnética/métodos , Neuroimagem/métodos , Neuroma Acústico/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/patologia , Variações Dependentes do Observador , Estudos Retrospectivos
16.
Biomed Pharmacother ; 116: 108985, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31146115

RESUMO

Vestibular schwannoma (VS) is a common disease in the region of the cerebellopontine angle in the posterior cranial fossa. Large VS and its surgical management usually lead to severe cranial nerve dysfunction and affect the patient's quality of life. We aimed to find some possible progression markers of VS. Here, we sought to characterize the cerebrospinal fluid (CSF) proteome of patients with different VS grades and recurrence to identify biomarkers predictive of VS growth or recurrence. CSF was collected intraoperatively prior to removal of untreated VS, including grade I-V and recurrence. Isobaric tags for relative and absolute quantitation-based proteomic analysis of CSF from 43 VS patients and 3 control patients was used to identify candidate proteins. Ninety-three overlapping proteins were found to display differential expression in grade I, II, III, IV, and V VS patients compared with the control group. Nine proteins were chosen for validation with enzyme-linked immunosorbent assay. VS was distinguished from control patients based on the expression patterns of six proteins (ATP-binding cassette subfamily A member 3 [ABCA3], secretogranin-1 [SCG1], Krueppel-like factor 11 [KLF11], voltage-dependent calcium channel subunit alpha-2/delta-1 [CA2D1], brain acid soluble protein 1 [BASP1], and peroxiredoxin-2 [PRDX2]. ABCA3 and KLF11 were positively correlated with the size of early-phase of VS, while BASP1 and PRDX2 showed a negative correlation. ABCA3, CA2D1, and KLF11 were upregulated, while BASP1 and PRDX2 were downregulated in the CSF from VS recurrence. But SCG1 was increased only at early-phase. These data suggest that increased ABCA3 and KLF11 and decreased BASP1 and PRDX2 in CSF are associated with VS growth at the early phase or recurrence.


Assuntos
Neuroma Acústico/líquido cefalorraquidiano , Neuroma Acústico/cirurgia , Proteômica/métodos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Proteínas de Neoplasias/metabolismo , Recidiva Local de Neoplasia/líquido cefalorraquidiano , Recidiva Local de Neoplasia/patologia , Neuroma Acústico/patologia , Proteoma/metabolismo , Carga Tumoral
17.
Proteomics Clin Appl ; 13(5): e1800175, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31120176

RESUMO

PURPOSE: Vestibular schwannomas (VSs) are benign tumors that account for 8-10% of all intracranial tumors. So far, the tumorigenesis of VS has not been fully elucidated. This study is designed to identify differently expressed proteins involved in VS tumorigenesis. EXPERIMENTAL DESIGN: An isobaric tag is used for relative and absolute quantification (iTRAQ) approach to characterize the protein expression profiles from pooled VS tissues (n = 12) and pooled matched normal vestibular tissues (n = 12). RESULTS: A total of 933 differentially expressed proteins are identified between VS and the matched normal vestibular tissues, with 489 being upregulated and 444 being downregulated. Bioinformatics analyses are performed according to Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses. Several of the differentially expressed proteins are validated by western blotting analyses, and upregulation of LGALS1, ANXA1, GRB2, and STAT1 is validated in VS tissue by immunohistochemistry. CONCLUSIONS AND CLINICAL RELEVANCE: The study represents the successful application of iTRAQ technology to an investigation of VS. Many of the differentially expressed proteins identified here have not been linked to VS before, and these dysregulated proteins may provide potential biomarkers for human VS diagnosis.


Assuntos
Carcinogênese , Neuroma Acústico/metabolismo , Neuroma Acústico/patologia , Proteômica , Adulto , Estudos de Casos e Controles , Feminino , Perfilação da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade
18.
Acta Neurochir (Wien) ; 161(7): 1457-1465, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31127373

RESUMO

BACKGROUND: Accumulated stereotactic radiosurgery (SRS) experience for large vestibular schwannomas (VSs) based on over 5 years of follow-up are as yet insufficient, and chronological volume changes have not been documented. METHOD: Among 402 patients treated between 1990 and 2015, tumor volumes exceeded 8 cc in 30 patients. We studied 19 patients with follow-up for more than 36 post-SRS months or until an event. Median tumor volume was 11.5 cc (range; 8.0 to 30.6). The target volume was basically covered with 12.0 Gy. RESULTS: The median magnetic resonance imaging and clinical follow-up periods were both 98 months (range 49 to 204). Tumor shrinkage was documented in 13 patients (72%), no change in 2 (11%), and growth in the other 3 (17%). Therefore, the crude growth control rate was 83%. All three patients with tumor enlargement needed salvage treatment. Thus, the crude clinical control rate was 84%. Actuarial further procedure-free rates were 91%, 83% and 76%, at the 60th, 120th, and 180th post-SRS month. Among six patients followed chronologically, transient tumor expansion was observed in three (43%) and two cystic VSs showed rapid tumor growth. Transient trigeminal neuropathy occurred in two patients (11%). No patients experienced facial nerve palsy. None of the six patients with useful hearing pre-SRS maintained serviceable hearing. Ventricular-peritoneal shunt placement was required in three patients. CONCLUSIONS: Long-term tumor control with SRS was moderately acceptable in large VSs. In terms of functional outcome, trigeminal neuropathies and facial palsies were rare. However, hearing preservation remains a challenge. In the long term, chronological tumor volumes were generally decreased after SRS. However, caution is required regarding rapid increases in tumor size, especially for cystic type VSs. Further studies are needed to optimize clinical positioning of SRS for large VSs.


Assuntos
Paralisia Facial/epidemiologia , Perda Auditiva/epidemiologia , Neuroma Acústico/radioterapia , Complicações Pós-Operatórias/epidemiologia , Radiocirurgia/métodos , Doenças do Nervo Trigêmeo/epidemiologia , Adulto , Idoso , Paralisia Facial/diagnóstico por imagem , Paralisia Facial/etiologia , Feminino , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/patologia , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Radiocirurgia/efeitos adversos , Resultado do Tratamento , Doenças do Nervo Trigêmeo/diagnóstico por imagem , Doenças do Nervo Trigêmeo/etiologia , Carga Tumoral
19.
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
20.
J Laryngol Otol ; 133(3): 205-207, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30983565

RESUMO

BACKGROUND: Ki-67 is a monoclonal antibody that provides a means of evaluating the growth fraction of normal and neoplastic human cell populations. A Ki-67 index of less than 3 per cent is expected for a typical schwannoma. Vestibular schwannomas with an index of greater than 3 per cent are presumed to be actively proliferating and pose a theoretically higher risk for regrowth or recurrence. METHODS: A retrospective chart review was conducted. Ki-67 staining was performed and specimens were divided into two groups according to Ki-67 activity: less than 3 per cent (low index), and 3 per cent or greater (elevated index). RESULTS: Eight patients (53.3 per cent) with elevated Ki-67 had recurrence or regrowth, versus five (8.5 per cent) in the low Ki-67 group. Among the 13 patients with recurrence or regrowth, the average Ki-67 value was 4.3 per cent. Among the 61 patients without recurrence or regrowth, the average Ki-67 value was 1.0 per cent. CONCLUSION: The Ki-67 labelling index reliably identifies vestibular schwannomas with an elevated potential for recurrence or regrowth in subtotal or total resection cases. In patients with a Ki-67 index greater than 3 per cent, more frequent clinical examination and radiological follow up are recommended.


Assuntos
Antígeno Ki-67/metabolismo , Neuroma Acústico/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neuroma Acústico/metabolismo , Neuroma Acústico/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos
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