Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 245
Filtrar
1.
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
2.
J Clin Neurosci ; 68: 174-178, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31324471

RESUMO

INTRODUCTION: Vestibular schwannomas are benign tumors of the 8th cranial nerve. Initial treatment options include active surveillance, surgery, and/or radiation therapy. We analyzed the United States National Cancer Database (NCDB) for patients with vestibular schwannomas and evaluated the initial management trends after diagnosis. METHODS: We queried the NCDB for patients with vestibular schwannomas, excluding patients who did not have schwannomas of the vestibulocochlear nerve. Categorical and continuous variables were analyzed, and multivariate Cox regression analyses were performed to investigate for predictors of initial local therapy at diagnosis. All statistical analyses were performed using commercially available software (SPSS, Version 22; SPSS Inc., Chicago, IL). RESULTS: A total of 28,446 patients met the inclusion criteria. In this cohort, 7351 (25.8%) underwent observation, 12,362 (43.5%) underwent surgical resection, 7785 (27.4%) underwent SRS, 824 (2.9%) underwent EBRT, and 124 (0.4%) underwent RT NOS. On multivariate analysis, younger age, increased distance to treating facility, Charlson/Deyo score of 1, primary payer insurance, facility location and facility type (academic or cancer center) (p < 0.001) were all factors that predicted patients undergoing initial definitive treatment. CONCLUSION: Age, distance to treating facility, Charlson/Deyo score, primary payer, facility location, and facility type are factors that influence initial treatment for patients with vestibular schwannoma. Clinical stratification systems are needed to identify which patients would benefit most from initial local therapy versus active surveillance.


Assuntos
Neuroma Acústico/terapia , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Adolescente , Adulto , Idoso , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Procedimentos Neurocirúrgicos/tendências , Radiocirurgia/estatística & dados numéricos , Radiocirurgia/tendências , Estados Unidos , Conduta Expectante/estatística & dados numéricos , Conduta Expectante/tendências , Adulto Jovem
3.
J Laryngol Otol ; 133(8): 668-673, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31309905

RESUMO

OBJECTIVE: To determine the impact of pre-operative intratympanic gentamicin injection on the recovery of patients undergoing translabyrinthine resection of vestibular schwannomas. METHODS: This prospective, case-control pilot study included eight patients undergoing surgical labyrinthectomy, divided into two groups: four patients who received pre-operative intratympanic gentamicin and four patients who did not. The post-operative six-canal video head impulse test responses and length of in-patient stay were assessed. RESULTS: The average length of stay was shorter for patients who received intratympanic gentamicin (6.75 days; range, 6-7 days) than for those who did not (9.5 days; range, 8-11 days) (p = 0.0073). Additionally, the gentamicin group had normal post-operative video head impulse test responses in the contralateral ear, while the non-gentamicin group did not. CONCLUSION: Pre-operative intratympanic gentamicin improves the recovery following vestibular schwannoma resection, eliminating, as per the video head impulse test, the impact of labyrinthectomy on the contralateral labyrinth.


Assuntos
Gentamicinas/administração & dosagem , Neuroma Acústico/terapia , Procedimentos Cirúrgicos Otológicos/métodos , Vestíbulo do Labirinto/cirurgia , Adulto , Estudos de Casos e Controles , Feminino , Teste do Impulso da Cabeça , Humanos , Injeção Intratimpânica , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Centros de Atenção Terciária
4.
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
5.
Acta Otolaryngol ; 139(9): 753-758, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31282832

RESUMO

Background: Prediction of vestibular schwannoma (VS) growth would allow for a more differentiated follow-up protocol. Objectives: The natural course of a VS and predictive factors of growth are investigated. Methods: Sixty-two sporadic VS cases diagnosed between 2003 and 2015 were included in this retrospective cohort study. After initial surveillance, active therapy was initiated in 31/62 patients. Regular magnetic resonance images (MRIs) were performed. Two mm/year linear difference was the cut-off value for significant growth. The STROBE guidelines have been implemented. Results: Growth of the tumor was detected in 56% of patients and mainly observed in the first three years of follow-up. Tumor size remained stable in 34% and decreased in 10% of patients. No baseline information, symptom, or sign was found to be predictive for growth. Conclusions: In 56% of the initially conservatively managed VSs growth was observed and active treatment was initiated. Eighty-seven percent of the growing VSs were identified during the first three years of follow-up. The initially larger VSs seemed to grow faster and needed active treatment earlier during follow-up. No predicting factors for growth identified from the literature could be confirmed in the present study. Serial MRI remains the appropriate method to detect tumor growth.


Assuntos
Tratamento Conservador , Neuroma Acústico/diagnóstico , Neuroma Acústico/terapia , Conduta Expectante , Adulto , Idoso , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otológicos/métodos , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
6.
World Neurosurg ; 129: e754-e760, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31203081

RESUMO

BACKGROUND: Evolving technologies and health care quality metrics have altered treatment algorithms for acoustic neuromas (ANs), increasing trends toward observation and radiosurgery, with proportionate declines in use of microsurgery. A correlation between increasing surgical volumes and superior outcomes has been investigated previously in numerous surgical diseases, including AN. OBJECTIVE: To re-evaluate the volume-outcome relationship of AN resection in a changing health care system, with evolving treatment strategies. METHODS: Patients who underwent AN resection between 2009 and 2013 were retrospectively identified in the State Inpatient Database subset of the Healthcare Cost and Utilization Project. Generalized linear mixed-effect models were used to assess odds of various outcome measures (length of stay [LOS], discharge disposition, and facial nerve or severe clinical complications). Institutions were grouped into low-volume centers (1-6 cases/year) and high-volume centers (HVC; ≥31 cases/year) for analysis. RESULTS: A total of 1873 patients underwent AN resection between 2009 and 2013 with a mean age of 50.1 ± 14.1 years (±standard deviation). For each additional case treated annually, patients were 2% (odds ratio [OR], 0.98; 95% confidence interval, 0.96-0.99) less likely to experience a severe complication (P = 0.004). Each additional case also trended toward a decreased rate of facial nerve complications and nonroutine discharge. Inpatient LOS was also shorter for patients at HVCs (median, 4 vs. 5 days; P < 0.001). CONCLUSIONS: Despite a relative decline in microsurgery compared with previous eras, care at HVCs is still associated with superior short-term outcomes, such as decreased LOS, facial nerve or other severe complications, and nonroutine discharges.


Assuntos
Microcirurgia , Neuroma Acústico/terapia , Radiocirurgia , Adulto , Idoso , Bases de Dados Factuais , Assistência à Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/radioterapia , Neuroma Acústico/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Resultado do Tratamento
7.
Otolaryngol Head Neck Surg ; 161(2): 330-335, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30885097

RESUMO

OBJECTIVE: To assess the risk recall of complications among patients who underwent different vestibular schwannoma (VS) treatments. STUDY DESIGN: Patients with VS completed a voluntary and anonymous survey. SETTING: Survey links were distributed via the Acoustic Neuroma Association (ANA) website, Facebook, and email list. SUBJECTS AND METHODS: Surveys were distributed to ANA members from January to March 2017. Of the 3200 ANA members with a VS diagnosis at the time of survey distribution, 789 (25%) completed the survey. RESULTS: Subjects reported the following incidence of posttreatment complications: imbalance (60%), hearing issues (51%), dry eyes (30%), headache (29%), and facial weakness (27%). Overall, 188 (25%) recalled remembering all the risks associated with their treatment. Among those in the surgical cohort (52%) who experienced balance issues, facial weakness, cerebrospinal fluid leak, meningitis, and stroke, 73%, 91%, 77%, 67%, and 33% claimed recall of these associated risks. Among those in the radiosurgery cohort (28%) who experienced balance issues, facial weakness, and hydrocephalus, 56%, 52%, and 60% recalled discussions of those risks. Patients with higher-level education (P = .026) and those who underwent surgery (P = .001) had a significantly higher risk recall ratio, while sex, age, and tumor size were not significant contributing factors. CONCLUSION: Not all patients with VS who experienced treatment complications recalled remembering those risks being discussed with them. Patients with higher education and those who underwent surgery had a better recall of risks associated with different treatment modalities. The risk recall ratio of patients experiencing complications ranged 33% to 91%, suggesting an opportunity for decision-making and discussion improvement.


Assuntos
Neuroma Acústico/terapia , Adulto , Feminino , Humanos , Masculino , Rememoração Mental , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Lesões por Radiação/epidemiologia , Risco , Autorrelato
9.
Otolaryngol Head Neck Surg ; 161(1): 137-143, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30857474

RESUMO

OBJECTIVE: A better understanding of the natural history of vestibular schwannoma (VS) has resulted in a change in treatment paradigms. It has also been proposed that increased use of high-resolution magnetic resonance imaging has allowed for an increased identification of small tumors. The aim of this study was to evaluate recent trends in the presentation and primary management of VS in the United States. STUDY DESIGN: Retrospective analysis of the National Cancer Database (NCDB). SETTING: NCDB database. SUBJECTS AND METHODS: All patients with a diagnosis of VS between 2004 and 2014 were included. Data were analyzed with univariable and multivariable logistic regression. RESULTS: In total, 28,190 patients (mean age 55 years, 52.9% female) with VS were analyzed. Linear regression showed a small decrease in average tumor size over time (-0.06 mm/year, P = .03). Overall, 11,121 patients (40%) received surgery, 8512 (30%) radiation, and 7686 (27%) observation. Controlling for patient, tumor, and treatment center factors, the odds ratio (OR) for receiving surgery in 2014 was 0.60 (confidence interval [CI], 0.50-0.71) while the OR for receiving radiation was 0.75 (CI, 0.64-0.87) as compared to those diagnosed in 2004. The largest increases in observation rates occurred among tumors ≤2 cm (P < .001). CONCLUSION: There was not a clinically significant change in the average tumor size at diagnosis. Although surgery remained the most common treatment modality in the United States, there was a strong shift in the management of VS away from primary surgery and radiation and toward a "wait-and-scan" approach.


Assuntos
Neurilemoma/terapia , Neuroma Acústico/terapia , Padrões de Prática Médica/estatística & dados numéricos , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/epidemiologia , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
10.
Otol Neurotol ; 40(2): e142-e149, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30624406

RESUMO

OBJECTIVE: Characterize the morbidity associated with vestibular schwannoma (VS) as documented by treating providers. STUDY DESIGN: Retrospective analysis of the MarketScan database. SETTING: MarketScan database. SUBJECTS AND METHODS: A study of morbidity in VS patients who underwent treatment between 2002 and 2012 was conducted. A detailed account of morbidity at multiple time points before and after treatment was described. RESULTS: Of 3,355 patients treated for VS, 2,029 (60.5%) underwent surgery and 1,326 (39.5%) radiation. The average (SD) age of diagnosis was 52.5 (12.1) years. Patients were followed for a mean (SD) of 29.1 (24.2) months before and 39.2 (30.5) months after treatment. Hearing loss (65.4%), vertigo (28.0%), tinnitus (24.7%), and headache (15.2%) were the most documented symptoms at 6 months before treatment. At this juncture, higher rates of hearing loss (71.6 versus 58.6%, p < 0.0001), vertigo (32.3 versus 21.4%, p<0.0001), and tinnitus (26.9 versus 21.5%, p=0.0004) were reported for the surgery cohort. At 6 months posttreatment, surgery cohort were reported to have higher rates of hearing loss (OR 2.15, 95% CI: 1.82-2.52), vertigo (OR 1.56, 95% CI: 1.23-1.96), balance (OR 4.17, 95% CI: 3.03-5.56), facial weakness (OR 10.0, 95% CI: 6.67-14.29), headache (OR 1.56, 95% CI: 1.23-1.96), fatigue (OR 2.22, 95% CI: 1.19-4.17), and swallowing difficulties (OR 2.33, 95% CI: 1.43-3.70) compared with radiosurgery group. Surgery patients also experienced more treatment-related complications than the radiation (28.5 versus 2.6%, p<0.0001) cohort. CONCLUSIONS: Patients who eventually underwent surgery were reported by their providers to have higher morbidity before and after treatment.


Assuntos
Cefaleia/etiologia , Perda Auditiva/etiologia , Neuroma Acústico/complicações , Zumbido/etiologia , Vertigem/etiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Cefaleia/epidemiologia , Perda Auditiva/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/terapia , Estudos Retrospectivos , Zumbido/epidemiologia , Resultado do Tratamento , Vertigem/epidemiologia
11.
Eur Arch Otorhinolaryngol ; 276(1): 71-78, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30421174

RESUMO

OBJECTIVE: To compare international diagnostic and management strategies for vestibular schwannoma (VS). METHODS: A web-based questionnaire was sent to 130 otolaryngologists, mainly identified through the European Skull Base Society. It contained questions on general information including guideline usage as well as questions on diagnosis (focussing on selection of patients for MRI) and management of VS, including case scenarios. Descriptive statistics were reported. RESULTS: Thirty-six otolaryngologists working in 11 different countries completed the questionnaire (response rate: 28%). Guidelines for diagnosis and management of VS are used by 44% and 42% of respondents, respectively. In the diagnostic strategy for VS, different types and combinations of audiovestibular function tests are used when deciding whether a patient should undergo an MRI. Respondents apply 18 different definitions of asymmetrical hearing loss. Variation was also apparent from reported considerations on management of VS. Most respondents (84%) prefer a wait-and-scan strategy in case of a small intrameatal VS (Koos 1). Variety in management strategies increases for patients with a medium to large sized VS (Koos 2, 3 and 4). The details of each management strategy (wait-and-scan, microsurgery, stereotactic radiosurgery and fractionated radiotherapy) also differ among respondents. CONCLUSIONS: A large variation in diagnostic and management strategies for VS was identified between respondents. More evidence and/or consensus seem warranted to reduce uncertainties for patients, and differences in outcome and costs that might result from the variety of strategies currently being applied.


Assuntos
Gerenciamento Clínico , Microcirurgia/métodos , Neuroma Acústico/diagnóstico , Radiocirurgia/métodos , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/terapia , Inquéritos e Questionários , Resultado do Tratamento
12.
Neurosurgery ; 85(6): 779-785, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30395303

RESUMO

BACKGROUND: The diagnosis of vestibular schwannomas (VS) is associated with reduced patient quality of life (QOL). Minimal clinically important difference (MCID) was introduced as the lowest improvement in a patient-reported outcome (PRO) score discerned as significant by the patient. We formerly presented an MCID for the Penn Acoustic Neuroma QOL (PANQOL) battery based on cross-sectional data from 2 tertiary referral centers. OBJECTIVE: To validate the PANQOL MCID values using prospective data. METHODS: A prospective registry capturing QOL was queried, comprising patients treated at the authors' institution and Acoustic Neuroma Association members. Anchor- and distribution-based techniques were utilized to determine the MCID for domain and total scores. We only included anchors with Spearman's correlation coefficient larger than 0.3 in the MCID threshold calculations. Most domains had multiple anchors with which to estimate the MCID. RESULTS: A total of 1254 patients (mean age: 57.4 yr, 65% females) were analyzed. Anchor-based methods produced a span of MCID values (median, 25th-75th percentile) for each PANQOL domain and the total score: hearing (13.1, 13-16 points), balance (14, 14-19 points), pain (21, 20-28 points), face (25, 16-36 points), energy (16, 15-18 points), anxiety (16 [1 estimate]), general (13 [1 estimate]), and total (12.5, 10-15 points). CONCLUSION: Current findings corroborate our formerly shared experience using multi-institutional, cross-sectional information. These MCID thresholds can serve as a pertinent outcome when deciphering the clinical magnitude of VS QOL endpoints in cross-sectional and longitudinal studies.


Assuntos
Diferença Mínima Clinicamente Importante , Neuroma Acústico/diagnóstico , Neuroma Acústico/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/terapia , Estudos Prospectivos , Sistema de Registros , Resultado do Tratamento
13.
Otolaryngol Head Neck Surg ; 160(3): 526-532, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30373466

RESUMO

OBJECTIVE: Bevacizumab for hearing preservation in patients with neurofibromatosis type 2 (NF2) is an emerging practice. We set out to characterize the effectiveness and toxicity of bevacizumab in our patient group. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Seventeen consecutive patients with NF2 received bevacizumab treatment for vestibular schwannomas, including 2 patients treated to maintain cochlear implant performance. Volumetric analysis of serial magnetic resonance imaging scans was used to evaluate radiographic response, and hearing response was evaluated with serial audiograms. Patient-reported outcomes were also assessed, including subjective hearing improvement, changes in tinnitus, vertigo, headaches, ear pain, and improvement in ability to communicate via telephone. RESULTS: A positive radiographic response occurred in 8 of 17 (47%) patients and the median tumor volume change was a tumor decrease of 19%. A positive hearing response was recorded in 5 of 9 (56%) patients. Two patients had a word recognition score improvement over 40%. There was an approximately 40% improvement in patient-reported outcomes. Primary toxicities included hypertension, proteinuria, dysgeusia, and amenorrhea. CONCLUSION: Bevacizumab treatment was followed by hearing improvement in 56% of patients, while decreased tumor volume was noted in 47%. These outcomes agree favorably with prior reported series. There were significant improvements in patient-reported outcomes that have not been described previously.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Perda Auditiva/prevenção & controle , Neurofibromatose 2/complicações , Neuroma Acústico/complicações , Adolescente , Adulto , Estudos de Coortes , Feminino , Perda Auditiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurofibromatose 2/patologia , Neurofibromatose 2/terapia , Neuroma Acústico/patologia , Neuroma Acústico/terapia , Medidas de Resultados Relatados pelo Paciente , Resultado do Tratamento , Carga Tumoral , Adulto Jovem
15.
Laryngoscope ; 129(5): 1197-1205, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30450631

RESUMO

OBJECTIVE: To describe changes in management trends of vestibular schwannoma (VS) and the effects of median income, education level, insurance status, and tumor size on receipt of treatment. METHODS: Cross-sectional analysis using the National Cancer Database from 2004 to 2014. All patients with a diagnosis of VS were identified between 2004 and 2014. Trends in treatment modality over time were analyzed. Correlation between demographics, institution type, median income, education level, and insurance status were assessed using univariate and multivariate logistic regressions. RESULTS: Of the 22,290 VS patients identified, 16,011 (71.8%) received treatment, whereas 6,279 (28.2%) received observation. Management trend analysis over the 11-year period revealed patients with tumor size < 1 cm are more frequently observed (34.6% of cases in 2004 vs. 60.8% of cases in 2014) and less frequently received surgery (34.6% vs. 16.8%). Multivariate analysis showed observation was more frequently used in patients ≥ 65 years; black patients; and those on Medicaid, Medicare, and noninsured (P < 0.0001). All tumors > 2 cm were more likely to be treated with surgery, specifically subtotal resections (P < 0.0001). Patients treated at nonacademic centers were more likely to receive linear accelerator, or LINAC (Accuray Incorporated, Sunnyvale, CA) therapy than Gamma Knife (Elekta, Stockholm, Sweden) (P < 0.0001). CONCLUSION: Management of VS is shifting toward increased observation, most significantly in tumors size < 1 cm. Insurance provider plays a significant role on receipt of treatment and modality, whereas income and education do not. LEVEL OF EVIDENCE: NA Laryngoscope, 129:1197-1205, 2019.


Assuntos
Neuroma Acústico/terapia , Idoso , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/epidemiologia , Neuroma Acústico/patologia , Fatores Socioeconômicos , Carga Tumoral , Estados Unidos
16.
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
17.
Laryngorhinootologie ; 97(12): 875-896, 2018 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-30536286

RESUMO

Vestibular schwannomas are benign neoplasms originating from the Schwann cells of the vestibular vestibular nerve of the vestibulocochlear nerve, and rarely from the pars cochlearis. These are tumors that are in contact with the nerve but do not bind the fibers. Benign neoplasms of the Schwann cells of the auditory and equilibrium nerves can also occur primarily in the inner ear and are referred to as intralabyrinthine schwannomas (ILS). Vestibular schwannomas represent 6-7 % of all intracranial and 90 % of cerebellopontine angle tumors. Bilateral occurrence occurs in < 5 % of cases, and then corresponds to type 2 neurofibromatosis. The first symptom is often a unilateral hearing loss. It may then lead to balance disorders, tinnitus, facial paralysis and other impairments. Diagnosis is audiological, vestibular and imaging. Magnetic resonance imaging currently represents the gold standard. Management chooses between an observational strategy and surgery, depending on tumor size, age, and other factors. The possible access routes offer different advantages and disadvantages; the potential complications include the liquorrhoea. Radiation therapy is possible in special cases, and drug therapies are also being tested. In the rehabilitation of the hearing function, in addition to a CROS or BICROS restoration, the cochlear implant has been used with good success. The impact on quality of life is largely determined by hearing impairment, balance disorders, tinnitus, and possibly headache, which must be considered in patient consultation and long-term care.


Assuntos
Neuroma Acústico/diagnóstico , Neuroma Acústico/terapia , Adulto , Idoso de 80 Anos ou mais , Implantes Cocleares , Paralisia Facial , Feminino , Perda Auditiva Unilateral , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Zumbido
18.
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
19.
Rev Med Suisse ; 14(621): 1739-1741, 2018 Oct 03.
Artigo em Francês | MEDLINE | ID: mdl-30303324

RESUMO

The majority of vestibular schwannomas have a stable evolution or a progression of size. Some publications report cases of spontaneous involution. We report here the clinical and radiological characteristics of this type of tumor observed in 14 patients showing a spontaneous tumor involution of their vestibular schwannoma. The results showed an incidence of 8 % with an average tumor regression of 50 %. Functionally, a hearing loss was found in all patients, without correlation with the duration of the observational follow-up. There are spontaneously involutive vestibular schwannomas, but tumor regression does not prevent the deterioration of hearing. Patients should be considered as a subset of those receiving observational management.


Assuntos
Perda Auditiva , Neuroma Acústico , Perda Auditiva/etiologia , Testes Auditivos , Humanos , Neuroma Acústico/complicações , Neuroma Acústico/diagnóstico , Neuroma Acústico/terapia
20.
Acta Otorhinolaryngol Ital ; 38(4): 384-392, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30197430

RESUMO

The current treatment options for acoustic neuromas (AN) - observation, microsurgery and radiotherapy - should assure no additional morbidity on cranial nerves VII and VIII. Outcomes in terms of disease control and facial function are similar, while the main difference lies in hearing. From 2012 to 2016, 91 of 169 patients (54%) met inclusion criteria for the present study, being diagnosed with unilateral, sporadic, intrameatal or extrameatal AN up to 1 cm in the cerebello-pontine angle; the remaining 78 patients (46%) had larger AN and were all addressed to surgery. The treatment protocol for small AN included observation, translabyrinthine surgery, hearing preservation surgery (HPS) and radiotherapy. Hearing function was assessed according to the Tokyo classification and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification. Sixty-one patients (71%) underwent observation, 19 (22%) HPS and 6 (7%) translabyrinthine surgery; 5 patients were lost to follow-up. Median follow-up was 25 months. In the observation group, 24.6% of patients abandoned the wait-and-see policy for an active treatment; the risk of switching from observation to active treatment was significant for tumour growth (p = 0.0035) at multivariate analysis. Hearing deteriorated in 28% of cases without correlation with tumour growth; the rate of hearing preservation for classes C-D was higher than for classes A-B (p = 0.032). Patients submitted to HPS maintained an overall preoperative hearing class of Tokyo and AAO-HNS in 63% and 68% of cases, respectively. Hearing preservation rate was significantly higher for patients presenting with preoperative favourable conditions (in-protocol) (p = 0.046). A multi-option management for small AN appeared to be an effective strategy in terms of hearing outcomes.


Assuntos
Neuroma Acústico/terapia , Terapia Combinada , Feminino , Audição , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/patologia , Neuroma Acústico/fisiopatologia , Estudos Prospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA