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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: closed (15 August 2024) | Viewed by 9469

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Special Issue Editors

Prof. Dr. Thierry Mom

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Guest Editor

Department of Otolaryngology Head Neck Surgery, University Hospital Center, Hospital Gabriel Montpied, 58, Rue Montalembert, 63000 Clermont-Ferrand, France
Interests: otology; neurotology; otoneurosurgery; cochlear implants and other auditory implants; audiology

Prof. Dr. Olivier Sterkers

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Guest Editor

Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, 75013 Paris, France
Interests: deafness; inner ear; gene therapy; regeneration
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Special Issue Information

Dear Colleagues,

The management of vestibular schwannomas has undergone drastic changes in the last decades. From the initial aim of complete removal whatever the functional cost, considering vestibular schwannomas as lethal tumors at the same level of cancers, most pluridisciplinary teams now aim at controlling the tumor with a minimum loss of function. From a surgical standpoint, total tumor removal has progressively been replaced by near-total or sub-total resection, followed by regular scanning, to avoid as much facial paralysis as possible, which is a devastating condition.

Hearing preservation, which requires intraoperative hearing monitoring, is being increasingly considered by the surgical team because of patient demand. As a consequence, therapeutic strategies have considerably evolved. While most teams only consider treatment for growing tumors, some challenging cases could be optimally managed sooner, in particular by surgery.

I am convinced that this Special Issue focused on the current management of vestibular schwannomas will be of high interest, not only for specialized otolaryngologists but also for general practitioners.

Prof. Dr. Thierry Mom
Prof. Dr. Olivier Sterkers
Guest Editors

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Keywords

vestibular schwannoma
hearing preservation
hearing rehabilitation
intraoperative hearing monitoring
intraoperative facial monitoring

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Published Papers (8 papers)

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12 pages, 1723 KiB

Open AccessArticle

The Impact of Tumor Elongation on Facial Nerve Outcome after Surgery for Koos Grade 3 and 4 Vestibular Schwannomas in the Semi-Sitting Position via the Retrosigmoid Approach

by Franziska Glieme, Lisa Haddad, Felix Arlt, Martin Vychopen, Clemens Seidel, Alonso Barrantes-Freer, Erdem Güresir and Johannes Wach

J. Clin. Med. 2024, 13(17), 5319; https://doi.org/10.3390/jcm13175319 - 8 Sep 2024

Viewed by 770

Abstract

Background: Facial nerve paralysis is a severe dysfunction after vestibular schwannoma (VS) surgery. Methods: This monocentric study analyzed 61 patients who underwent sporadic VS surgery in a standardized manner. The primary endpoint was the facial nerve outcome (FNO) at 3 months after VS surgery. FNO was dichotomized into “good” (House–Brackmann (HB) score ≤ 2) and “poor” (HB > 2). Results: Poor FNO was observed in 11 patients (18.0%) at 3 months after VS surgery. Radiomic tumor shape features were analyzed, and the AUC of elongation in the prediction of a poor HB at 3 months was 0.70 (95% CI: 0.56–0.85, p = 0.03) and the optimum threshold value (≤/>0.35) yielded a sensitivity and specificity of 64.0% and 75.4%, respectively. Multivariable logistic regression analyses considering the extent of resection (</≥93.4%), preoperative tumor volume (</≥2.6 cm³), age (</≥55), sex (female/male), and elongation (≤/>0.35) revealed that more elongated VSs (≤0.35; OR: 5.8; 95%CI: 1.2–28.2; p = 0.03) and those with an increased EoR (≥93.4%; OR: 6.5; 95%CI: 1.0–42.5; p = 0.05) are independently associated with poorer FNO at 3 months after surgery. Conclusions: Highly elongated VS shape seems to be a risk factor for worsened facial nerve outcome at 3 months after surgery for Koos grade 3 and 4 tumors. Full article

(This article belongs to the Special Issue Current Trends in the Management of Vestibular Schwannoma)

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18 pages, 28213 KiB

Open AccessArticle

A Proposal for Comprehensive Audio-Vestibular Test Battery Protocol for Diagnosis and Follow-Up Monitoring in Patients with Vestibular Schwannoma Undergoing Surgical Tumor Removal

by Patrycja Torchalla, Agnieszka Jasińska-Nowacka, Magdalena Lachowska and Kazimierz Niemczyk

J. Clin. Med. 2024, 13(17), 5007; https://doi.org/10.3390/jcm13175007 - 23 Aug 2024

Viewed by 802

Abstract

Background: A vestibular schwannoma (VS) is a benign tumor, causing audiological and vestibular symptoms. This study aimed to propose a comprehensive audio-vestibular test battery protocol for diagnosis and follow-up monitoring in patients with unilateral VSs undergoing surgical removal. Methods: The detailed interpretation of audiological and vestibular findings was presented in two example cases. The surgery was performed through the middle cranial fossa (#1) and translabyrinthine approach (#2). The participants were evaluated with tonal, speech, and impedance audiometry, ABR, caloric test, vHIT, cVEMP, oVEMP, SOT, and DHI. Patient and tumor characteristics were retrieved from the patient’s history. Results: In the postoperative period, the reduction in gain of the lateral semicircular canal was observed in the vHITs of both patients. The DHI in case #1 increased after surgery, while it decreased in case #2. The improvement in postural performances compared to the preoperative SOT (CON 5, CON 6, composite score) and immediately after the procedure was observed. Conclusions: A specific diagnostic protocol is necessary to compare the results of different surgical techniques and approaches. Diagnostic tests performed before the surgery should be repeated within a specific time frame during postoperative follow-up to enable the comparison of results. The proposed protocol can help us better understand the processes ongoing during tumor growth and postoperative vestibular compensation. Full article

(This article belongs to the Special Issue Current Trends in the Management of Vestibular Schwannoma)

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Figure 1

Figure 1
A proposal for comprehensive audio-vestibular test battery protocol for diagnosis and follow-up monitoring in patients with vestibular schwannomas undergoing surgical tumor removal. The set of diagnostics tests performed before and after the surgery necessary to monitor the audiological outcome and vestibular compensation. * Pure-tone and speech audiometry performed after the surgery only in patients treated through the middle cranial fossa approach. cVEMP—cervical vestibular myogenic potential, DHI—Dizziness Handicap Inventory, oVEMP—ocular vestibular myogenic potential, SOT—sensory organization test, vHIT—video head impulse test, VNG—videonystagmography. Full article ">Figure 2
Post-gadolinium T1 magnetic resonance images of vestibular schwannoma in Patient #1, tumor located in the left internal auditory canal; and in Patient #2, tumor located in the right internal auditory canal protruding to the right cerebellopontine angle. The tumors are marked with arrows. (A)—axial, (B)—coronal, (C)—sagittal scans. Full article ">Figure 3
Videonystagmography (VNG)—caloric test results before the surgery: in Patient #1, a significant asymmetry of responses—weakness of the left labyrinth at 30%; in Patient #2, a significant asymmetry of responses—weakness of the right labyrinth at 91%. UW—unilateral weakness. Full article ">Figure 4
Video head impulse test (vHIT) results obtained before the surgical removal of the vestibular schwannoma, one month, three months, and one year after in Patients #1 (tumor on the left) and #2 (tumor on the right), respectively. Right color curves mark the movement of the head to the right side, blue color the movement of the head to the left side, and black color movement of the eyes. LARP—left anterior, right posterior canal; RALP—right anterior, left posterior canal; SHIMP—suppression head impulse test. Full article ">Figure 5
Air–conducted cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) recordings obtained from Patients #1 (tumor on the left) and #2 (tumor on the right) before surgical vestibular schwannoma removal. In each patient, the first row shows cVEMP and the second oVEMP. The first column shows responses from the right ear and the second from the left ear. In each recording, the waves P1 and N1 are marked if present. cVEMPs and oVEMPs were recorded using stimuli of 500 Hz and 1000 Hz with an intensity of 95 dBnHL. Full article ">Figure 6
Sensory organization test (SOT) results obtained before the surgical removal of the vestibular schwannoma one month, three months, and one year after in Patients #1 (tumor on the left) and #2 (tumor on the right), respectively. Results within normal range are green. SOM—somatosensory, VIS—vision, VEST—vestibular, PREF—visual preference. Full article ">

18 pages, 1391 KiB

Open AccessArticle

Intraoperative Hearing Monitoring Using ABR and TT-ECochG and Hearing Preservation during Vestibular Schwannoma Resection

by Kazimierz Niemczyk, Izabela Pobożny, Robert Bartoszewicz and Krzysztof Morawski

J. Clin. Med. 2024, 13(14), 4230; https://doi.org/10.3390/jcm13144230 - 19 Jul 2024

Cited by 1 | Viewed by 926

Abstract

Background: Quick and appropriate diagnostics and the use of intraoperative monitoring (IM) of hearing during vestibular schwannoma (VS) resection increase the likelihood of hearing preservation. During surgery, various methods of IM can be used, i.e., auditory brainstem responses (ABRs), transtympanic electrocochleography (TT-ECochG), and direct cochlear nerve action potentials. The aim of the study was to evaluate the prognostic values of IM of hearing using ABR and TT-ECochG in predicting postoperative hearing preservation and to evaluate relationships between them during various stages of surgery. Methods: This retrospective study presents the pre- and postoperative audiological test results and IM of hearing records (TT-ECochG and ABR) in 75 (43 women, 32 men, aged 18–69) patients with diagnosed VS. Results: The preoperative pure tone average hearing threshold was 25.02 dB HL, while after VS resection, it worsened on average by 30.03 dB HL. According to the American Academy of Otolaryngology–Head and Neck Surgery (AAO—HNS) Hearing Classification, before and after (pre/post) surgery, there were 47/24 patients in hearing class A, 9/8 in B, 2/1 in C, and 17/42 in D. In speech audiometry, the average preoperative speech discrimination score at an intensity of 60 dB SPL was 70.93%, and after VS resection, it worsened to 38.93%. The analysis of electrophysiological tests showed that before the tumor removal the I–V ABR interlatencies was 5.06 ms, and after VS resection, it was 6.43 ms. Conclusions: The study revealed correlations between worse postoperative hearing and changes in intraoperatively measured ABR and TT-ECochG. IM of hearing is very useful in predicting postoperative hearing in VS patients and increases the chance of postoperative hearing preservation in these patients. Full article

(This article belongs to the Special Issue Current Trends in the Management of Vestibular Schwannoma)

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Figure 1
Preoperative and postoperative tonal audiometry as well as preoperative and postoperative tonal audiometry calculated using the following formula: (0.5 kHz + 1.0 kHz + 2.0 kHz + 3.0 kHz)/4)(PTA-4). dB HL: decibel hearing level; Hz: Hertz; PTA-4: tonal audiometry calculated during option (0.5 kHz + 1.0 kHz + 2.0 kHz + 3.0 kHz)/4). Full article ">Figure 2
Correlation between American Academy of Otolaryngology–Head and Neck Surgery Hearing Classification (difference between post- and preoperative hearing category) and intraoperative changes of parameters describing transtympanic electrocochleography parameters (action potential latency and amplitude) during three stages of the surgery. AAO—HNS: American Academy of Otolaryngology–Head and Neck Surgery; ms: milliseconds; AP_Lat: action potential latency; AP_Amp: action potential amplitude; Post–intra: difference between results after and during surgery; Post–pre: difference between results after and before surgery. Full article ">Figure 3
Correlation between auditory brainstem response interlatencies I–V and action potential latency changes during vestibular schwannoma resection calculated in various forms: Intra—Pre; Post—Intra and Pos—Pre. ABR I–V: auditory brainstem response interlatencies I–V; AP_Latency: action potential latency; ms: milliseconds; Intra–pre: difference between results during and before surgery; Post–intra: difference between results after and during surgery; Post–pre: difference between results after and before surgery. Full article ">

15 pages, 2448 KiB

Open AccessArticle

Pathophysiology of Postoperative Hearing Disorders after Vestibular Schwannoma Resection: Insights from Auditory Brainstem Response and Otoacoustic Emissions

by Idir Djennaoui, Mathilde Puechmaille, Chloé Trillat, Justine Bécaud, Nicolas Saroul, Toufic Khalil, Paul Avan and Thierry Mom

J. Clin. Med. 2024, 13(7), 1927; https://doi.org/10.3390/jcm13071927 - 27 Mar 2024

Viewed by 953

Abstract

Background: In order to better understand the pathophysiology of surgically induced hearing loss after vestibular schwannoma (VS) surgery, we postoperatively analyzed the hearing status in a series of patients where hearing was at least partially preserved. Methods: Hearing was assessed through tonal audiometry, speech discrimination score, maximum word recognition score (dissyllabic word lists—MaxIS), otoacoustic emissions (OAEs), and auditory brainstem response (ABR). The magnetic resonance imaging (MRI) tumor characterization was also noted. Results: In a series of 24 patients operated on for VS over 5 years, depending on the results of this triple hearing exploration, we could identify, after surgery, patients with either a myelin alteration or partial damage to the acoustic fibers, others with a likely partial cochlear ischemia, and some with partial cochlear nerve ischemia. One case with persisting OAEs and no preoperative ABR recovered hearing and ABR after surgery. Long follow-up (73 ± 57 months) revealed a mean hearing loss of 30 ± 20 dB with a drastic drop of MaxIS. MRI revealed only 25% of fundus invasion. Conclusion: a precise analysis of hearing function, not only with classic audiometry but also with ABR and OEAs, allows for a better understanding of hearing damage in VS surgery. Full article

(This article belongs to the Special Issue Current Trends in the Management of Vestibular Schwannoma)

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Figure 1

Figure 1
(a) Pre- and postoperative audiogram of the patient in whom a hearing improvement was noted (bone conduction not shown). Solid line: preoperative hearing levels, dotted line: postoperative hearing levels. (b) pre- and postoperative speech audiometry in silence with dissyllabic word lists. The speech discrimination score, SDS, was recorded with monosyllabic word lists. Preoperative SDS was not recorded because the required intensity was >100 dB HL. Solid points: preoperative hearing levels, empty points: postoperative hearing levels. (c,d) ABR recording before and after surgery. (c): preoperative situation, red column: impaired right side, blue column: safe left side. (d): postoperative situation where the wave V is clearly identified on both sides (Right side: red curves, Left side: blue curves). Full article ">Figure 2
Preoperative (solid line) and postoperative (dashed line) tonal and speech audiometry of a patient with a sharp amputation on high frequency thresholds. Solid line: preoperative audiogram, dotted line: postoperative audiogram. Solid points: preoperative hearing levels, empty points: postoperative hearing levels. Downward arrows: hearing level is beyond 120 dBHL. Full article ">Figure 3
(a) Tonal and speech audiometry for patient 10 (GP 1). Solid line: preoperative audiometry, dashed line: postoperative audiometry. (b) Preoperative left ABR recording in patient 10, waves I, III V are clearly identified, waves with prime symbols correspond to an additional measure. (c) Postoperative left ABR recordings in patient 10, showing no response. (d) Postoperative TOAEs in patient 10 (GP 1). (e) Postoperative recording of auditory cortically evoked responses for the same patient 10 (GP 1): the N1, P1, and N2 waves are clearly identifiable, upper red curve: right ear, lower blue curve: operated left ear. Full article ">Figure 4
Tonal and vocal audiogram illustrating hearing fatigability phenomenon, solid line: before surgery, dotted line: after surgery, grey line: after 80 dB sound exposure for two minutes. Full article ">Figure 5
Tonal and vocal audiogram of a patient in subgroup GP 3. Solid line: before surgery, dotted line: after surgery. Full article ">Figure 6
Tonal and speech audiogram of a patient in subgroup GP4. Solid line: before surgery, dotted line after surgery. Full article ">

9 pages, 710 KiB

Open AccessArticle

Hearing Outcomes from Gamma Knife Treatment for Intracanalicular Vestibular Schwannomas with Good Initial Hearing

by Philippine Toulemonde, Nicolas Reyns, Michael Risoud, Pierre-Emmanuel Lemesre, Frédéric Gabanou, Marc Baroncini, Jean-Paul Lejeune, Rabih Aboukais and Christophe Vincent

J. Clin. Med. 2024, 13(6), 1685; https://doi.org/10.3390/jcm13061685 - 14 Mar 2024

Viewed by 1384

Abstract

Background: The objective of this study was to describe the long-term hearing outcomes of gamma knife treatment for unilateral progressing vestibular schwannomas (VS) presenting with good initial hearing using audiologic data. Methods: A retrospective review was performed between 2010 and 2020 to select patients with progressing unilateral VS and good hearing (AAO-HNS class A) treated with stereotactic gamma knife surgery (GKS). Their audiograms were analyzed along with treatment metrics and patient data. Results: Hearing outcomes with a median follow-up of 5 years post-treatment showed statistically significant loss of serviceable hearing: 34.1% of patients maintained good hearing (AAO-HNS class A), and 56.1% maintained serviceable hearing (AAO-HNS class A and B). Non-hearing outcomes are favorable with excellent tumor control and low facial nerve morbidity. Conclusions: Hearing declines over time in intracanalicular VS treated with GKS, with a significant loss of serviceable hearing after 5 years. The mean cochlear dose and the presence of cochlear aperture obliteration by the tumor are the main statistically significant factors involved in the hearing outcomes. Full article

(This article belongs to the Special Issue Current Trends in the Management of Vestibular Schwannoma)

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12 pages, 2636 KiB

Open AccessArticle

Monitoring Cochlear Nerve Action Potential for Hearing Preservation in Medium/Large Vestibular Schwannoma Surgery: Tips and Pitfalls

by Baptiste Hochet, Hannah Daoudi, Etienne Lefevre, Yann Nguyen, Isabelle Bernat, Olivier Sterkers, Ghizlene Lahlou and Michel Kalamarides

J. Clin. Med. 2023, 12(21), 6906; https://doi.org/10.3390/jcm12216906 - 2 Nov 2023

Cited by 2 | Viewed by 1355

Abstract

The diagnosis of large vestibular schwannomas (VS) with retained useful hearing has become increasingly common. Preservation of facial nerve (FN) function has improved using intraoperative EMG monitoring, hearing preservation remains challenging, with the recent use of cochlear nerve action potential (CNAP) monitoring. This prospective longitudinal series of VS with useful hearing operated on using a retrosigmoid approach included 37 patients with a mean largest extrameatal VS. diameter of 25 ± 8.7 mm (81% of Koos stage 4). CNAP was detected in 51% of patients, while auditory brainstem responses (ABR) were present in 22%. Patients were divided into two groups based on the initial intraoperative CNAP status, whether it was present or absent. FN function was preserved (grade I–II) in 95% of cases at 6 months. Serviceable hearing (class A + B) was preserved in 16% of the cases, while 27% retained hearing with intelligibility (class A–C). Hearing with intelligibility (class A–C) was preserved in 42% of cases when CNAP could be monitored in the early stages of VS resection versus 11% when it was initially absent. Changes in both the approach to the cochlear nerve and VS resection are mandatory in preserving CNAP and improve the rate of hearing preservation. Full article

(This article belongs to the Special Issue Current Trends in the Management of Vestibular Schwannoma)

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Figure 1

Figure 1
Screenshot of cochlear nerve action potential (CNAP) monitoring. Amplitudes in microvolts and latencies in milliseconds. Full article ">Figure 2
Surgical strategy for the electrode-ball placement during VS removal under CNAP monitoring. Retrosigmoid approach, surgical view. Blind mapping of the posterior VS surface (A). The electrode-ball was placed on the cochlear nerve (CN) after debulking of the superior and inferior tumor poles (B). After drilling the IAC posterior wall, the electrode-ball was moved to ensure the integrity of the CN and compare the CNAP responses between the surface on the brainstem (1), the VS (2), the fundus (3) (C). Surgical field view at the end of a GTR (D). V: trigeminal nerve, IX, X, XI: cranial caudal nerves. Full article ">Figure 3
Flow chart of per-operative CNAP monitoring and hearing preservation results. ABR: auditory brainstem response; AAO-HNS: American Academy of Otolaryngology-Head and Neck Surgery; CNAP: cochlear nerve action potential; IAC: internal auditory canal. Full article ">Figure 4
A 39–year-old woman presented with stage 4 VS of 34 mm diameter (A) with total invasion of the IAC (grade A) and hearing class A (C). There were no preoperative ABR. Resection of the VS was performed using an RS approach. After debulking and some tumor removal, there was a good CNAP amplitude of 6.8 µV at the time of cochlear nerve identification. There was no change in CNAP after tumor removal from the CPA (E). During cochlear nerve dissection from the tumor in the IAC, CNAP amplitude decreased by 50% (F). Surgery was transiently interrupted then resumed after a few minutes. At the end of surgery, there was no change in CNAP compared to the start of surgery (G). Resection of the tumor was total (B) and postoperative facial function was grade 1. Postoperative audiometry was comparable to preoperative measurements with hearing class A at 6 weeks (D). Full article ">Figure 5
A 55-year-old woman presented with very rapidly growing stage 3 VS of 17 mm diameter with partial IAC invasion (grade B) and hearing class B. Resection of the VS by a RS approach was decided. After debulking and some tumor removal, there was a good CNAP amplitude (5.1 µV) at the time of cochlear nerve identification (A). Because of bleeding, there was a progressive loss of ABR and then CNAP 20 min after coagulation of the internal auditory artery during tumor dissection in the CPA (B). CNAP was absent at IAC fundus (C). Resection of the tumor was total and immediate postoperative facial function was grade 3. Postoperative audiometry confirmed anacusis (hearing class D). Full article ">Figure 6
A 49-year-old woman presented with stage 4 VS of 25 mm diameter with partial IAC invasion (grade B) and preoperative hearing class A. Preoperative ABR were synchronized. It was decided to operate through a RS approach. After debulking and some tumor removal, there was a good CNAP amplitude (7.8 µV) at the time of cochlear nerve identification (A). CNAP at the brainstem was stable at the end of tumor dissection in the CPA. There was a sudden loss of CNAP at the brainstem during dissection of the cochlear nerve in the IAC (B). Despite stopping the surgical procedure for several minutes, there was no recovery of CNAP. At the end of the procedure, CNAP was absent from the brainstem but present at the IAC fundus indicating nerve conduction block (C). Resection of the tumor was total and postoperative facial function was grade 1. Postoperative audiometry confirmed anacusis despite corticosteroid treatment (hearing class D). Full article ">

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11 pages, 2480 KiB

Open AccessCase Report

A Case Report Demonstrating Preservation of Vestibular Receptor Function after Transcochlear Removal of an Intracochlear Schwannoma with Extension to the Fundus of the Internal Auditory Canal

by Stefan K. Plontke, Francesco P. Iannacone, Udo Siebolts, Beatrice Ludwig-Kraus, Sabrina Kösling and Luise Wagner

J. Clin. Med. 2024, 13(12), 3373; https://doi.org/10.3390/jcm13123373 - 7 Jun 2024

Viewed by 783

Abstract

Preservation of function is an important goal during surgical management of cochleovestibular schwannomas. We here demonstrate the relief of vertigo and the preservation of function of all five vestibular receptors after removal of an intracochlear schwannoma with extension to the fundus of the internal auditory canal. A 61-year-old male with a five-year history of left-sided deafness, tinnitus, vertigo attacks, and an MRI consistent with an intracochlear schwannoma with limited extension through the modiolus to the fundus of the internal auditory canal (IAC) underwent transcanal, transcochlear total tumor removal and—due to a cerebrospinal fluid leak from the fundus of the IAC—revision surgery with lateral petrosectomy and blind sac closure of the external auditory canal. Despite complete removal of the cochlear partition of the inner ear (total cochlectomy), the patient’s vestibular receptors remained functional, and the vertigo symptoms disappeared. These results show that vestibular labyrinthine function may not only be preserved after partial or subtotal cochlectomy but also after complete cochlear removal. This further confirms the vestibular labyrinth’s robustness and encourages surgical management of transmodiolar schwannomas with limited extension to the fundus of the IAC. Full article

(This article belongs to the Special Issue Current Trends in the Management of Vestibular Schwannoma)

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Figure 1

Figure 1
Preoperative videonystagmography showed isolated spontaneous nystagmus to the right, which showed no relevant change postoperatively and after 1 year follow-up. The red lines in horizontal plane mark nystagmus to the right, in vertical plane they symbolize upward movement. The x-axis shows time in seconds. Full article ">Figure 2
Preoperative videonystagmography showed asymmetry in the caloric excitability favoring the right side. Postoperative caloric testing could not be performed due to blind sac closure of the ear canal. In horizontal plane the red lines mark nystagmus to the right, blue lines to the left. In vertical plane the red lines symbolize upward movement. The x-axis shows time in seconds. Full article ">Figure 3
Results of vHIT and bone conducted VEMPs. On the left, the vHIT results with eye velocity in black and head velocity in blue and red are shown. The preoperative (A) and 1-year follow-up measurements (C) demonstrate physiological responses. The higher lateral gains at (B) one week after surgical tumor removal can be interpreted as artifacts due to movements (slipping) of the vHIT glasses. On the right, the VEMPs are plotted with positive values upwards. The 1000 Hz response is plotted in grey, 500 Hz in red or blue corresponding to the side. Cervical VEMPs are plotted in relation to muscular tension. A recovery of ocular VEMPs can be seen at the 1-year follow-up (C). Triangles mark minimum and maximum of vestibular evoked potentials. Some non-vestibular evoked potentials (left (A) and right (C)) can be found (marked with arrows). Full article ">Figure 4
Romberg test results (A) showing a slight decrease in stability immediately after surgery but fast recovery to preoperative results or even better. The Unterberger’s test (B) was within the physiological limit of 50° during all measurements apart from one week after second surgery. Full article ">Figure 5
MRI (axial images: (A) T1-weighted with contrast medium, (B) T2-weighted) showing a left-sided tumor in the apical, middle (arrow in (A)), and approximately half of the basal (arrow in B) cochlear turn with circumscribed spread via the modiolus and cochlear aperture into fundus of the internal auditory canal (dotted arrow in (A)). Full article ">Figure 6
Intraoperative, transcanal view (left ear). (A) The cochlear capsule is partially removed. The intracochlear tumor parts are visible in the basal (1) and second (2) cochlear turn. (B) Removal of the intracochlear tumor parts. The vestibular entrance is blocked with soft tissue (arrow). (C) The tumor part from the fundus of the internal auditory canal (arrowhead) is removed with the remnants of the modiolus (insert image). The dashed arrow shows the opening of the internal auditory canal. (D) The defect is closed with a cartilage–perichondrium compound transplant. (E,F) Additional defect closure with a temporalis muscle patch (*) and TachoSil (**) during revision surgery with lateral petrosectomy, blind sac closure of the outer ear canal, and blockage of the tympanic opening of the Eustachian tube due to cerebrospinal fluid leak. C: cartilage M: modiolus; MH: malleus handle; PCW: posterior canal wall; S: stapes. Full article ">Figure 7
Histopathological and immunohistochemical representation. (A) Overview magnification of the tumor with intraosseous tumor component (dashed arrow) adjacent to a resected nerve (arrow) (H&E, 25×); (B) same section as A showing the resected nerve (arrow) (IHC NF200, 25×); (C) detailed magnification of the schwannoma (H&E, 250×); (D) portion of the schwannoma positive for S100 (IHC, 300×). IAC: Internal auditory canal. Full article ">

14 pages, 1725 KiB

Open AccessSystematic Review

Vestibular Schwannoma and Tinnitus: A Systematic Review of Microsurgery Compared to Gamma Knife Radiosurgery

by Ava M. King, Jaimee N. Cooper, Karina Oganezova, Jeenu Mittal, Keelin McKenna, Dimitri A. Godur, Max Zalta, Ali A. Danesh, Rahul Mittal and Adrien A. Eshraghi

J. Clin. Med. 2024, 13(11), 3065; https://doi.org/10.3390/jcm13113065 - 23 May 2024

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Abstract

Background: Vestibular schwannoma (VS) is a benign tumor of the eighth cranial nerve formed from neoplastic Schwann cells. Although VS can cause a variety of symptoms, tinnitus is one of the most distressing symptoms for patients and can greatly impact quality of life. The objective of this systematic review is to comprehensively examine and compare the outcomes related to tinnitus in patients undergoing treatment for VS. Specifically, it evaluates patient experiences with tinnitus following the removal of VS using the various surgical approaches of traditional surgical resection and gamma knife radiosurgery (GKS). By delving into various aspects such as the severity of tinnitus post-treatment, the duration of symptom relief, patient quality of life, new onset of tinnitus after VS treatment, and any potential complications or side effects, this review aims to provide a detailed analysis of VS treatment on tinnitus outcomes. Methods: Following PRISMA guidelines, articles were included from PubMed, Science Direct, Scopus, and EMBASE. Quality assessment and risk of bias analysis were performed using a ROBINS-I tool. Results: Although VS-associated tinnitus is variable in its intensity and persistence post-resection, there was a trend towards a decreased tinnitus burden in patients. Irrespective of the surgical approach or the treatment with GKS, there were cases of persistent or worsened tinnitus within the studied cohorts. Conclusion: The findings of this systematic review highlight the complex relationship between VS resection and tinnitus outcomes. These findings underscore the need for individualized patient counseling and tailored treatment approaches in managing VS-associated tinnitus. The findings of this systematic review may help in guiding clinicians towards making more informed and personalized healthcare decisions. Further studies must be completed to fill gaps in the current literature. Full article

(This article belongs to the Special Issue Current Trends in the Management of Vestibular Schwannoma)

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