Partial Hearing Preservation after Translabyrinthine Vestibular Schwannoma Resection: Case Report and Review of the Literature.
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ABSTRACT:
SUBMITTER: Ahsan SF
PROVIDER: S-EPMC4648718 | biostudies-other | 2015 Nov
REPOSITORIES: biostudies-other
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Project description:OBJECTIVE:To determine the long-term hearing preservation rate for spontaneous vestibular schwannoma treated by primary radiotherapy. DATA SOURCES:The MEDLINE/PubMed, Web of Science, Cochrane Reviews, and EMBASE databases were searched using a comprehensive Boolean keyword search developed in conjunction with a scientific librarian. English language papers published from 2000 to 2016 were evaluated. STUDY SELECTION:Inclusion criteria: full articles, pretreatment and posttreatment audiograms or audiogram based scoring system, vestibular schwannoma only tumor type, reported time to follow-up, published after 1999, use of either Gamma Knife or linear accelerator radiotherapy. EXCLUSION CRITERIA:case report or series with fewer than five cases, inadequate audiometric data, inadequate time to follow-up, neurofibromatosis type 2 exceeding 10% of study population, previous treatment exceeding 10% of study population, repeat datasets, use of proton beam therapy, and non-English language. DATA EXTRACTION:Two reviewers independently analyzed papers for inclusion. Class A/B, 1/2 hearing was defined as either pure tone average less than or equal to 50?db with speech discrimination score more than or equal to 50%, American Academy of Otolaryngology-Head & Neck Surgery (AAO-HNS) Hearing Class A or B, or Gardner-Robertson Grade I or II. Aggregate data were used when individual data were not specified. DATA SYNTHESIS:Means were compared with student t test. CONCLUSIONS:Forty seven articles containing a total of 2,195 patients with preserved Class A/B, 1/2 hearing were identified for analysis. The aggregate crude hearing preservation rate was 58% at an average reporting time of 46.6 months after radiotherapy treatment. Analysis of time-based reporting shows a clear trend of decreased hearing preservation extending to 10-year follow-up. This data encourages a future long-term controlled trial.
| S-EPMC5807198 | biostudies-literature
Project description:BACKGROUND:Schwannomas are nerve sheath tumors that commonly originate from the stomach and small intestine. A primary schwannoma of the diaphragm is rare and does not show any symptoms until it grows to a certain size. Hence, it is extremely rare that it was found at a size that allowed resection under videoscopic surgery. CASE PRESENTATION:A 77-year-old woman was referred to our department for surgical treatment of a tumor located near the gastric fornix. She underwent a routine esophagogastroduodenoscopy 2 years and 7 months prior to the referral. It was suspected that she had a submucosal tumor measuring 10 mm, located in the fornix, and was then referred to her previous physician. During her follow-up, endoscopic ultrasonography (EUS) revealed that the cystic structure had continued to grow toward the gastric wall, and she was then referred to the endoscopy division of our hospital. She continued to be followed-up, and it was noted that the tumor was gradually increasing in size. Therefore, she requested surgical resection, and was finally referred to our division. Since the tumor was rather small, we planned a laparoscopic surgery. An initial examination during the operation revealed that the tumor was located on the left diaphragm. Since the tumor was relatively small and visibility was good, we decided to continue with the laparoscopic surgery. Partial diaphragmectomy with complete inclusion of the tumor was performed, and the defect of the diaphragm was directly closed by a running suture. Pathological examination revealed a benign schwannoma that had originated from the diaphragm. To support our findings, we also reviewed the scientific literature on diaphragmatic schwannoma cases reported up to April 2020. CONCLUSIONS:In this extremely rare case, we successfully resected the diaphragmatic schwannoma using laparoscopic surgery.
| S-EPMC7678197 | biostudies-literature
Project description:INTRODUCTION:Soft tissue tumors of Schwann cells in either the peripheral or cranial nerves are known as schwannomas or also as neurilemmomas. Limited data exists regarding psoas muscle schwannoma in the literature. Therefore, we have done an extensive literature review and found a total number of 46 cases of intra-psoas schwannoma including our case, which are summarized in this article along with reporting our new case. PRESENTATION OF CASE:We report a very rare case of primary left intra-psoas muscle schwannoma in a 39-year-old Saudi gentleman, smoker with an unremarkable medical and surgical history. The patient presented to the emergency department with exacerbated chronic lower abdominal pain since almost 2 years. After conforming the diagnosis, the patient was admitted electively and underwent uneventful laparoscopic hand-assisted resection. DISCUSSION:Schwannomas are neurogenic tumors which known to be solitary, benign, well circumscribed, encapsulated, and slow-growing tumors. Multiple imaging modalities are used to detect such a tumor. Although there is no consensus on the best surgical approach, endoscopic mini-laparotomy, laparoscopy (anterior [as in our case] or lateral), and robotic resection were reported with good outcomes. CONCLUSION:Retroperitoneal schwannoma and intra-psoas muscle variant are a rare entity, with slow growing rate and risk of malignant transformation. Therefore, high index of suspicion, good follow-up, and large-cohort studies are encouraged.
| S-EPMC7399171 | biostudies-literature
Project description:In vestibular schwannoma patients with functional hearing status, surgical resection while preserving the hearing is feasible. Hearing levels, tumor size, and location of the tumor have been known to be candidates of predictors. We used a machine learning approach to predict hearing outcomes in vestibular schwannoma patients who underwent hearing preservation surgery: middle cranial fossa, or retrosigmoid approach. After reviewing the medical records of 52 patients with a pathologically confirmed vestibular schwannoma, we included 50 patient's records in the study. Hearing preservation was regarded as positive if the postoperative hearing was within serviceable hearing (50/50 rule). The categorical variable included the surgical approach, and the continuous variable covered audiometric and vestibular function tests, and the largest diameter of the tumor. Four different algorithms were lined up for comparison of accuracy: support vector machine(SVM), gradient boosting machine(GBM), deep neural network(DNN), and diffuse random forest(DRF). The average accuracy of predicting hearing preservation ranged from 62% (SVM) to 90% (DNN). The current study is the first to incorporate machine learning methodology into a prediction of successful hearing preservation surgery. Although a larger population may be needed for better generalization, this study could aid the surgeon's decision to perform a hearing preservation approach for vestibular schwannoma surgery.
| S-EPMC7188896 | biostudies-literature
Project description:RATIONALE:Intracranial solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) are rare spindle cell tumors of mesenchymal origin that include benign and malignant neoplasms. PATIENT CONCERNS:We present a 66-year-old male with a 5-year history of headache and dizziness, with left progressive sensorineural hearing loss over 1 month. DIAGNOSES:WHO grade II SFT/HPC originating from the internal auditory canal in the left cerebellopontine angle. INTERVENTIONS:surgical resection. OUTCOMES:No local recurrence or metastases were observed in the follow-up 3 months after the surgery. LESSONS:Intracranial SFTs/HPCs are rare mesenchymal neoplasms that are challenging to manage. If the imaging characteristics of tumor are not typical, clinicians should depend on tissue biopsy and immunohistochemistry to make a definitive diagnosis.
| S-EPMC7220372 | biostudies-literature
Project description:BackgroundThe clinical features and therapeutic measures of vestibular schwannoma (VS) radiation-related aneurysm (RRA) have not been well described. We reported the first VS RRA case admitted for acute anterior inferior cerebella artery (AICA) ischemic symptoms. Literature was reviewed to present the research fruits about VS RRAs, and some therapeutic advices were given.Materials and methodsA 54-year-old woman who had undergone GKS 10 years previously for a right VS was admitted to our hospital in 2018 because of sudden onset of severe vertigo and vomiting, accompanied with unsteady gait. During tumor resection, a dissecting aneurysm arose from the main trunk of AICA was encountered accidently within the tumor. The aneurysm was successfully treated with direct clip ligation, sparing the parent vessel. Data about this case were combined with those of other 11 radiation-related AICA aneurysm cases retrieved from the current literature. The following parameters were evaluated: Age, Sex, Diagnostic method, Location of aneurysm, Age of radiotherapy (Years)/Latency, Rupture, x-ray dosage, Type of radiotherapy, History of surgical resection of VS, Aneurysm Type, Morphology, Number, Treatment, Operative complications, Sequela, Outcome. VS RRAs mainly occurred in women (75%) with a median age of 62.5 years and were mainly located on AICA. Ruptured aneurysms accounted for 75.0% of the total cases. This paper reported the first VS case admitted with acute AICA ischemic symptoms. Cases with sacciform-like, irregular and fusiform-shaped aneurysms accounted for 50.0%, 25.0% and 25.0% of the total, respectively. After surgical treatment, 75.0% patients recovered, except for 3 patients who developed new ischemic consequence.ConclusionPatients should be informed of the risk of RRAs after receiving radiotherapy for VS. In these patients, RRAs should be suspected when subarachnoid hemorrhage or AICA ischemic symptoms occurred. Active intervention should be conducted considering the high instability and bleeding rate of VS RRAs.
| S-EPMC9949606 | biostudies-literature
Project description:BackgroundIntracranial intraparenchymal schwannomas (IS) are rare tumors that have mainly been described in case reports. Here, we report on a case of a brainstem IS and included a comprehensive literature review.Case descriptionA 74-year-old man presented with progressive gait disturbances. CT- and MRI-imaging revealed a contrast-enhancing mass accompanied by a cyst in the dorsolateral pons. Hemangioblastoma was suspected and surgery was advised. During surgery, gross total resection of a non-invasive tumor was performed. Postoperative recovery was uneventful. Based on histopathological examination, the intraparenchymal brainstem tumor was diagnosed as schwannoma.ConclusionOur extensive review illustrates that ISs are benign tumors that most often present in relatively young patients. Malignant cases have been described but form an extremely rare entity. Preoperative diagnosis based on radiological features is difficult but should be considered when peritumoral edema, calcifications, and cysts are noted. In benign cases, gross total resection of the lesion is curative. To adequately select this treatment and adjust the surgical strategy accordingly, it is important to include IS in the preoperative differential diagnosis when the abovementioned radiological features are present.
| S-EPMC8571199 | biostudies-literature
Project description:Although hearing improvement after surgery for small tumors of the cerebellopontine angle has been reported, the mechanism by which surgery leads to the improvement in hearing remains controversial. We report a patient who sought treatment for progressive tinnitus and hearing loss. Magnetic resonance imaging showed a large (5-cm) schwannoma in the cerebellopontine angle. At surgery the lesion was found to originate from rootlets of cranial nerve X at the jugular foramen. The patient underwent gross total resection of the tumor. Immediately after surgery, his hearing improved dramatically. We believe that our patient represents an example of hearing impairment at least in part referable to direct compression of the brainstem. Importantly, the patient's hearing deficit was completely reversible. Some authors claim that surgery to preserve hearing may be contraindicated in patients with speech discrimination scores below 50%. However, when extrinsic brainstem compression may contribute to the cause of such a hearing decrement, postoperative improvement in hearing may be a reasonable expectation.
| S-EPMC2459327 | biostudies-other
Project description:Background and importanceVestibular schwannomas are benign tumors and are the most common tumor found in the cerebellopontine angle. Surgical management of these lesions involves consideration of various operative approaches, which can have profound effects on procedural course and patient outcomes. Therefore, a comprehensive understanding of the location of the tumor and surrounding anatomical structures is vital for a positive outcome. We present a case of a 47-year-old female patient with vestibular schwannoma. A novel mixed reality (MR) system was used to register patient-specific 3D models onto the patient's head for operative planning and anatomical visualization.Case descriptionA 47-year-old female presented with a history of left-sided hearing loss, tinnitus, and episodic left facial tingling. Magnetic Resonance Imaging (MRI) demonstrated a 3.3 cm enhancing lesion in the left cerebellopontine angle at the with mass effect on the brachium pontis and medulla. Surgical resection was performed via retrosigmoid craniotomy.ConclusionsIn this study, we report the use of Augmented Reality (AR) visualization for planning of vestibular schwannoma resection. This technology allows for efficient and accurate registration of a patient's 3D anatomical model onto their head while positioned in the operating room. This system is a powerful tool for operative planning as it allows the surgeon to visualize critical anatomical structures where they lie on the patient's head. The present case demonstrates the value and use of AR for operative planning of complex cranial lesions.
| S-EPMC10944942 | biostudies-literature
Project description:Bullous pemphigoid (BP) is a rare, life-threatening autoimmune blistering disease with pruritus and tension blisters/bullous as the main clinical manifestations. Glucocorticosteroids are the main therapeutic agents for it, but their efficacy is poor in some patients. Tofacitinib, a small molecule agent that inhibits JAK1/3, has shown incredible efficacy in a wide range of autoimmune diseases and maybe a new valuable treatment option for refractory BP. To report a case of refractory BP successfully treated with tofacitinib, then explore the underlying mechanism behind the treatment, and finally review similarities to other cases reported in the literature. Case report and literature review of published cases of successful BP treatment with JAK inhibitors. The case report describes a 73-year-old male with refractory BP that was successfully managed with the combination therapy of tofacitinib and low-dose glucocorticoids for 28 weeks. Immunohistochemistry and RNA sequencing were performed to analyze the underlying mechanism of tofacitinib therapy. A systematic literature search was conducted to identify other cases of treatment with JAK inhibitors. Throughout the 28-week treatment period, the patient experienced clinical, autoantibody and histologic resolution. Immunohistochemical analysis showed tofacitinib significantly decreased the pSTAT3 and pSTAT6 levels in the skin lesions of this patient. RNA sequencing and immunohistochemical testing of lesion samples from other BP patients identified activation of the JAK-STAT signaling pathway. Literature review revealed 17 previously reported cases of BP treated with four kinds of JAK inhibitors successfully, including tofacitinib (10), baricitinib (1), upadacitinib (3) and abrocitinib (3). Our findings support the potential of tofacitinib as a safe and effective treatment option for BP. Larger studies are underway to better understand this efficacy and safety.
2024-11-13 | GSE278926 | GEO