Cochlear radiation dose and hearing loss in patients with vestibular schwannoma undergoing radiosurgery: systematic review

Abstract Objectives: To determine the cut-off point of the cochlear radiation dose as a risk factor for hearing loss in patients with vestibular schwannoma treated with radiosurgery. Methods: A systematic review of the literature was performed without language or publication year restrictions in the MEDLINE/PubMed, EMBASE, Web of Science, LILACS/VHL and Cochrane Library databases. Studies that met the following criteria were included: 1) population: adults of both sexes who underwent radiosurgery for vestibular schwannoma treatment; 2) exposure: cochlear radiation; 3) outcome: hearing loss; 4) type of study: cohort. Two independent reviewers conducted the entire review process. The registration number in PROSPERO was CRD42020206128. Results: From the 333 articles identified in the searches, seven were included after applying the eligibility criteria. There was no standardization as to how to measure exposure or outcome in the included studies, and most studies did not present sufficient data to enable meta-analysis. Conclusion: It was not possible to determine a cut-off point for high cochlear dose that could be considered a risk factor for hearing loss.

Application of Mixed Reality Technology in Surgical Resection of Vestibular Schwannoma and Doctor-patient Communication / 肿瘤防治研究

Objective To investigate application value and significance of mixed reality technology in surgical treatment and doctor-patient communication for vestibular schwannoma. Methods We selected randomly 13 vestibular schwannoma patients treated with surgical treatment. After the three-dimensional models were constructed, preoperative surgical planning and doctor-patient communication were performed with mixed reality technology. Craniotomy through retrosigmoid sinus approach, tumor resection and facial nerve protection were achieved intraoperatively with the assistance of mixed reality technology. Questionnaires were collected and facial nerve function of 13 patients was recorded one week after operation. Results Holographic model images of 13 cases were showed successfully using mixed reality technology. The locations of preoperative facial nerves reconstructed were completely consistent with actual locations in 10 cases (84.6%). After preoperative anatomic analysis, it was decided to remove partly the posterior wall of the internal auditory canal in 11 cases. The result of doctor-patient communication questionnaire showed that 13 patients and their family all had a thorough understanding of the condition, operative plan and risks, and expressed satisfaction with the preoperative conversation. With the assistance of mixed reality technology, the tumors were resected totally without injury of vein sinus in 13 cases. The facial nerve function was gradeⅠin 3 cases, gradeⅡin 6 cases, grade Ⅲ in 3 case and grade Ⅳ in 1 case based on House-Brackmann grading one week after surgery. Conclusion Mixed reality technology is quite helpful in individual surgical planning and preoperative doctor-patient communication. It helps reduce the side injuries of surgery and protect the function of facial nerve as a surgical assistant tool intraoperatively.

Multistep translation and cultural adaptation of the Penn Acoustic Neuroma Quality of Life scale in Chinese / 中国实用护理杂志

Objective@#To translate and culturally adapt the Penn Acoustic Neuroma Quality of Life (PANQOL) scale into Chinese, and introduce the first specific evaluation tool for the quality of life of acoustic neuroma patients.@*Methods@#Based on strict scale introduction requirements (scale preparation, translation, cultural adaptation and performance evaluation), elaborate on the multistep translation model (forward translation, synthesis, back translation, back translation review, comprehensive coordination) and cultural adaptation process (expert committee, preliminary experiment) to the preliminary experiments PANQOL scale in Chinese version. A preliminary survey and cognitive interview were conducted on 30 patients with acoustic neuroma, and the scale was further revised to establish the Chinese version of PANQOL scale.@*Results@#The translation validity index of each item (I-TVI) in the Chinese version of the PANQOL scale was 96%-100%, and the translation validity index at the scale level (S-TVI) was 100%, reaching the translation standard. The PANQOL scale of 30 patients in the preliminary experiment was generally divided into 73.75 ± 12.12.@*Conclusions@#The multistep translation and cultural adaptation of PANQOL scale is a complex and time consuming process. Strict implementation of this process can ensure the quality of the scale introduction. The performance of the Chinese version of PANQOL scale needs to be studied and evaluated by expanding the sample size latterly.

Multistep translation and cultural adaptation of the Penn Acoustic Neuroma Quality of Life scale in Chinese / 中国实用护理杂志

Objective To translate and culturally adapt the Penn Acoustic Neuroma Quality of Life (PANQOL) scale into Chinese, and introduce the first specific evaluation tool for the quality of life of acoustic neuroma patients. Methods Based on strict scale introduction requirements (scale preparation, translation, cultural adaptation and performance evaluation), elaborate on the multistep translation model (forward translation, synthesis, back translation, back translation review, comprehensive coordination) and cultural adaptation process (expert committee, preliminary experiment) to the preliminary experiments PANQOL scale in Chinese version. A preliminary survey and cognitive interview were conducted on 30 patients with acoustic neuroma, and the scale was further revised to establish the Chinese version of PANQOL scale. Results The translation validity index of each item (I-TVI) in the Chinese version of the PANQOL scale was 96%-100% , and the translation validity index at the scale level (S-TVI) was 100%, reaching the translation standard. The PANQOL scale of 30 patients in the preliminary experiment was generally divided into 73.75 ± 12.12. Conclusions The multistep translation and cultural adaptation of PANQOL scale is a complex and time consuming process. Strict implementation of this process can ensure the quality of the scale introduction. The performance of the Chinese version of PANQOL scale needs to be studied and evaluated by expanding the sample size latterly.

Morbidity Rate of the Retrosigmoid versus Translabyrinthine Approach for Vestibular Schwannoma Resection

BACKGROUND AND OBJECTIVES: Controversy related to the choice of surgical approach for vestibular schwannoma (VS) resection remains. Whether the retrosigmoid (RS) or translabyrinthine (TL) approach should be performed is a matter of debate. In the context of a lack of clear evidence favoring one approach, we conducted a retrospective study to compare the morbidity rate of both surgical approaches. SUBJECTS AND METHODS: 168 patients underwent surgical treatment (2007-2013) for VS at our tertiary care center. There were no exclusion criteria. Patients were separated into two groups according to the surgical approach: TL group and RS group. Signs and symptoms including ataxia, headache, tinnitus, vertigo and cranial nerve injuries were recorded pre- and postoperatively. Surgical complications were analyzed. Perioperative facial nerve function was measured according to House-Brackmann grading system. RESULTS: Tumor resection was similar in both groups. Facial paresis was significantly greater in RS group patients preoperatively, in the immediate postoperative period and at one year follow-up (p < 0.05). A constant difference was found between both groups at all three periods (p=0.016). The evolution of proportion was not found to be different between both groups (p=0.942), revealing a similar rate of surgically related facial paresis. Higher rate of ataxic gait (p=0.019), tinnitus (p=0.039) and cranial nerve injuries (p=0.016) was found in RS group patients. The incidence of headache, vertigo, vascular complications, cerebrospinal fluid leak and meningitis was similar in both groups. No reported mortality in this series. CONCLUSIONS: Both approaches seem similar in terms of resection efficacy. However, according to our analysis, the TL approach is less morbid. Thus, for VS in which hearing preservation is not considered, TL approach is preferable.

The Pure Tone Audiometry and Auditory Brainstem Response in Patients with Small Acoustic Neuroma's / 听力学及言语疾病杂志

Objective To understand the characteristics of the hearing loss in patients with small acoustic neuroma .Methods A retrospective analysis was used to analyze the results of pure tone audiometry (PTA) and au-ditory brainstem response (ABR) in 35 patients (35 ears) diagnosed with small acoustic neuroma .The types of au-diometric curves ,degrees and frequencies of hearing loss and latent periods of ABR were analyzed .Results Moder-ate deafness was the most common type in this study ,with a total of 13 ears (37 .14％ ,13/35) .In addition ,8 ears were profound deafness (22 .86％ ,8/35) ,7 ears of binaural severe deafness (20 .00％ ,7/35) ,6 ears of mild deafness (17 .14％ ,6/35) ,and 1 normal ear (2 .86％ .1/35) ,respectively .The types of audiometric curves were mainly U -shaped and sloping .15 audiometric curves were U -shaped (42 .86％ ,15/35) ,15 sloping (42 .86％ ,15/35) ,3 flat (8 .57％ ,3/35) ,and 1 tent-shaped (2 .86％ .1/35％ ) .The main frequencies of hearing loss were 1 kHz ,2 kHz ,4 kHz ,and 8 kHz .The mean thresholds had statistically significant differences (P<0 .05) compared with the other frequencies by S -N -K test .ABR was abnormal in 32 ears(91 .43％ ,32/35) .20 of the ears'I - V waves were prolonged or the inter-aural latency difference of V wave was>0 .4 ms .Five ears failed to show any ABR wave , but their 4 kHz pure tone threshold was < 80 dB HL .25 (71 .43％ ,25/35)ears'ABR results indicated a retroco-chlear nature of ear disease .Conclusion Moderate deafness is the most common type of hearing loss in small acous-tic neuroma patients ,but only 71 .43％ of the patients'ABR indicate a retrocochlear disease ,so an analysis of PTA together with ABR will help to diagnose .

Relationship of Vertigo and Postural Instability in Patients With Vestibular Schwannoma

OBJECTIVES: Growth of vestibular schwannomas (VS) causes progressive vestibular symptoms and postural instability. Since the tumor grows slowly, compensation of decaying vestibular input may decrease subjective symptoms of dizziness. This study aims to estimate the relationship of subjective vestibular symptoms and objective postural instability in patients with VS. METHODS: A retrospective review of 18 patients newly diagnosed with VS and with subjective vertigo symptoms was performed. The results of vestibular function tests including the sensory organization test (SOT) using computerized dynamic posturography, caloric test, and self-report measures of subjective dizziness handicap (Dizziness Handicap Inventory) and visual analogue scale were compared according to the onset of vertigo symptoms. RESULTS: In VS patients, SOT showed decreased equilibrium score for all vestibular function related conditions, condition (C) 5 and 6, and composite (COMP) score. COMP scores were not correlated with visual analogue scale or Dizziness Handicap Inventory scores. Acute onset group included six patients and insidious onset group, 12 patients. Equilibrium scores for C5 and C6, and COMP scores were lower for insidious onset group, but the difference was not statistically significant. CONCLUSION: Our findings confirmed postural instability is prevalent in VS patients. SOT parameters did not differ significantly between acute onset and insidious onset groups, but increased tumor size and canal weakness were noted in the insidious onset group. Clinicians should consider that postural instability is likely present even in patients who do not complain of acute vertigo, and appropriate counseling should be discussed with the patients.

Local experience with radiosurgery for vestibular schwannomas and recommendations for management

<p><b>INTRODUCTION</b>There are many treatment options for vestibular schwannomas (VSs), including radiosurgery. Previous studies have shown good outcomes for smaller tumours. We report the results of a seven-year cohort of patients with VS who were treated at our centre using a linear accelerator-based stereotactic radiosurgery system.</p><p><b>METHODS</b>We retrospectively reviewed the case notes and magnetic resonance (MR) images of patients with VS treated with radiosurgery. Treatment was administered as either a single 13 Gy session or 25 Gy in five sessions. At our centre, only larger or higher Koos grade VSs, were routinely treated with hypofractionated radiosurgery. Tumour response and hearing were assessed using RECIST criteria and Gardner-Robertson scale, respectively. Other toxicities were assessed using physical examination and history-taking. Freedom from radiological progression was estimated with the Kaplan-Meier method.</p><p><b>RESULTS</b>46 patients received single-fraction radiosurgery and 31 received hypofractionated radiosurgery. Median follow-up duration was 40.6 months. 29 patients had prior surgery to remove the tumour (median size 1.68 cm3). One patient who had symptomatic increase in tumour size (> 20% in largest diameter) was treated conservatively and subsequently showed stable disease on MR imaging. Progression-free survival was 98.7%. Another patient had symptomatic oedema requiring ventriculoperitoneal shunt insertion. 11 patients had serviceable hearing before radiotherapy and 72.7% of them retained useful hearing (20.1 dB mean decline in pure tone average). Facial and trigeminal nerve functions and sense of equilibrium were preserved in > 90% of patients.</p><p><b>CONCLUSION</b>Radiosurgery is effective and safe for small VSs or as an adjunct therapy after microsurgery.</p>

Analysis on clinical features and prognosis of patients with neurofibromatosis type 2 after operation / 中国综合临床

Objective To investigate the correlation between clinical features and prognosis of patients with neurofibromatosis type 2(NF2)after operation.Methods The clinical features and prognosis of sixty patients with neurofibromatosis type 2(NF2)from 2000 to 2013 in Xi′an No.1 Hospital were analyzed.Cox proportional hazards regression model was used for variable analysis.Results The patients were followed up for 1-188 months,53 patients survived(88.3%,53/60),and 7 patients died(11.7%,7/60).Single factor analysis showed that the first symptom age,age of diagnosis,intracranial meningioma and spinal cord tumor were related to the prognosis of the patients(P<0.05).However,gender,genetic factors,skin lesions,eye diseases, postoperative hearing improvement and relief of dizziness after surgery were not correlated with the prognosis of patients(P>0.05).Spinal cord tumors or intracranial meningiomas were the independent risk factors for the prognosis of NF2 patients(P=0.042,0.037,95%CI=0.021-2.069,0.587-2.543,RR=2.475,3.663).The first symptoms age,age of diagnosis,ocular lesions were the risk factors for the occurrence of spinal cord tumors and intracranial meningiomas(P<0.05).Conclusion NF2 has many clinical symptoms,accompanied by spinal cord tumor and intracranial meningioma,which are the important prognostic factors in patients with poor prognosis.

Influencing Factors Analysis of Facial Nerve Function after the Microsurgical Resection of Acoustic Neuroma

OBJECTIVE: To explore and analyze the influencing factors of facial nerve function retainment after microsurgery resection of acoustic neurinoma. METHODS: Retrospective analysis of our hospital 105 acoustic neuroma cases from October, 2006 to January 2012, in the group all patients were treated with suboccipital sigmoid sinus approach to acoustic neuroma microsurgery resection. We adopted researching individual patient data, outpatient review and telephone followed up and the House-Brackmann grading system to evaluate and analyze the facial nerve function. RESULTS: Among 105 patients in this study group, complete surgical resection rate was 80.9% (85/105), subtotal resection rate was 14.3% (15/105), and partial resection rate 4.8% (5/105). The rate of facial nerve retainment on neuroanatomy was 95.3% (100/105) and the mortality rate was 2.1% (2/105). Facial nerve function when the patient is discharged from the hospital, also known as immediate facial nerve function which was graded in House-Brackmann: excellent facial nerve function (House-Brackmann I–II level) cases accounted for 75.2% (79/105), facial nerve function III–IV level cases accounted for 22.9% (24/105), and V–VI cases accounted for 1.9% (2/105). Patients were followed up for more than one year, with excellent facial nerve function retention rate (H-B I–II level) was 74.4% (58/78). CONCLUSION: Acoustic neuroma patients after surgery, the long-term (≥1 year) facial nerve function excellent retaining rate was closely related with surgical proficiency, post-operative immediate facial nerve function, diameter of tumor and whether to use electrophysiological monitoring techniques; while there was no significant correlation with the patient’s age, surgical approach, whether to stripping the internal auditory canal, whether there was cystic degeneration, tumor recurrence, whether to merge with obstructive hydrocephalus and the length of the duration of symptoms.

A Case of Recurrent Vertigo in Vestibular Schwannoma Treated with Chemical Labyrinthectomy / 대한평형의학회지

Vestibular schwannoma (VS) can have various symptoms and almost half of the patients have balance problems. Some patients with VS can suffer from recurrent vertigo mimicking Meniere's disease. We present the case of a 61-year-old male patient who was suffering from recurrent vertigo due to VS while symptoms improved by chemical labyrinthectomy with gentamicin. We consider that chemical labyrinthectomy can be an option in the treatment of patients with recurrent vertigo for VS.

A Case Study Of Auditory Brainstem Implant in a Patient with Neurofibromatosis Type Ⅱ / 听力学及言语疾病杂志

Objective To study the clinical characteristics and treatment of neurofibromatosis type Ⅱ (neuro-fibromatosis type 2 ,NF2 ,bilateral acoustic neuroma) ,and the effects of auditory brainstem implant for treating to-tal deafness after bilateral acoustic neuroma resection .Methods One case of bilateral acoustic neuroma and all clini-cal data in terms of diagnosis ,treatment and hearing -speech rehabilitation after surgery were retrospectively stud-ied .Results The patient was a thirteen years old boy .His clinical symptoms were hearing loss on the right ear ,tin-nitus ,hoarseness and gait instability three years .MRI showed space occupying lesion in the cerebellopontine angle . The postoperative pathological diagnosis was bilateral acoustic neuroma .The initial switch -on was peformed six weeks after the surgery ,and confirmed that all electrodes generated listening responses .As the extension of recov-ery time ,the correct recognition rate of patients on the natural environment sound ,vowel ,monosyllabic were on the rise and the pure tone hearing threshold gradually decreased .The vowel correct recognition rate of postoperative 6 , 9 ,12 ,24 ,and 36 months were 14% ,18% ,20% ,24% ,and 20% ,respectively .The recognition rate of monosyl-labic and open words at each postoperative rehabilitation stage were 0 .Conclusion The clinical characteristics and treatment of bilateral acoustic neuroma were different from the unilateral acoustic neuroma .The individualized treat-ment should be followed .Auditory brainstem implant could be performed in patients with post - bilateral acoustic neuroma resection .The accurate location of the cochlear complex during the surgery was the crucial point for the success of ABI .

Analysis on clinical features and prognosis of patients with neurofibromatosis type 2 after operation / 中国综合临床

Objective To investigate the correlation between clinical features and prognosis of patients with neurofibromatosis type 2(NF2)after operation.Methods The clinical features and prognosis of sixty patients with neurofibromatosis type 2(NF2)from 2000 to 2013 in Xi′an No.1 Hospital were analyzed.Cox proportional hazards regression model was used for variable analysis.Results The patients were followed up for 1-188 months,53 patients survived(88.3%,53/60),and 7 patients died(11.7%,7/60).Single factor analysis showed that the first symptom age,age of diagnosis,intracranial meningioma and spinal cord tumor were related to the prognosis of the patients(P<0.05).However,gender,genetic factors,skin lesions,eye diseases, postoperative hearing improvement and relief of dizziness after surgery were not correlated with the prognosis of patients(P>0.05).Spinal cord tumors or intracranial meningiomas were the independent risk factors for the prognosis of NF2 patients(P=0.042,0.037,95%CI=0.021-2.069,0.587-2.543,RR=2.475,3.663).The first symptoms age,age of diagnosis,ocular lesions were the risk factors for the occurrence of spinal cord tumors and intracranial meningiomas(P<0.05).Conclusion NF2 has many clinical symptoms,accompanied by spinal cord tumor and intracranial meningioma,which are the important prognostic factors in patients with poor prognosis.

Outcome of different facial nerve reconstruction techniques / Resultados de diferentes técnicas de reconstrução do nervo facial

Abstract Introduction: There is no technique of facial nerve reconstruction that guarantees facial function recovery up to grade III. Objective: To evaluate the efficacy and safety of different facial nerve reconstruction techniques. Methods: Facial nerve reconstruction was performed in 22 patients (facial nerve interpositional graft in 11 patients and hypoglossal-facial nerve transfer in another 11 patients). All patients had facial function House-Brackmann (HB) grade VI, either caused by trauma or after resection of a tumor. All patients were submitted to a primary nerve reconstruction except 7 patients, where late reconstruction was performed two weeks to four months after the initial surgery. The follow-up period was at least two years. Results: For facial nerve interpositional graft technique, we achieved facial function HB grade III in eight patients and grade IV in three patients. Synkinesis was found in eight patients, and facial contracture with synkinesis was found in two patients. In regards to hypoglossal-facial nerve transfer using different modifications, we achieved facial function HB grade III in nine patients and grade IV in two patients. Facial contracture, synkinesis and tongue atrophy were found in three patients, and synkinesis was found in five patients. However, those who had primary direct facial-hypoglossal end-to-side anastomosis showed the best result without any neurological deficit. Conclusion: Among various reanimation techniques, when indicated, direct end-to-side facial-hypoglossal anastomosis through epineural suturing is the most effective technique with excellent outcomes for facial reanimation and preservation of tongue movement, particularly when performed as a primary technique.

Resumo Introdução: Não existe uma técnica de reconstrução do nervo facial que garanta a recuperação da função facial até o grau III. Objetivo: Avaliar a eficácia e segurança de diferentes técnicas de reconstrução do nervo facial. Método: Ao todo, 22 pacientes foram submetidos a reconstrução do nervo facial (enxerto com interposição do nervo facial em 11 pacientes e com transferência do nervo hipoglosso facial em 11 pacientes). Todos os pacientes apresentavam função facial de grau VI (de acordo com a classificação de House-Brackmann - HB) causada por trauma ou pela ressecção de um tumor. A reconstrução do nervo principal foi efetuada, exceto em sete pacientes, nos quais a reconstrução foi realizada entre duas semanas a quatro meses após a cirurgia inicial. O período de acompanhamento foi de, no mínimo, dois anos. Resultados: Para a técnica de enxerto com interposição de nervo facial, o grau de função facial obtido foi HB III em oito pacientes e HB IV em três pacientes. Sincinesia foi observada em oito pacientes e contratura facial com sincinesia em dois pacientes. Em relação à transferência do nervo hipoglosso facial com o uso de diferentes modificações, obtivemos função facial HB grau III em nove pacientes e HB grau IV em dois pacientes. Contratura facial, sincinesia e atrofia lingual foram observadas em três pacientes e sincinesia observada em cinco pacientes. No entanto, aqueles submetidos a anastomose primária direta hipoglosso-facial término-lateral apresentaram o melhor resultado, sem qualquer déficit neurológico. Conclusão: Entre as várias técnicas de reanimação, sempre que possível, a anastomose direta término-lateral hopoglosso-facial por meio de sutura epineural é a técnica mais eficaz, com excelentes resultados para reanimação facial e preservação do movimento da língua, especialmente quando realizada como técnica primária.

Risk Factors of Acoustic Neuroma: Systematic Review and Meta-Analysis

PURPOSE: Many epidemiological studies have investigated environmental risk factors for the development of acoustic neuroma. However, these results are controversial. We conducted a meta-analysis of case-control studies to identify any potential relationship between history of noise exposure, smoking, allergic diseases, and risk of acoustic neuroma. MATERIALS AND METHODS: We searched PubMed to identify relevant articles. Two researchers evaluated the eligibility and extracted the data independently. RESULTS: Eleven case-control studies were included in our meta-analysis. Acoustic neuroma was found to be associated with leisure noise exposure [odds ratio (OR)=1.33, 95% confidence interval (CI): 1.05-1.68], but not with occupational noise exposure and ever noise exposure (OR=1.20, 95% CI: 0.84-1.72 and OR=1.15, 95% CI: 0.80-1.65). The OR of acoustic neuroma for ever (versus never) smoking was 0.53 (95% CI: 0.30-0.94), while the subgroup analysis indicated ORs of 0.95 (95% CI: 0.81-1.10) and 0.49 (95% CI: 0.41-0.59) for ex-smoker and current smoker respectively. The ORs for asthma, eczema, and seasonal rhinitis were 0.98 (95% CI: 0.80-1.18), 0.91 (95% CI: 0.76-1.09), and 1.52 (95% CI: 0.90-2.54), respectively. CONCLUSION: Our meta-analysis is suggestive of an elevated risk of acoustic neuroma among individuals who were ever exposed to leisure noise, but not to occupational noise. Our study also indicated a lower acoustic neuroma risk among ever and current cigarette smokers than never smokers, while there was no significant relationship for ex-smokers. No significant associations were found between acoustic neuroma and history of any allergic diseases, such as asthma, eczema, and seasonal rhinitis.

The Difference of Clinical Symptoms and Audiovestibular Function between Intrameatal and Extrameatal Acoustic Neuroma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various hearing tests and vestibular function tests are used to diagnose acoustic neuroma. We analyzed the clinical characteristics and the results of audiovestibular function tests between patients of intrameatal and extrameatal acoustic neuroma. SUBJECTS AND METHOD: Reviewing the medical records for 64 patients with acoustic neuroma between March 2007 and February 2014, we divided the patients into two groups, intrameatal (31 patients) and extrameatal acoustic neuroma (33 patients) according to the involvement of cerebropontine angle. We compared the clinical characteristics, pure tone audiograms, speech audiometry, caloric test, and vestibular evoked myogenic potential (VEMP) between the two groups. RESULTS: While hearing loss was the most frequent presenting symptom in patients with intrameatal acoustic neuroma, dizziness was the most common symptom in patients with extrameatal acoustic neuroma. Hearing thresholds measured by pure tone audiometry and speech discrimination scores were significantly worse for patients with extrameatal acoustic neuroma. Abnormal unilateral canal paresis of caloric test was significantly higher for extrameatal acoustic neuroma than for intrameatal acoustic neuroma. Most patients with acoustic neuroma showed abnormal findings in the VEMP test, but the number of patients between intrameatal and extrameatal acoustic neuroma did not differ significantly. CONCLUSION: Clinical symptoms and the results of audiovestibular function tests differed according to the tumor size of acoustic neuroma. Physicians should counsel patients presenting with audiovestibular symptoms of the possibility of acoustic neuroma.

The effectiveness of wechat-based transitional care in the acoustic neuroma patients with postoperative facial palsy / 中国实用护理杂志

Objective To evaluate the effectiveness of wechat-based transitional care in the acoustic neuroma patients with postoperative facial palsy.Methods 90 acoustic neuroma patients with postoperative facial palsy were randomly enrolled into 2 groups by tossing coin,45 cases in each group.Control group received routine discharge education,while the experimental group received wechat-based transitional care for three months.The rehabilitation adherence,the level of facial palsy,the ocular infection and the quality of life at patients discharged and three months after operation were compared between the two groups.Results Three months after operation,the cases of high,middle,low level of rehabilitation in the experimental group were 28,12,5,which were more than the control group whose cases were 15,21,9 (x2=7.528,P＜ 0.05).Facial palsy and the quality of life of the experimental group were 66.7％ (30/45) and (71.62±6.36) points,which was significantly higher than 42.4％ (19/45) and (63.75±11.28) points in the control group (x2=5.421 and 4.073,P ＜ 0.01).The incidence of ocular infection in the experimental group was 8.9％ (4/45) which was significantly lower than 31.1％ (14/45) in the control group (x2=6.671,P ＜0.05).Conclusions Wechat-based transitional care achieves good effectiveness in patients with postoperative facial palsy,which could improve the level of rehabilitation,facial palsy and the quality of life,and reduce the incidence of ocular infection,is worthy of promotion.

Surgical exposure of the internal auditory canal through the retrosigmoid approach with semicircular canals anatomical preservation / Avaliação da exposição do fundo do conduto auditivo interno através do acesso retrosigmóide-transmeatal

Objective Evaluate the feasibility of an adequate exposure with anatomical preservation of labyrinth structures through retrosigmoid transmeatal approach (RSA) in surgeries for resection of acoustic neuromas/vestibular schwannomas (VS). Method Thirty patients underwent surgical resection and were preoperatively evaluated with fine slice high definition CT scans and 3D-MRI volumetric reconstructions. Extension of internal auditory canal (IAC) opening during surgery was measured using 3 mm right-angle calibrated hook and neuronavigation parameters. Postoperatively, the extension of IAC opening and integrity of the labyrinth were confirmed through preoperatively images procedures. Results The preoperative length of IACs varied between 7.8 and 12.0 mm (mean 9.3 mm, SD 0.98, 95%CI 8.9 to 9.6, and median 9.0 mm). Postoperative images demonstrated adequate opening of the IAC and semicircular channels integrity. Conclusion A complete drilling of the posterior wall of IAC through the RSA is feasible and allows direct visualization of the IAC-fundus without damaging the semicircular canals. .

Objetivo Avaliar a possibilidade de exposição adequada preservando anatomia das estruturas labirínticas pelo acesso retrosigmóide-transmeatal (RSA) nas ressecções de schwannomas do vestibular (VS). Método Trinta pacientes foram submetidos à ressecção cirúrgica e avaliados no pré-operatório com tomografias de alta definição e reconstruções de ressonância magnética 3D. A extensão da abertura do conduto auditivo interno (CAI) foi medida e confirmada com parâmetros de neuronavegação. No pós-operatório, a extensão da abertura e a integridade do labirinto foram confirmadas por imagens de tomografia computadorizada. Resultados A extensão do CAI no pré-operatório apresentou variação de 7,8-12 mm (média 9,3 mm, DP 0,98, IC95% de 8,9-9,6 e mediana 9 mm). Imagens pós-operatórias demonstraram abertura adequada do IAC e integridade dos canais semicirculares. Conclusão A abertura completa da parede posterior do CAI pelo RSA é possível e permite a visualização direta do fundo do conduto sem prejudicar os canais semicirculares. .

Intracochlear Schwannoma: Diagnosis and Management

Introduction: Schwannomas of the eighth cranial nerve are benign tumors that usually occur in the internal auditory canal or the cerebellopontine angle cistern. Rarely, these tumors may originate from the neural elements within the vestibule, cochlea, or semicircular canals and are called intralabyrinthine schwannomas. Intracochlear schwannomas (ICSs) represent a small percentage of these tumors, and their diagnosis is based on high-resolution magnetic resonance imaging (MRI). Objectives: To report the clinical and radiologic features and audiometric testing results of an ICS in a 48-year-old man after a 22-month follow-up period. Resumed Report A patient with an 8-year history of persistent tinnitus in his right ear, combined with ipsilateral progressive hearing loss and aural fullness. Audiometry revealed normal hearing in the left ear and a moderate to severe sensorineural hearing loss in the right ear, with decreased speech reception threshold and word recognition score, compared with the exam performed 5 years previously. MRI showed a small intracochlear nodular lesion in the modiolus, isointense on T1 with a high contrast enhancement on T1 postgadolinium images. During the follow-up period, there were no radiologic changes on imaging studies. Thus, a wait-and-scan policy was chosen as the lesion remained stable with no considerable growth and the patient still presents with residual hearing. Conclusions: Once diagnosed, not all ICS patients require surgery. Treatment options for ICS include stereotactic radiotherapy and rescanning policy, depending on the tumor's size, evidence of the tumor's growth, degree of hearing loss, intractable vestibular symptoms, concern about the pathologic diagnosis, and the patient's other medical conditions...

Surgical Findings to Differentiate Between Facial Nerve Schwannoma and Vestibular Schwannoma

OBJECTIVES: Facial nerve schwannomas may be misdiagnosed as vestibular schwannomas (VSs) if the tumor is confined to the internal auditory canal (IAC) without involvement the geniculated ganglion or labyrinthine segment of facial nerve. Because facial nerve schwannomas may be misdiagnosed as VSs, we investigated the differences between the two. METHODS: The study included 187 patients with a preoperative diagnosis of VS. Of these, six were diagnosed with facial nerve schwannomas during surgery. We reviewed the preoperative evaluations and surgical findings of facial nerve schwannomas mimicking VSs. RESULTS: No useful preoperative predictors are available for facial nerve schwannomas mimicking VSs. Facial nerve schwannomas are usually confined to the IAC. After opening the dura of the IAC, a facial nerve schwannoma can be diagnosed after identifying a normal-appearing nerve located lateral to the tumor. When this was the case, we performed facial nerve preservation surgery or decompression. CONCLUSION: Facial nerve schwannomas can be differentiated from VSs by identifying specific findings during surgery.