Quality of life in patients with unilateral vestibular schwannoma on wait and see - strategy.

OBJECTIVE: A 'wait and see' strategy is an option when managing patients with small vestibular schwannomas (VS). A risk of growth and worsening of hearing may influence a patient's daily quality of life (QOL). Therefore, the present study focused on QOL parameters in patients who are on a 'wait and see' strategy following magnetic resonance imaging (MRI)-based diagnosis of small unilateral VS. PATIENTS AND METHODS: Sixty-five patients (mean age 64.4 years; male:female, 32:33) who suffered from a small unilateral VS (9.34 mm, range 1.5-23 mm) between 2013 and 2016 were included in a prospective single center study. During follow-up, in addition to clinical and neurological examinations and MRI imaging, all patients answered the Short Form 36 questionnaire once to characterize QOL. Additionally, the severity of tinnitus was determined by the Mini-TQ-12 from Hiller and Goebel. RESULTS: It was found during follow-up that there was no lowering of QOL in patients with small VS who were on 'wait and see' strategy compared with Germany's general population and no tumor growth was detected in 53 patients (81.5%). Patients with a tumor diameter larger than 10 mm did not suffer from stronger tinnitus, vertigo or unsteadiness than the group with an average tumor size, which is smaller than 10 mm. Sixty-two patients (95.4%) showed ipsilateral hearing loss and three of these reported deafness (4.6%). Severe vertigo or tinnitus is connected with lower levels of mental component scale and physical component scale. These findings reduced the QOL (p = 0.05). CONCLUSION: In our series, QOL is not influenced in patients with unilateral untreated small VS in comparison to Germany's general population. This is helpful information when advising patients during follow-up and finding out the optimal timing of individual treatment.

High Resolution Imaging of Viscoelastic Properties of Intracranial Tumours by Multi-Frequency Magnetic Resonance Elastography.

PURPOSE: In recent years Magnetic Resonance Elastography (MRE) emerged into a clinically applicable imaging technique. It has been shown that MRE is capable of measuring global changes of the viscoelastic properties of cerebral tissue. The purpose of our study was to evaluate a spatially resolved three-dimensional multi-frequent MRE (3DMMRE) for assessment of the viscoelastic properties of intracranial tumours. METHODS: A total of 27 patients (63 ± 13 years) were included. All examinations were performed on a 3.0 T scanner, using a modified phase-contrast echo planar imaging sequence. We used 7 vibration frequencies in the low acoustic range with a temporal resolution of 8 dynamics per wave cycle. Post-processing included multi-frequency dual elasto-visco (MDEV) inversion to generate high-resolution maps of the magnitude |G*| and the phase angle φ of the complex valued shear modulus. RESULTS: The tumour entities included in this study were: glioblastoma (n = 11), anaplastic astrocytoma (n = 3), meningioma (n = 7), cerebral metastasis (n = 5) and intracerebral abscess formation (n = 1). Primary brain tumours and cerebral metastases were not distinguishable in terms of |G*| and φ. Glioblastoma presented the largest range of |G*| values and a trend was delineable that glioblastoma were slightly softer than WHO grade III tumours. In terms of φ, meningiomas were clearly distinguishable from all other entities. CONCLUSIONS: In this pilot study, while analysing the viscoelastic constants of various intracranial tumour entities with an improved spatial resolution, it was possible to characterize intracranial tumours by their mechanical properties. We were able to clearly delineate meningiomas from intraaxial tumours, while for the latter group an overlap remains in viscoelastic terms.

Recurrence rate, time to progression and facial nerve function in microsurgery of vestibular schwannoma.

OBJECTIVE: Recurrence rate, time to progression, and facial nerve function were analysed by comparing patients with complete and near total tumor removal after suboccipital craniotomy for vestibular schwannoma surgery. METHODS: From 1996 to 2004, 118 patients with vestibular schwannoma were operated with an interdisciplinary approach. Fifty patients fulfilled the inclusion criteria and were included in the study. Progression was defined as an increase of ⩾2 mm in the largest diameter in the magnetic resonance imaging. Preoperative tumor size, facial nerve function estimated using the House-Brackmann score (HBS), time to progression, and recurrence rate were analysed and related to the extent of resection. RESULTS: In 28 cases (group I), a capsular remnant was left. In 22 cases (group II), tumor removal was complete. In group I, nine patients (32·1%) showed progression. In group II, two patients (9·1%) developed a recurrent tumor, no significance (P = 0·085). In groups I and II, 53·6 and 59·6% had a good function of the facial nerve (HBS I+II), 28·6% in group I and 13·5% in group II had a moderate disturbance (HBS III+IV), and 17·9% in group I and 27·7% in group II had a poor function (HBS V+VI). There was no significant difference between median preoperative tumor size and facial nerve function within patients with HBS III and IV. CONCLUSION: Complete tumor removal may be associated with a risk of functional loss, whereas near total tumor removal may be associated with a higher risk of progression.

Cerebrospinal fluid leak after microsurgical surgery in vestibular schwannomas via retrosigmoidal craniotomy.

OBJECTIVE: Cerebrospinal fluid (CSF) leak is still a common complication in surgery of vestibular schwannoma, increasing morbidity and prolonging hospital stay. Our single center study was performed to determine the incidences of CSF leaks after microsurgical removal of vestibular schwannoma via a retrosigmoidal approach with two different surgical closure techniques. METHODS: Between January 2003 and December 2009 in 81 patients, microsurgical tumor resection using a suboccipital, retrosigmoidal approach was performed with an interdisciplinary ENT and neurosurgical management was performed. In 41 cases, the dural closure was done using a sandwich technique: subdural closure with TissuFleece® respectively Spongostan®, and after that dural suture and epidural Tachosil® were fixed on. In 40 cases, the dura was sealed epidurally with Tachosil after suture. In 65 cases, the posterior wall of the petrous bone was drilled. The closure was performed using muscle and FibrinGlue®. All patients had a minimal follow-up of 1 year. RESULTS: Seven patients (8.6%) developed a CSF fistula. Three patients (3.7%) underwent surgical procedure because of persisting CSF fistula while in four cases (4.9%) spontaneous closure under lumbar drain was observed. Comparing the different techniques of dural sealing, we found in 41 patients with sandwich technique three CSF leaks (7.3%) while there were four CSF leaks (10%) in 40 patients with a single epidurally sealed dural closure (P=0.69). No rhinorrhea or otorhinorrhea was observed. No intracranial infection or meningitis in case of CSF leak occurred. CONCLUSION: Suture and occlusion of the dura is an important step to prevent CSF leak and postoperative infection. By comparing sandwich technique and single-layer dural sealing, no significant difference could be shown.

Recombinant antibody toxins specific for ErbB2 and EGF receptor inhibit the in vitro growth of human head and neck cancer cells and cause rapid tumor regression in vivo.

Overexpression of the ErbB2 and epidermal growth factor receptor (EGFR) tyrosine kinases is frequently observed in squamous cell carcinomas of the head and neck, and has been correlated with shorter overall survival. By immunoblot analysis, we have found EGFR and ErbB2 expression in 6 out of 6 established head and neck cancer cell lines. Elevated EGFR protein levels were noted in 3 and elevated ErbB2 levels in 5 of them. Significant expression of EGFR and ErbB2 was also detected in 17 of 47 and 26 of 45 primary tumor samples. Due to their enhanced expression on the tumor cell surface, these receptors can be regarded as suitable targets for directed cancer therapy. We have analyzed the antitumoral activity of recombinant single-chain antibody toxins specific for ErbB2 and EGFR against head and neck cancer cells in vitro and in vivo. The recombinant toxins consist of the variable domains of the heavy and light chains of monoclonal antibodies (MAbs) genetically fused to a truncated Pseudomonas exotoxin A (ETA). At low concentrations, the ErbB2-specific single-chain antibody (scFv) toxin scFv(FRP5)-ETA and the EGFR-specific toxins scFv(225)-ETA and scFv(14E1)-ETA inhibited the in vitro growth of established head and neck cancer cell lines and primary tumor cells. In a nude mouse tumor model, intratumoral injection of the antibody toxins resulted in the rapid regression of subcutaneously growing CAL 27 tumor xenografts, with scFv(FRP5)-ETA and scFv(14E1)-ETA treatment being most effective and leading to the cure of up to 50% of the animals. Our results suggest that EGFR and ErbB2-specific antibody toxins may become valuable therapeutic reagents for the treatment of squamous cell carcinomas of the head and neck.

Intracerebral hemorrhage during fibrinolytic therapy in children: a review of the literature of the last thirty years.

In a retrospective study all available publications concerning children with thromboembolic disease and fibrinolytic therapy between January 1, 1964, and June 30, 1995, were reviewed with regard to the occurrence of intracerebral hemorrhages (ICH). ICH was found in 14/929 patients analyzed. According to the age when thrombolytic therapy was performed, ICH was described in 2/468 children after the neonatal period, in 1/83 term infants; and in 11/86 preterm infants; 10/40 preterm infants who were treated in the first week of life developed ICH. ICH during thrombolytic therapy in children is reported with the use of streptokinase, urokinase (UK), UK-activated plasmin, UK and plasminogen, and recombinant tissue plasminogen activator (rt-PA). The risk of developing an ICH from thrombolytic therapy seems to be low in children after the neonatal period and in term infants. Because of the high incidence of "spontaneous" ICH in preterm infants, it cannot be established whether the more frequently described ICH in these patients is a complication of thrombolytic therapy. In the absence of randomized trials this analysis may be helpful for decision making in children with thromboembolic disorders. However, the data have to be regarded with caution because of the summation of cases with different thromboembolic disorders, treatment with different substances in different dosages, and the retrospective study design that could lead to an underrepresentation of this complication.