Surgical Treatment of Acoustic Neuroma (Vestibular Schwannoma) in the United States
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Abstract In 1989, the Acoustic Neuroma Association established a multisurgeon, multi‐institutional registry to collect data related to the treatment of patients with acoustic neuroma. This report analyzes information from the 1579 surgically treated patients who were entered in the registry between January 1, 1989, and February 28, 1994.Keywords:
Acoustic neuroma
Neuroma
ガンマナイフ時代に外科的治療を担う脳神経外科医には,腫瘍を全摘出し,かつ新たな神経症状を出さないことが外科的治療の目標となる.本稿では,後頭下アプローチにおいて遭遇するさまざまな構造物,すなわち導出静脈,弓下動脈,内リンパ嚢,前庭水管,総脚,頸静脈球,蝸牛水管などの画像所見に言及し,それらに関連した手術手技を解説した.本アプローチは脳神経外科手術の最も基本的なアプローチの一つであるが,日進月歩の神経画像の知識を常に手術に還元するよう努めるべきである.
Neuroma
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We present a case of spontaneous 79% regression in the size of a vestibular schwannoma (VS). A 41-year-old lady with a large (36 mm) vestibular schwannoma underwent serial follow-up MRI scans which demonstrated the shrinkage over 9 years; the highest relative spontaneous regression recorded in the literature for vestibular schwannoma of this size.
Acoustic neuroma
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Abstract Two cases are presented in which patients flying home shortly after translabyrinthine removal of a vestibular schwannoma (acoustic neuroma) developed acute bacterial meningitis on landing. This complication has not been described before. The incidence and management of CSF leaks after vestibular schwannoma surgery is also discussed.
Acoustic neuroma
Neuroma
Translabyrinthine approach
Vestibular nerve
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A vestibular Schwannoma is a non-cancerous primary intracranial tumor of the myelin-forming cells of the vestibulo-cochlear nerve 8th cranial nerve. It grows slowly or not at all. Rarely it may grow rapidly and become large enough to press against the brain and interfere with the vital functions. Treatment includes regular monitoring radiation and surgical removal. Here we report a rare case of recurrent vestibular Schwannoma which recurred after complete removal of tumor.
Vestibular nerve
Acoustic neuroma
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To determine the long-term, spontaneous growth arrest rates in a large cohort of vestibular schwannoma patients.This paper describes a retrospective case series of 735 vestibular schwannoma patients organised into four groups: group A patients showed tumour growth which then stopped without any treatment; group B patients showed tumour growth which continued, but were managed conservatively; group C patients had a growing vestibular schwannoma and received active treatment; and group D patients had a stable, non-growing vestibular schwannoma. Demographics, tumour size and vestibular schwannoma growth rate (mm/month) were recorded.A total of 288 patients (39.2 per cent) had growing vestibular schwannomas. Of the patients, 103 (35.8 per cent) were managed conservatively, with 52 patients (50.5 per cent of the conservative management group, 18 per cent of the total growing vestibular schwannoma group) showing growth arrest, which occurred on average at four years following the diagnosis. Eighty-two per cent of vestibular schwannomas stopped growing within five years. Only differences between age (p = 0.016) and vestibular schwannoma size (p = 0.0008) were significant.Approximately 20 per cent of growing vestibular schwannomas spontaneously stop growing, predominantly within the first five years; this is important for long-term management.
Demographics
Conservative Management
Acoustic neuroma
Neuroma
Vestibular Schwannomas
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Introdução: O schwannoma é um tumor benigmo que em geral acomete o nervo vestíbulococlear, sede de 60-80% dos tumores no ângulo pontocerebelar.Essa neoplasia do acústico foi observada em autopsia e descrita pela primeira vez em 1777, pelo profesor Edward Sandiford.Histologicamente esse tumor deriva das células de schwann, sendo relacionado com distúrbios cromossômicos, neurofibromatose e ausênçia de supressão tumoral.Apresenta crescimento lento, 0,25 a 0,4 mm/ano, variando de acordo com a localização, sendo que os tumores intracanaliculares apresentam crescimento mais lento que os extracanaliculares.Quando microscópicos, apresentamse assintomáticos até a idade adulta.Entretanto, tumores não tratados podem levar à compressão do tronco cerebral, aumento da pressão intracraniana e até morte.Objetivo: Estabelecer uma revisão de literatura acerca das condutas neurocirúrgicas pertinentes aos casos de schwannoma vestibular avaliando as possíveis complicações e o risco cirúrgico lesivo de estruturas adjacentes.Metodologia: Procedeu-se a revisão sistemática por meio de pesquisa, sendo selecionados 20 artigos da base de dado SCIELO e Pubmed no periodo de 2007 a 2019.Resultados: As abordagens relacionadas ao schwannoma do oitavo par craniano são indicadas quando se faz presente os efeitos compressivos sobre o tronco cerebral, são elas; via fossa média, via suboccipital retrosigmoide e via retrolabiríntica, todas indicadas para ressecção cirúrgica completa do tumor.A técnica de dissecção extracisternal foi mais comumente usada associada à abordagem suboccipital.A partir da craniotomia retrosigmoide e drenagem do líquor da cisterna magna, o conduto auditivo interno é aberto dando início à visualização do tumor, ressecção da capsula, postergando a região proximal do CAI devido sua maior aderência, mantendo sempre íntegra a aracnóide como um marcador de limite anatômico com outras estruturas nervosas.Conclusões: A preservação da aracnoide mater como limite cirúrgico está relacionada com um menor risco de lesão do nervo facial, que compartilha trajetória com o vestíbulococlear pelo CAI, com 93% dos pós-operatórios tendo a função preservada ou
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Hearing preservation is exceedingly difficult in vestibular schwannoma surgery, especially with increasing tumor size. We herein report a case of hearing preservation in a 2.7 cm vestibular schwannoma, where the patient maintained her pre-operative hearing threshold of 55 dB till a year after surgery. Hence, it appears that an attempt at hearing preservation is worth pursuing.
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Vestibular schwannomas are benign, slow-growing tumors that originate from Schwann cells lining the vestibular nerves, most commonly the superior vestibular nerve. They arise at the neurilemmal/neuroglial junction which is situated within the internal auditory canal. They have an incidence of 1 per 100,000 per year and a prevalence of around 700 per million. A case of a patient undergoing a period of observation for a vestibular schwannoma whose hearing improved despite growth of the tumor is described. This raises interesting questions regarding the pathophysiology of hearing loss in patients with vestibular schwannomas. Possible hypotheses are discussed.
Vestibular nerve
Neuroma
Acoustic neuroma
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Currently, cerebellopontine angle tumor and, more specifically, vestibular schwannoma is diagnosed using magnetic resonance imaging (MRI). The main reason to perform an MRI scan is to determine asymmetrical sensorineural hearing loss. The extent of asymmetry differs in the presentation of vestibular schwannoma, making it difficult to determine when to perform imaging diagnostics. Several studies have determined the probability of the presence of a cerebellopontine angle lesion using different audiological protocols. Further, there is also a cost aspect: what are the accepted sensitivity and specificity of these protocols? In this study, we reviewed the existing protocols.
Acoustic neuroma
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Vestibular schwannomas are, on average, slowly growing tumors that may remain quiescent for some time before manifesting themselves symptomatically or being found incidentally on imaging. We describe a case of a vestibular schwannoma that grew rapidly and to a large size in a patient who had undergone negative imaging 5 years earlier for unrelated issues. This case highlights the importance of repeat imaging in patients with symptoms concerning for vestibular schwannoma who might have previously undergone negative scans.
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