Cyclin D1 Expression and Facial Function Outcome After Vestibular Schwannoma Surgery
Luis LassalettaLaura Del Rı́oMiguel Torres‐MartínJuan A. ReyMercedes PatrónRosário MaderoJ.M. RodaJaviér Gavilán
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The proto-oncogen cyclin D1 has been implicated in the development and behavior of vestibular schwannoma. This study evaluates the association between cyclin D1 expression and other known prognostic factors in facial function outcome 1 year after vestibular schwannoma surgery.Sixty-four patients undergoing surgery for vestibular schwannoma were studied. Immunohistochemistry analysis was performed with anticyclin D1 in all cases. Cyclin D1 expression, as well as other demographic, clinical, radiologic, and intraoperative data, was correlated with 1-year postoperative facial function.Good 1-year facial function (Grades 1-2) was achieved in 73% of cases. Cyclin D1 expression was found in 67% of the tumors. Positive cyclin D1 staining was more frequent in patients with Grades 1 to 2 (75%) than in those with Grades 3 to 6 (25%). Other significant variables were tumor volume and facial nerve stimulation after tumor resection. The area under the receiver operating characteristics curve increased when adding cyclin D1 expression to the multivariate model.Cyclin D1 expression is associated to facial outcome after vestibular schwannoma surgery. The prognostic value of cyclin D1 expression is independent of tumor size and facial nerve stimulation at the end of surgery.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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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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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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Vestibular schwannoma (VS) is a benign tumor that develops in the internal auditory canal and the cerebellopontine angle, potentially diminishing hearing or balance. Most VS tumors arise from one of two vestibular branches: the superior or inferior vestibular nerve. Determining the specific nerve of origin could improve patient management in terms of preoperative counseling, treatment selection, and operative decision-making and planning. The aim of this study was to assess a novel scoring system that was designed to predict the nerve of origin.
Vestibular nerve
Acoustic neuroma
Vestibulocochlear nerve
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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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Abstract A vestibular schwannoma in an only hearing ear is a difficult management problem. A case is presented of a patient who had a Nucleus-22 channel device implanted into a nonfuctioning ear and auditory rehabilitation prior to resection of a large vestibular schwannoma in the contralateral ear.
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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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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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