The causes of late diagnostics of vestibular shwannomas

Abstract

The objective of the present study was to elucidate the causes of late diagnostics of vestibular shwannomas based on the results of the analysis of the medical histories of the patients admitted to the Academician N.N. Burdenko National Medical Research Centre of Neurosurgery for the management of this condition. We undertook the retrospective review of a series of 192 cases of vestibular shwannomas in the patients treated based at the N.N. Burdenko National Medical Research Centre of Neurosurgery in 2015. The study included the analysis of demographic characteristics of the patients as well as their anamnestic and clinical data. A total of 55 (29%) patients were found to have small tumours (Samii T1-T3) whereas 137 (71%) ones presented with giant neoplasms including T4a and T4b tumours (in accordance with the Samii classification) in 63 (33%) and 74 (38%) patients respectively. The duration of the disease from the appearance of its first clinical symptoms up to the establishment of the definitive diagnosis was 41 months on the average. 37 (19%) patients appeared to have paid no attention to the unilateral impairment of hearing. 46 (24%) patients applied for the medical assistance to the therapists and neurologists. 56 (29%) patients had remained for a long time under the supervision of the ENT specialists and surdologists based at the local outpatient facilities. More than 2/3 of the examined patients presenting with vestibular shwannomas apply for the medical assistance at the late stages of the disease. Such situation can be attributed to the low level of oncological alertness among the general population and health providers, the poor awareness of the general practitioners and otorhinolaryngologists about this pathology, the unavailability or inefficient application of the modern neurovisualization technologies, in the first place magnetic resonance imaging. The problems encountered in connection with the performance of screening studies give evidence of the necessity of the introduction of up-to-date otoneurological and audiological investigations as well as the neurovisualization techniques into the everyday clinical practice for the comprehensive examination of all the patients suffering from unilateral hearing loss.