The Preoperative Diagnostic Value of MRI and Otoneural Tests in Acoustic Neuroma.

Qingqing Dai,Hong Zheng,Meijun Zheng,Bilan Li,Qiurong Chen

doi:10.3389/fonc.2021.626485

Abstract

ObjectivesTo determine the preoperative diagnostic accuracy of MRI and otoneural tests (ONT) for acoustic neuroma (AN) in a cohort of unselected patients with pontocerebellar angle tumors. To find a convenient way to screening out the potential asymptomatic AN patient earlier.DesignThis diagnostic accuracy study was performed in a central hospital and included a consecutive sample of unilateral incipient pontocerebellar angle tumor patients referred for MRI and ONT before surgery. Different AN features of MRI and ONT were collected and concluded into preoperative diagnostic variables or variable combinations. Those of MRI and ONT are analyzed and compared with biopsy results by multivariable receiver operating characteristic (ROC) analysis. The early-stage group, the course of which is 1 year or less, was separately computed and compared.ResultsEighty-three subjects were collected from June 2013 to June 2019; 62 were confirmed AN postoperatively by biopsy, whereas others are not AN. The area under the curve (AUC) of MRI was 0.611, whereas the AUC of ONT was 0.708. In the early-stage group, the AUC of MRI was 0.539, and the AUC of ONT was 0.744.ConclusionsONT was able to identify more subjects affected by unilateral incipient AN than MRI preoperatively. Given that ONT is a functional test for internal auditory canal nerves, it is an optimal screening test for AN patients because it provides more information than MRI for the further clinical plan. It is particularly noteworthy for identifying asymptomatic AN patients and for early stage. Therefore, it may help more patients from unnessesary surgery. Furthermore, an MRI follow-up is suggested if the patient was found alert in ONT.

Highlights

Acoustic neuroma (AN), termed vestibulocochlear schwannoma, from the Schwann cells of the vestibular division or the cochlear division, is the most common tumor in pontocerebellar angle
We studied the magnetic resonance imaging (MRI) and otoneural tests (ONT) tests that are commonly used in daily clinical practice, which are as follows: pure-tone test, speech reception threshold (SRT), speech discrimination score (SDS), videonystagmography (VNG), and caloric test
We examined the medical records of all patients diagnosed with unilateral incipient pontocerebellar angle tumors based on their MRI imaging between June 2013 and June 2019 in the neurosurgery department at West China Hospital

Summary

Introduction

Acoustic neuroma (AN), termed vestibulocochlear schwannoma, from the Schwann cells of the vestibular division or the cochlear division, is the most common tumor in pontocerebellar angle. AN is shown to represent 6% to 8% of all intracranial tumors [1]. The typically presenting complaints in AN patients are unilateral hearing loss, tinnitus, and disequilibrium. These disorders do not necessarily correlate close with tumor size or shape [2]. As the natural history of the AN is variable [3], only less than 1% of AN exhibit sufficient growth to become clinically active. The patients with small tumors that do not compress the nerves and lead dysfunction may be asymptomatic. AN patients’ managing options vary from observation, microsurgery, stereotactic radiosurgery to surgical debulking [4]

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