Diagnosis Of Vestibular Schwannoma Research Articles

The Association Between Medicaid Expansion and Disparities in Vestibular Schwannoma Incidence.

The effect of Medicaid expansion as a part of the Affordable Care Act on vestibular schwannoma (VS) incidence overall and in marginalized populations has not yet been elucidated. The goal of this study was to determine if Medicaid expansion was associated with increases in VS incidence overall, as well as in patients of non-white race or in counties of low socioeconomic status (SES). We performed a difference-in-difference (DiD) analysis from January 1st 2010-December 31st 2017 utilizing the Surveillance, Epidemiology, and End Results (SEER) database. Our DiD method compared the change in VS rate between counties that did and did not expand Medicaid among patients of white and non-white race, in low and high SES counties, before and after expansion. The study included 17,312 cases across 1020 counties. Medicaid expansion was associated with a 15% increase (incidence rate ratio 95% CI: [11%, 19]) in VS incidence. White populations saw a 10% increase (CI: [1.06, 1.19]), Black populations saw a 20% increase (CI: [1.10, 1.29]), and patients of other races saw a 44% increase in incidence associated with expansion (CI: [1.21, 1.70]). Low SES counties saw an increase in incidence 1.12 times higher than that of high SES counties (CI:[1.04, 1.20]). Medicaid expansion was associated with increases in VS incidence across populations. Furthermore, this increase was more evident in disadvantaged populations, such as patients of non-white race and those from low SES counties. These findings emphasize the impact of Medicaid expansion on healthcare utilization for VS diagnosis. Step/Level 3-Retrospective Cohort Study Laryngoscope, 2024.

Cerebellopontine angle tumor presenting as acute audiovestibular syndrome

Background Acute audiovestibular deficits may be a harbinger of vestibular schwannoma (VS). Objective To investigate clinical and laboratory features of 25 consecutive patients with VS presenting with acute audiovestibular deficits. Methods A symptomatic combination of acute audiovestibular deficits was investigated. Audiometric and vestibular function tests, and internal auditory canal magnetic resonance imaging (IAC MRI) results were evaluated. Results Varying combinations of symptoms may develop in VS patients with acute audiovestibular deficits, of whom sudden hearing loss (HL) without acute vertigo or acute facial nerve palsy (FNP) was most common. The most common audiometric configuration was high-tone hearing loss, and no patient showed low-tone hearing loss. IAC MRI demonstrated that the tumor had an intracanalicular portion and attachment to the bony IAC wall in all patients and widened the IAC wall in some patients. Conclusion Different symptomatic combinations of acute audiovestibular deficits may develop in patients with VS. Awareness about the possibility of VS as a cause of sudden HL, acute vertigo, and acute FNP, as well as subsequent IAC MRI scanning is vital to earlier diagnosis of VS in these patients.

Socioeconomic determinants impact quality of life at vestibular schwannoma diagnosis

BackgroundSocioeconomic variables including race, education, and income have been shown to affect vestibular schwannoma incidence, treatment, and outcomes. We sought to determine the impact of socioeconomic factors on quality of life at the time of vestibular schwannoma diagnosis. MethodsRetrospective cohort study conducted at a tertiary academic center. All patients evaluated for vestibular schwannoma from March 1, 2010 to December 31, 2021 who completed at least one Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire at presentation or prior to any intervention were included. PANQOL scores were compared across income quintiles, racial groups, and health insurance categories. ResultsTwo-hundred and ninety-six patients who had non-missing information on variables of interest were included. Compared to White/Caucasian patients (84.5 %), Black/African American patients (4.7 %) had significantly lower PANQOL total scores (b = -12.8[-21.7, −4.0], p = 0.005). Compared to patients with Commercial insurance (53 %), patients who were Uninsured/ Self-pay (1.7 %) had significantly lower PANQOL total scores (b = -16.7[-31.4, −1.9], p = 0.027). Patients in higher income quintiles had significantly higher PANQOL total scores (b = 11.7[3.9, 19.5], p = 0.004 comparing highest income quintile to lowest). After controlling for potential confounders, income quintile (b = 9.6[1.3, 17.9], p = 0.023 comparing highest quintile to lowest) and insurance (b = -17.0[-31.9, −21], p = 0.025 comparing Uninsured/Self-pay to Commercial insurance) remained predictors of total PANQOL score. ConclusionsSocioeconomic factors including race, health insurance, and income appear to contribute to quality of life at the time of vestibular schwannoma diagnosis. These variables are interrelated and the effects of race may be mediated in part by differences in income and health insurance coverage.

Vestibular schwannomas with neuroimaging signs of spontaneous regression: frequency of continued growth after surgery

Purpose. To determine the frequency of continued growth after surgical treatment in patients with neuroimaging signs of spontaneous regression of vestibular schwannoma. Material and methods. The study included 55 patients with histologically verified vestibular schwannoma. For a comparative assessment of the results of the study, 2 groups were formed: group I included 58.2 % of patients who had no signs of spontaneous regression (gender ratio — 1:4, more often — women), group II included 41.8 % of patients with the presence of one of the MR signs of regression (gender ratio was 1:1.3). The following parameters were analyzed as the studied MR characteristics: the presence of scalloped borders, the filling of the internal auditory canal with cerebrospinal fluid, and the heterogeneity of the accumulation of contrast agent by the tumor. The retrosigmoid access was used for the patients of the studied groups. Results. The patients with these neuroimaging parameters were characterized by a prolonged asymptomatic period which led to the diagnosis of vestibular schwannoma in the late stages — KOOS 4 (𝜒2=4.8; p<0.03). In the patients with MR characteristics of spontaneous regression with any size of vestibular schwannoma, a high frequency of continued growth after surgical treatment was revealed (p<0.05), which demonstrates the «aggressiveness» of the course of the disease. The results obtained indicate the need for increased oncological alertness in these patients. Conclusions. A detailed study of the MR characteristics of spontaneous regression of vestibular schwannomas can improve the patients’ quality of life and treatment outcomes.

Steroid Efficacy on Audiologic Recovery in Patients With Sudden Sensorineural Hearing Loss and Vestibular Schwannoma: A Retrospective Review.

The objectives of this study are to (i) estimate the incidence of vestibular schwannoma (VS) among patients in an integrated healthcare system who present for evaluation of sudden sensorineural hearing loss (SSNHL) and (ii) evaluate the efficacy of empiric steroid therapy on audiologic recovery among SSNHL patients ultimately diagnosed with VS. A retrospective chart review was performed on patients presenting with SSNHL in 2021 at a multicenter integrated healthcare system serving over 4 million members. Patient demographics, audiometric data, VS diagnosis, therapeutic steroid intervention, and data regarding treatment response were recorded. A clinically significant audiometric improvement was defined as (i) an increase of 15% in word recognition score, (ii) a decrease of 15 dB in four-frequency pure-tone average (PTA) using frequencies of 500, 1000, 2000, and 4000 Hz, or (iii) a PTA of <20 dB on follow-up audiogram. Six hundred fifty-eight patients were reviewed, of which 309 (56.0% male; mean, 57.5 years) met the inclusion criteria with audiometric data and magnetic resonance imaging data. Ten patients (70.0% male; mean, 51.3 years) were found to have VS. Of these, five patients received oral steroid therapy alone, and five had combination therapy (oral + intratympanic steroid injections). No patients received intratympanic steroid therapy alone. Median PTA improvement with steroid therapy was 3.1-dB hearing loss, and median word recognition score improvement was 16.5%. Six of 10 patients demonstrated clinically significant audiometric improvement with steroid therapy. This study represents the largest US-based study showcasing the prevalence of VS in patients originally presenting with SSNHL. It also reinforces previous findings that VS does not preclude trials of steroid therapy.

Diagnosis of vestibular schwannoma following an 11-year interval of head and neck manifestations: case report.

The vestibular schwannoma (VS) is a benign peripheral nerve sheath tumor involving the vestibulocochlear nerve. Affected patients typically experience a gradual emergence of episodic imbalance and unilateral hearing loss, tinnitus, and headache. Less often, VS may be associated with facial pain; ocular, otic and taste disturbance; paresthesia of the tongue and face; and temporomandibular disorder-like presentations. There is limited information in the dental literature relating the myriad of oral and maxillofacial manifestations of VS. The objective of this article is to underscore the importance for dental clinicians to seek clinicopathologic correlations with VS-related symptomatology, potentially resulting in a timelier diagnosis and improved patient outcomes. To convey this clinical challenge, a detailed narrative of a 45-yearold patient with a 11-year delay in diagnosis has been reported. In addition, the typical radiographic appearance of an implanted cranial device placed following VS resection has been provided.

AKT question relating to diagnosis of vestibular schwannoma

AKT question relating to diagnosis of vestibular schwannoma

AKT answer relating to diagnosis of vestibular schwannoma

AKT answer relating to diagnosis of vestibular schwannoma

Incidental findings on magnetic resonance imaging of the internal auditory meatus for vestibular schwannoma: a systematic review.

Magnetic resonance imaging of the internal auditory meatus is a highly sensitive and specific way to diagnose vestibular schwannoma. However, the rate of incidental findings with this method is believed to be high and can lead to increased patient anxiety and health interventions with unclear benefit. A systematic review of the literature was performed using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify incidental findings from magnetic resonance imaging of the internal auditory meatus; 12 studies were identified for inclusion within this review. A total of 10 666 patients were included within the review. The overall rate of diagnosis of vestibular schwannoma was 0.87 per cent; 21 per cent of the study population had incidental findings on magnetic resonance imaging of the internal auditory meatus, and 9.56 per cent had clinically significant incidental findings. Standardised pre-scan counselling may mitigate the risks of overdiagnosis, but future work should be undertaken to assess the benefits of such a strategy as well as the exact significance of some incidental findings.

Can I Diagnose a Vestibular Schwannoma Using Non-Contrast Imaging?

&#x0D; &#x0D; &#x0D; &#x0D; “I have an adult patient with new-onset unilateral sensorineural hearing loss. I would like to rule out a vestibular schwannoma by performing an MRI exam. However, the patient has a kidney problem that prevents him from receiving contrast material. Can I still diagnose a vestibular schwannoma using a non-contrast imaging study?”&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; The answer to this question is ... YES! At the current time, gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) is considered the gold standard for the diagnosis of vestibular schwannomas.1 However, the use of gadolinium-based contrast material may be contraindicated in patients with impaired renal function, in those who have had an allergic reaction to such contrast material, and in patients who are or may be pregnant.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; High-resolution T2-weighted MR sequences as a means of visualizing the fluid-filled inner ear and the 7th and 8th cranial nerves in the internal auditory canal and cerebellopontine angle cistern was described in the early 1990’s.2 These steady-state imaging sequences currently include various manufacturer-specific sequences such as CISS (Constructive Interference into Steady State, Siemens), FIESTA-C (Fast Imaging Employing Steady-state Acquisition Cycled Phases, GE), DRIVE (Driven Equilibrium Radiofrequency Reset Pulse, Philips), bFFE (Balanced Fast Field Echo, Philips) and SPACE (Sampling Perfection with Application optimized Contrasts using different flip angle Evolutions, Siemens).3 The submillimeter-resolution images from these sequences can be manipulated on computer-based DICOM imaging software to provide reformatted images in non-orthogonal planes that allow visualization of the entire 8th cranial nerve, from the brainstem to the fundus of the internal auditory canal. In these sequences, cerebrospinal fluid (CSF) displays a high signal intensity that provides an excellent contrasting background to the inherent low signal intensity of the 7th and 8th cranial nerves. (Figure 1)&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Similar to the nerves, a vestibular schwannoma will appear as a low-intensity (dark) filling defect that may be nodular, oblong, or ice cream cone-shaped, and located in the internal auditory canal and/or the cerebellopontine angle cistern immediately adjacent to it. (Figure 2)&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; In evaluating a patient for the presence of a vestibular schwannoma, the current medical literature indicates that high-resolution T2- weighted imaging sequences have a high sensitivity and specificity compared to gadolinium-enhanced T1-weighted imaging. However, T2-weighted imaging alone may not detect inflammatory, infectious or malignant conditions that may also present with sensorineural hearing loss.1 As such, a gadolinium-enhanced T1-weighted sequence will be needed when such conditions are suspected.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Finally, local experience with institutions that perform imaging of the internal auditory canal and cerebellopontine angle shows that not all centers routinely perform the high-resolution T2-weighted imaging sequences. Therefore, it would be prudent to specifically indicate the need for “a T2-weighted imaging sequence with submillimeter- resolution, such as the CISS or FIESTA-C sequence” in the imaging request, in order to ensure the performance of the appropriate imaging strategy.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

The Diagnostic Accuracy of Pure-Tone Audiometry Screening Protocols for Vestibular Schwannoma in Patients with Asymmetrical Hearing Loss-A Systematic Review and Meta-Analysis.

(1) Background: Magnetic resonance imaging (MRI) is the gold standard investigation for all patients who present with asymmetrical hearing loss (AHL) and a high index of suspicion for vestibular schwannoma (VS). However, pure-tone audiometry (PTA) is an investigation that can be used for the screening of these patients in order to reduce the costs. The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of different PTA protocols for VS in patients with ASHL, when compared with MRI; (2) Methods: Medline, Embase, and Cochrane databases were used to find relevant studies. All prospective and retrospective observational studies that evaluated the accuracy of PTA protocols for the screening of VS were assessed, according to the international guidelines; (3) Results: We analyzed seven studies (4369 patients) of poor-to-moderate quality. Their pooled sensitivity was good (0.73-0.93), but their specificity was low (0.31-0.60). All protocols were located in the right lower quadrant on the likelihood scattergram, and the post-test probabilities for positive and negative diagnosis of these protocols were extremely low; (4) Conclusions: PTA protocols cannot be used for a proper screening or diagnosis of vestibular schwannoma despite their good sensibility, and MRI remains the gold standard for this purpose.

Use of a Novel Clinical Decision-Making Tool in Vestibular Schwannoma Treatment.

To determine the usefulness of a personalized tool and its effect on the decision-making process for those with vestibular schwannoma (VS). Prospective study. Single institution, academic tertiary care lateral skull base surgery program. Patients diagnosed with VS. A comprehensive clinical decision support (CDS) tool was constructed from a previously published retrospective patient-reported data obtained from members of the Acoustic Neuroma Association from January to March 2017. Demographic, tumor, and treatment modality data, including associated side effects, were collected for 775 patients and integrated in an interactive and personalized web-based tool. Pre- and posttool questionnaires assessing the process of deciding treatment for VS using a decisional conflict scale (DCS) and satisfaction with decision (SWD) scale were compared. A pilot study of 33 patients evaluated at a single institution tertiary care center with mean ± SD age of 63.9 ± 13.5 years and with average tumor size of 7.11 ± 4.75 mm were surveyed. CDS implementation resulted in a mean ± SD total DCS score decrease from 43.6 ± 15.5 to 37.6 ± 16.4 ( p < 0.01) and total SWD score increase from 82.8 ± 16.1 to 86.2 ± 14.4 ( p = 0.04), indicating a significant decrease in decisional conflict and increase in satisfaction. Implementing a decision-making tool after diagnosis of VS reduced decisional conflict and improved satisfaction with decision. Patients considered the tool to be an aid to their medical knowledge, further improving their comfort and understanding of their treatment options. These findings provide a basis for developing predictive tools that will assist patients in making informed medical decisions in the future.

Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review.

Management of vestibular schwannoma (VS) is a complex process aimed at identifying a clinical indication for fractionated stereotactic radiotherapy (sRT) or microsurgical resection or wait and scan (WS). The aim of the review was to clarify which patient and tumor parameters may lead to different therapeutic choices, with a view to a personalized VS approach. A systematic review according to Preferred Reporting Items for Systematic Review and Meta-Analysis criteria was conducted between February and March 2022. The authors defined six parameters that seemed to influence decision-making in VS management: 1-incidental VS; 2-tumor size; 3-tumor regrowth after sRT; 4-subtotal resection; 5-patients’ age; 6-symptoms. The initial search yielded 3532 articles, and finally, 812 articles were included. Through a qualitative synthesis of the included studies, management strategies were evaluated and discussed. An individualized proposal of procedures is preferable as compared to a single gold-standard approach in VS decision-making. The most significant factors that need to be considered when dealing with a VS diagnosis are age, tumor size and hearing preservation issues.

Development and validation of a new disease-specific quality of life instrument for sporadic vestibular schwannoma: the Mayo Clinic Vestibular Schwannoma Quality of Life Index.

Facial nerve function, hearing preservation, and tumor control have been the primary benchmarks used to assess vestibular schwannoma (VS) outcomes. Acknowledging the frequent discrepancy between what physicians prioritize and what patients value, there has been increasing prioritization of patient-reported outcome measures when evaluating the impact of VS diagnosis and its treatment. Motivated by reported limitations of prior instruments used to assess quality of life (QOL) in patients with VS, the authors describe the development and validation of a new disease-specific QOL measure: the Vestibular Schwannoma Quality of Life (VSQOL) Index. The content development phase comprised identification of clinically important domains and prioritization of feelings or concerns individuals with VS may have. The validation phase encompassed determining how items were grouped into domains and eliminating redundant items. Both phases leveraged data from cross-sectional and longitudinal surveys, expertise from a multidisciplinary working group, and patients with a broad range of experiences with VS (n = 42 during content development and n = 263 during validation). Domain scores from the new instrument were assessed for reliability and correlation with other measures of similar constructs. The VSQOL Index consists of 40 items that evaluate the impact of VS diagnosis and its management on QOL, treatment satisfaction, and employment and is estimated to take 8-10 minutes to complete. Domain scores range from 0 (worst) to 100 (best) and demonstrate excellent psychometric properties, including content, construct, and convergent validity and both internal consistency (Cronbach's alphas 0.83 to 0.91) and test-retest reliability (reliability coefficients 0.86 to 0.96). The VSQOL Index is a valid and reliable measure that overcomes several limitations of prior instruments, including omission or underrepresentation of domains that frequently impact well-being, such as pain, cognition, satisfaction or regret surrounding treatment decisions, and occupational limitations, to comprehensively evaluate the impact of VS diagnosis or its treatment on QOL.

Vestibularisschwannome – Basis- und Verlaufsdiagnostik

Vestibular (vestibulocochlear) schwannomas are rare, benign schwannomas of the cerebellopontine angle, the internal auditory canal, or the inner ear. They can occur with or without clinical symptoms. The most common symptoms are unilateral or side-differentiated hearing loss with or without tinnitus and balance disorders. Initial symptomatology is nonspecific in the basic functional diagnosis, raising the question of when a hearing or balance disorder should be thought of as a differential diagnosis of vestibular schwannoma and what diagnostic pathway is appropriate. This concerns not only the confirmation of the diagnosis and the recording of all dysfunctions of the involved cranial nerves in the initial basic diagnostics, but also the procedure in the course and follow-up diagnostics - especially in patients who are subject to an observation strategy. Today, imaging alone is no longer sufficient for differentiated and individualized patient counseling. Due to the increasing detection of smaller tumors on MRI and the growing proportion of nearly asymptomatic patients, a shift in thinking from pure imaging monitoring to a detailed analysis of auditory and vestibular function is timely. In this educational article, diagnostic pathways for a sufficient patient consultation will be compiled. Ultimately, functional examination techniques from follow-up and progression diagnostics will also be included.

Efficacy of steroid treatment for sudden sensorineural hearing loss in patients with vestibular schwannoma

Background Sudden sensorineural hearing loss (SSNHL) has several aetiologies and may be a presenting symptom of vestibular schwannoma (VS). Objectives The aim of this study was to investigate the recovery rate after steroid treatment and the prognostic factors of SSNHL with VS. Materials and Methods This was a retrospective observational study wherein 32 patients with VS who presented with SSNHL were analysed at a tertiary referral centre. Hearing gain and prognostic factors were the main outcome measures for steroid treatment intervention. Results Among the 1698 patients presenting with SSNHL, VS was found in 43 (2.5%) patients. Eleven cases (34.3%) showed good recovery, with significant improvements in the pure-tone audiometry values. Even though age was a significant factor, there were no associations between steroid response and initial hearing level, presence of vertigo, tumour size, and tumour extension. Conclusions and Significance Our study showed that hearing recovery of SSNHL does not exclude a VS diagnosis. We suggest that steroid treatment be considered in patients with VS presenting SSNHL.

Sporadic Vestibular Schwannoma Size and Location Do not Correlate With the Severity of Hearing Loss at Initial Presentation

Vestibular schwannoma (VS) is a non-malignant intracranial neoplasm arising from the vestibular branch of the 8th cranial nerve; sensorineural hearing loss (SNHL) is the most common associated symptom. Understanding whether VS imaging characteristics at the time of VS diagnosis can be associated with severity of VS-induced SNHL can impact patient counseling and define promising areas for future research. Patients diagnosed with VS at Massachusetts Eye and Ear (MEE) from 1994 through 2018 were analyzed if magnetic resonance imaging at VS presentation and sequential audiometry were available. Results were compared with original studies available in PubMed, written in English, on VS imaging characteristics and their impact on hearing in patients. A total of 477 patients with unilateral VS from the MEE database demonstrated no significant correlation between any features of tumor imaging at the time of VS diagnosis, such as VS size, impaction or location, and any hearing loss metric. Twenty-three published studies on the impact of VS imaging characteristics on patient hearing met inclusion criteria, with six solely involving NF2 patients and three including both sporadic and NF2-related VS patients. Fifteen studies reported a significant relationship between SNHL and at least one VS imaging characteristic; however, these trends were universally limited to NF2 patients or involved small patient populations, and were not reproduced in larger studies. Taken together, SNHL in sporadic VS patients is not readily associated solely with any tumor imaging characteristics. This finding motivates future studies to define how VS microenvironment and secreted molecules influence VS-induced SNHL.

Changes in pattern of presentation of patients with unilateral vestibular schwannoma over two decades: Influence of cell phone use in early diagnosis

We aimed to study whether the increased use of cell phone in south Asia over the past two decades has impacted presentation of patients with vestibular schwannoma (VS). In this observational cohort study, data on cell phone use and severity of hearing loss and tumor size was collected using a questionnaire through a patient interview (n = 62) in consecutive patients with VS managed between 2017 and 2020. Association between cell phone use and severity of hearing loss and tumor size were studied and compared with our data published earlier when telephone use was not widely prevalent. 71% of the 62 patients (aged between 15 and 81 years) had large or giant VS. Pure tone audiometry showed moderately severe or profound hearing loss in77.4%. Sixty (96.7%) patients used cell phones. 50% of patients complained of difficulty in using their cell phone because of hearing loss. Compared to the earlier era, a higher proportion consulted an ENT surgeon first for hearing loss (59.7% vs 26%; p = 0.0005) and had small or medium sized tumors (29% vs 8%; p = 0.008) with a smaller mean tumor size (3.3 vs 3.9 cm; p = 0.03). Increased cell phone use has led to earlier diagnosis of VS and smaller tumours in recent years when compared to an earlier era. However, the vast majority of patients continue to present with severe to profound hearing loss and large tumors.

P12.09 Clinical features and management of normal pressure hydrocephalus associated with non-obstructive vestibular schwannoma

Abstract BACKGROUND Some (elderly) patients present a communicating (normal pressure) hydrocephalus (NPH) in association with or secondary to vestibular schwannoma (VS). We aim to investigate the usefulness ventriculo-peritoneal shunt (VPS) without tumor removal. MATERIALS AND METHODS 8 patients aged from 50 to 78 years received both diagnosis of VS (mean maximum diameter 21 mm, range 13–28 mm) and NPH. None presented the classical Hakim’s triad. They presented isolated ataxia with gait impairment and loss of equilibrium. It was hard to distinguish if these symptoms were due to NPH or to VIII cranial nerve compression. They underwent TAP test, through a lumbar puncture with a very slow whithdrawal of at least 30 ml of cerebrospinal fluid (CSF). RESULTS None of the 8 patients presented improvement after lumbar puncture. Despite this, we decided to proceed with VPS in 4 patients because of a high risk of falls.... All these 4 patients showed clinical improvement after VPS.. The VS were treated as follows: 4 surgery, 2 radiosurgery, 2 observation. CONCLUSIONS Although some authors indicate VS removal as the best option to improve also NPH symptoms, some patients present high risk of falls in the presence of a small VS. These clinical features are more likely to be relayed related to NPH instead of VS.. VPS carries lower postoperative risks compared to VS removal. For this reason, VPS has to be considered, even without a positive response to a TAP test, as a good alternative to improve quality of life in patient affected by NPH associated with VS.

MRI T2-Weighted Cochlear Intensity as a Predictor of Hearing Loss with Vestibular Schwannoma Patients

Abstract Objective It is difficult to predict how hearing loss will progress with vestibular schwannomas (VSs) and to determine the optimal time for hearing preservation interventions. This study investigated the relationship between cochlear intensity on T2-weighted magnetic resonance imaging and hearing loss in VS patients over time. Design Retrospective cohort study. Setting Single major academic center. Participants Patients with a diagnosis of VS from 2007 to 2018. Main Outcome Measures Pure tone average (PTA) and cochlear-to-pontine relative signal intensity (RSI) measured at two time points. Results Fifty patients were included in the final analysis. For both affected and unaffected ears, the trend in PTA increased from baseline to follow-up. For affected ears, the trend in RSI increased from baseline to follow-up, while for the unaffected ears RSI decreased. There was a significant positive correlation between the initial RSI value in the ipsilateral ear when compared with the change in PTA from baseline to follow-up (r = 0.28, p = 0.048). Conclusion There is a trend between initial RSI and how hearing changes in the affected ears of patients with VS. Additional studies are needed to explore how this relationship may be better used to predict hearing loss.