Vestibular Schwannoma Removal Research Articles

Long-Term Hearing Outcome For Vestibular Schwannomas After Microsurgery And Radiotherapy: A Systematic Review and Meta-Analysis.

Hearing loss is a common symptom associated with vestibular schwannoma (VS), either because of the tumor's effects on the cochlear nerve or due to active treatments such as surgery or stereotactic radiosurgery (SRS). Treatment decisions for VS are based on factors including tumor size, hearing status, patient symptoms, and institutional preference. The study aimed to investigate long-term auditory outcomes in VS patients undergoing active treatments with a hearing preservation intent. A systematic literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching Scopus, Pubmed, and Web of Science databases from inception to January 2024. Studies meeting inclusion criteria, including a minimum 5-year follow-up and assessment of pre- and posttreatment hearing outcomes, were included. Pooled prevalence estimates for serviceable hearing after SRS and microsurgery were calculated using MetaXL software. Risk of bias assessment was performed with the Risk of Bias in Non-randomized Studies of Interventions tool. Nine studies met the inclusion criteria, with 356 patients included for analysis. The pooled prevalence of maintaining serviceable hearing after SRS at 10 years was 18.1% (95% confidence interval [CI]: 1.7%-43.3%), with wide prediction intervals indicating variability in outcomes. Microsurgery demonstrated a higher prevalence of maintaining long-term serviceable hearing, with a pooled estimate of 74.5% (95% CI: 63.5%-84.1%). This systematic review underscores the importance of long-term follow-up in evaluating auditory outcomes in VS treatment. Despite the biases inherent to pretreatment patients selection, hearing preservation microsurgery for sporadic VS removal demonstrated favorable and stable long-term serviceable hearing.

Customized Vestibular Rehabilitation for Vestibular Schwannoma Excision via Translabyrinthine Approach: A Single-Center Experience.

Objectives: To evaluate the effectiveness of intensive customized vestibular rehabilitation after vestibular schwannoma (VS) excision. Methods: 52 patients who underwent VS removal via a translabyrinthine approach from 2020 to 2022 were involved in this study. Bedside examination, video head impulse test (vHIT), functional head impulse test (fHIT), and the dizziness handicap inventory (DHI) were performed before and after the rehabilitation, which consisted of 10 sessions of specifically designed vestibular, visual, and physical integrated training. Results: After rehabilitation, the vHIT showed overall unchanged values on the affected and healthy side. In contrast, the scores of fHIT, which explores the higher connection of the vestibular system with visual and cerebellar pathways, improved on both the pathological and healthy sides after training (p-value 0.004 and 0.000, respectively). The effectiveness of the rehabilitation was reinforced by the DHI scores, which were considerably lower after training. Conclusions: To our knowledge, this is the first study to explore fHIT outcomes after removal of VS, estimating the impact of rehabilitation on the overall compensation process. The outcomes support the role of extensive postsurgical rehabilitation in the compensatory process, even just a few days after surgery.

Vestibular Schwannoma and Tinnitus: A Systematic Review of Microsurgery Compared to Gamma Knife Radiosurgery.

Background: Vestibular schwannoma (VS) is a benign tumor of the eighth cranial nerve formed from neoplastic Schwann cells. Although VS can cause a variety of symptoms, tinnitus is one of the most distressing symptoms for patients and can greatly impact quality of life. The objective of this systematic review is to comprehensively examine and compare the outcomes related to tinnitus in patients undergoing treatment for VS. Specifically, it evaluates patient experiences with tinnitus following the removal of VS using the various surgical approaches of traditional surgical resection and gamma knife radiosurgery (GKS). By delving into various aspects such as the severity of tinnitus post-treatment, the duration of symptom relief, patient quality of life, new onset of tinnitus after VS treatment, and any potential complications or side effects, this review aims to provide a detailed analysis of VS treatment on tinnitus outcomes. Methods: Following PRISMA guidelines, articles were included from PubMed, Science Direct, Scopus, and EMBASE. Quality assessment and risk of bias analysis were performed using a ROBINS-I tool. Results: Although VS-associated tinnitus is variable in its intensity and persistence post-resection, there was a trend towards a decreased tinnitus burden in patients. Irrespective of the surgical approach or the treatment with GKS, there were cases of persistent or worsened tinnitus within the studied cohorts. Conclusion: The findings of this systematic review highlight the complex relationship between VS resection and tinnitus outcomes. These findings underscore the need for individualized patient counseling and tailored treatment approaches in managing VS-associated tinnitus. The findings of this systematic review may help in guiding clinicians towards making more informed and personalized healthcare decisions. Further studies must be completed to fill gaps in the current literature.

"To implant or not to implant": electrically evoked auditory brainstem response audiometry for decision-making in vestibular schwannoma resection with CI.

Vestibular schwannomas (VS) are often associated with debilitating hearing loss. Therefore, preservation and rehabilitation of hearing have become major therapeutic goals of VS management. Recently, cochlear implantation (CI) has been established as an effective treatment option for VS-associated hearing loss. Nevertheless, the integrity and proper function of the cochlear nerve must be evaluated before conducting CI to ensure optimal CI outcomes. Various methods to determine cochlear nerve integrity and functionality have emerged in the last few years. Of these, the use of electrically evoked auditory brainstem response audiometry (eABR) in particular has been proven to be ameaningful tool for monitoring cochlear nerve health during VS surgery. Here, the cochlear nerve can be electrically stimulated using an intracochlear test electrode before, during, and after tumor extirpation. Subsequently, the resulting brainstem responses can be measured and interpreted accordingly to obtain direct information on the cochlear nerve function. This allows for continuous monitoring of cochlear nerve function throughout the course of VS surgery and aids in the decision-making for CI candidacy. Finally, in the case of preserved brainstem responses, CI can be performed instantly after VS extirpation. This simultaneous approach offers several advantages over two-staged procedures and has been shown to be an efficient and safe procedure for restoring hearing after VS removal.

Multiple Intracranial Schwannomas of the Vestibular and Trigeminal Nerves: A Technical Note

BackgroundA schwannoma is a nerve sheath tumor that is formed by Schwann cells. Vestibular schwannomas are thought to account for the majority of intracranial schwannomas. Non-vestibular schwannomas account for about 10%, about half of which are trigeminal schwannomas. Multiple intracranial schwannomas originating from different cranial nerves are extremely rare. Observation(s)We describe the clinical case of a 42-year-old female patient with vestibular schwannoma and multiple trigeminal schwannomas. That case shows how multiple trigeminal schwannomas were identified intraoperatively during elective surgery for vestibular schwannoma removal, most of which were resected. No new neurological deficits were observed in the patient. LessonsThe presence of multiple intracranial schwannomas is extremely rare in neurosurgical practice and can change the intraoperative strategy and the course of the surgery.

Audiovestibular Findings in Patients with Concurrent Superior Canal Dehiscence and Vestibular Schwannoma.

To describe the clinical-instrumental findings in case of concurrent superior canal dehiscence (SCD) and ipsilateral vestibular schwannoma (VS), aiming to highlight the importance of an extensive instrumental assessment to achieve a correct diagnosis. Retrospective case review. Tertiary referral center. Five patients with concurrent SCD and VS. Clinical-instrumental assessment and imaging. Clinical presentation, audiovestibular findings, and imaging. The chief complaints were hearing loss (HL) and unsteadiness (80%). Other main symptoms included tinnitus (60%) and pressure-induced vertigo (40%). Mixed-HL was identified in three patients and pure sensorineural-HL in 1, including a roll-over curve in speech-audiometry in two cases. Vibration-induced nystagmus was elicited in all cases, whereas vestibular-evoked myogenic potentials showed reduced thresholds and enhanced amplitudes on the affected side in three patients. Ipsilesional weakness on caloric testing was detected in three patients and a bilateral hyporeflexia in one. A global canal impairment was detected by the video-head impulse test in one case, whereas the rest of the cohort exhibited a reduced function for the affected superior canal, together with ipsilateral posterior canal impairment in two cases. All patients performed both temporal bones HRCT scan and brain-MRI showing unilateral SCD and ipsilateral VS, respectively. All patients were submitted to a wait-and-scan approach, requiring VS removal only in one case. Simultaneous SCD and VS might result in subtle clinical presentation with puzzling lesion patterns. When unclear symptoms and signs occur, a complete audiovestibular assessment plays a key role to address imaging and diagnosis.

Hearing Rehabilitation Using Bone Conduction Implants in Patients With Single-Sided Deafness After Vestibular Schwannoma Removal

Background and Objectives Vestibular schwannoma (VS) itself or treatment of VS can cause single-sided deafness (SSD), a unilateral sensorineural hearing loss. Patients of SSD experience communication problems, which can be frustrating. For decades, many types of bone conduction implants (BCIs) have been developed and used to treat such hearing problems. In this study, we evaluated the effectiveness of BAHD surgery to treat SSD patients’ hearing impairment and analysed the complications patients suffer.Subjects and Method A retrospective chart review was conducted on 12 patients who had undergone BCIs, such as Baha Attract, Bonebridge, and Sophono implantation, after removal of VS. From 2016 to 2021, one senior surgeon at a single tertiary hospital performed surgery for SSD rehabilitation. The authors analysed the clinical features, radiologic findings (CT and MRI), hearing tests (pure tone audiogram [PTA], speech audiogram [SA], and Korea hearing in noise test), subjective satisfaction scores (abbreviated profile of hearing aid benefit), and surgical outcomes of the patients.Results All patients underwent temporal MRI, temporal bone CT scan, PTA, and SA at least 3 years after VS removal and confirmed no residual tumour or serviceable contralateral hearing at the last follow-up. Among the patients (12), eight received Baha Attract implantation, three received Bonebridge implantation, and one received Sophono implantation. On the average, patients’ ipsilateral hearing outcomes improved by 82.7 dB (from 115.8±9.8 dB to 33.1±9.5 dB).Conclusion There are many methods of hearing rehabilitation in SSD that are used after VS, but BCI seemed to be the most useful treatment.

Surgical treatment of cystic vestibular schwannoma (clinical case)

Objective: to demonstrate the result of successful treatment of a patient with cystic vestibular schwannoma. Currently, there is no single approach to choosing a surgical treatment method of cystic vestibular schwannoma. When choosing tactics, neurosurgeons are guided, as a rule, by the location of the tumor and the thickness of its walls. Emptying the cyst can also lead to a change in the existing relationship of the tumor with neighboring structures, especially with the facial nerve. The chosen method of treatment of this disease in the form of total removal of cystic vestibular schwannoma under the control of neurophysiological monitoring made it possible to achieve early activation of the patient and avoid postoperative complications, preserve the function the facial and trigeminal nerves involved in the tumor capsule.

Proteomic Shotgun and Targeted Mass Spectrometric Datasets of Cerebrospinal Fluid (Liquor) Derived from Patients with Vestibular Schwannoma

Vestibular schwannomas are relatively rare intracranial tumors compared to other brain tumors. Data on the molecular features, especially on schwannoma proteome, are scarce. The 41 cerebrospinal fluid (liquor) samples were obtained during the surgical removal of vestibular schwannoma. Obtained peptide samples were analyzed by shotgun LC-MS/MS high-resolution mass spectrometry. The same peptide samples were spiked with 148 stable isotopically labeled peptide standards (SIS) followed by alkaline fractionation and scheduled multiple reaction monitoring (MRM) for quantitative analysis. The natural counterparts of SIS peptides were mapped onto 111 proteins that were Food and Drug Administration (FDA)-approved for diagnostic use. As a result, 525 proteins were identified by shotgun LC-MS/MS with high confidence (at least two peptides per protein, FDR < 1%) in liquor samples. Absolute quantitative concentrations were obtained for 54 FDA-approved proteins detected in at least five experimental samples. Since there is lack of data on the molecular landscape of vestibular schwannoma, the obtained datasets are unique and one of the first in its field.

Long-Term Outcomes of Hearing Preservation After Retrosigmoid Removal of Large Vestibular Schwannoma.

Hearing preservation after large vestibular schwannoma (VS) removal is challenging and the long-term outcomes of postoperatively preserved hearing have not been elucidated. We aimed to clarify long-term outcomes of hearing preservation after the retrosigmoid large VS removal and to recommend a strategy for treating large VS. Hearing preservation with total/nearly total (T/NT) tumor removal was accomplished in six of 129 patients who underwent retrosigmoid large VS (≥3 cm) removal. We evaluated the long-term outcomes of these six patients. Preoperative hearing of these six patients was 15-68 dB by pure tone audiometry (PTA) (Class I: 2, II: 3, and III: 1 by the Gardner-Robertson (GR) classification). Postoperatively, magnetic resonance imaging (MRI) with gadolinium administration confirmed T/NT removal, the preserved hearing was 36-88 dB (Class II: 4 and III: 2), and no facial palsy occurred. After long-term follow-up (8-16 [median: 11.5] years), five patients maintained hearing of 46-75 dB (Class II: 1 and III: 4) while one lost hearing. Three patients showed small tumor recurrence on MRI; two recurrences were controlled by gamma knife (GK) and one showed minimal change only by observation. Hearing preserved after T/NT removal of large VS is maintained for a long time (>10 years), though tumor recurrence on MRI is somewhat common. Detecting small recurrence early, and regular MRI follow-up contributes to the long-term maintenance of hearing. Hearing preservation with tumor removal is a challenging yet worthwhile strategy in large VS patients with preoperative hearing.

Is Preoperative Facial Palsy a Deterrent to Facial Nerve Preservation after Gross-Total Removal of Giant Vestibular Schwannomas?

Abstract Background Although rare in small vestibular schwannomas, preoperative facial nerve paresis is often present in giant schwannomas. Preserving facial nerve function in these cases remains a herculean task. This study evaluates the facial functions after complete tumor removal and whether preoperative facial nerve involvement affects postoperative functional status. Methods This retrospective study from January 2014 to August 2021 excluded nongiant tumors (< 4 cm), neurofibromatosis type 2 cases, incomplete removals, redo surgeries, deaths, and cases done without nerve monitoring. These were grouped into preoperative facial palsy present (PFP) and no preoperative facial palsy (NFP). Facial nerve functions were assessed on first postoperative day, at the time of discharge, and at last follow-up and dichotomized into two groups: nondisfiguring (House–Brackmann [HB] grades I–III) and disfiguring (HB grades IV–VI). The cohort outcomes of patients with nondisfiguring PFP (HB grades I–III) were also analyzed. Results There were 88 cases (PFP, n = 57; NFP, n = 31). Facial nerve was preserved anatomically in 62 (70.45%) patients (PFP, n = 38; NFP, n = 24) without any statistical difference (p = 0.29). Statistically significant disfiguring facial outcomes (HB IV, V, VI) were seen in patients with preoperative facial palsy (p = 0.01); however, a comparison of facial functions in patients with only nondisfiguring PFP with those in NFP group did not show the statistical difference (p = 0.12). Conclusions Facial nerve palsy present before surgery does not seem to be a deterrent to intraoperative preservation of facial nerve during complete removal of giant vestibular schwannomas. Patients with nondisfiguring facial palsies have postoperative facial functions comparable to those without facial palsy.

Microsurgery for vestibular schwannoma: analysis of short-term clinical outcome

BackgroundTotal removal of the vestibular schwannoma when preserving the function of the facial nerve is difficult. The objective of the current study was to investigate the short-term clinical outcome of vestibular schwannoma removal via retro-sigmoid approach.MethodsOne-hundred consecutive patients diagnosed with vestibular schwannoma were surgically treated between December 2018 and August 2019 in Xuanwu Hospital, Capital Medical University. The clinical classification, surgical position, gross total removal rate, the anatomical and functional preservation rates of facial nerve, and the postoperative complications were retrospectively analyzed.ResultsAll 100 patients including 34 males and 66 females were operated on via retro-sigmoid approach. According to Koos vestibular schwannoma grading system, 18 cases were grade 2, 34 cases were grade 3, and 48 cases were grade 4. According to Hannover vestibular schwannoma grading system, 5 cases were T2, 6 cases were T3a, 8 cases were T3b, 30 cases were T4a, and 51 cases were T4b. Seventy-three surgeries were performed under lateral position, and 27 cases were operated under semi-sitting position. The gross total removal rate was 90.0%; the anatomic reservation rate of the facial nerve was 96.0%. According to the House-Brackman system, the facial nerve function was grades 1–2 in 78.0% cases, grade 3 in 7.0% cases, and grades 4–5 in 15% cases. For patients with effective hearing before operation, the hearing reservation rate was 19.0%. Two patients (2.0%) developed intracranial hematoma after operation.ConclusionMost vestibular schwannoma could be completely removed with good postoperative facial nerve function. If total removal of tumor is difficult, we should give priority to the functional preservation of the nerve function.

Early reinnervation of facial muscles after removal of large and giant vestibular schwannomas

Removal of large and giant vestibular schwannomas is associated with the risk of paresis of facial muscles. The probability of anatomical damage to the facial nerve is 10.3–14.0%. Treatment of mimic muscle paralysis is one of the most difficult problems in reconstructive surgery. In this study, the results of neurotization of the facial nerve by masticatory were evaluated in 4 patients after its damage during the removal of large and giant vestibular schwannomas. Neurotization was carried out 10–14 days after tumor removal. With direct neurotization of the facial nerve by masticatory in all patients, it was possible to achieve the function of mimic muscles, corresponding to grade II–III according to the House–Brackmann scale. The use of an autoinsert from the greater ear nerve led to a worse result (House–Brackmann IV).

Vestibular schwannoma removal through expanded transcanal transpromontorial approach: a multicentric experience.

Expanded Transcanal Transpromontorial Approach (ExpTTA) is an endomicroscopic technique that allow surgical excision of small and symptomatic neuromas limited to the internal auditory canal (IAC) or minimally invasive the cerebellopontine angle (CPA). ExpTTA is a safer alternative to the exclusive endoscopic technique as it allows a wider surgical field and better management of the auditory porus and CPA. We report a retrospective case series of 34 patients who underwent ExpTTA between 2017 and 2022 at the ENT Departments of the University Hospital of Modena, Bologna and Verona. Tumor size was defined according to the Koos staging and hearing function was classified according to the AAOHNS. A clinical evaluation of facial nerve (FN) function was performed using the House and Brackman scale (HBs). Our cohort consists of 34 patients. At time of surgery all patients had a normal preoperative facial function. Gross total resection was achieved in all patients, without intraoperative complications, and FN continuity was preserved in all cases. No major complications were observed. Regarding post-operative FN function, at hospital discharge ten patients had impairment equal or greater than IV grade according to H&Bs. At 6months after surgery only two patients presented with moderate/severe facial paralysis (grade IV H&Bs) and finally at 12-month follow-up all patients had a satisfactory recovery of nervous function (grade < III H&Bs). ExpTTA is a safe and effectively technique for treatment of small VS (Koos I, II and selected cases of Koos III) with low postoperative morbidity.

The "Deep Subarcuate Fossa" sign and three types of anomalous subarcuate loops encountered during vestibular schwannoma removal.

An anomalous subarcuate loop (SL) of the anteroinferior cerebellar artery (AICA) is a rare anatomic variation, which increases the complexity and risk of vestibular schwannoma (VS) removal. However, preoperative diagnosis of this anomaly remains difficult. The aim of this study was to report three types of anomalous SLs encountered during VS removal and to describe the "Deep Subarcuate Fossa (SF)" sign and its significance in the diagnosis and treatment of an osseous-penetrating SL. We prospectively observed 963 patients with newly/recently diagnosed VS who underwent surgical treatment performed by the senior author (P.Z.) from 2012 to 2021 and identified 16 patients with an anomalous SL. The SF was retrospectively measured on preoperative thin-slice temporal bone computed tomography in 963 patients. Three types of anomalous SLs were encountered during VS removal: the apex of the SL was embedded in the dorsal tumor capsule (type I, 1 case), the dura (type II, 8 cases), or the dura and bone (type III, 7 cases) surrounding the SF. The depth of the SF in 7 patients with a type III anomalous SL ranged from 2.3 to 7.0mm (3.56 ± 1.56mm), which was significantly larger than that in 845 patients without an osseous-penetrating SL (1.23 ± 0.43mm) (p = 0.008). When the depth of the SF exceeded 2mm, the sensitivity and precision of the diagnosis of a type III anomalous SL were 100% (7/7) and 31.8% (7/22), respectively. Three types of anomalous SLs may be encountered during VS removal, and AICA displacement is recommended before tumor removal. The "Deep SF" sign may indicate the existence of a type III anomalous SL and it can predict the depth of the AICA in the bone and guide the drilling of the bone around the vessel loop.

Application of Surface Landmarks Combined with Image-Guided Sinus Location in the Retrosigmoid Approach and Their Clinic-Image Relationship Analysis.

Objectives During craniotomy for cerebellopontine angle (CPA) lesions, the exact exposure of the margin of the venous sinuses complex remains an essential but risky part of the procedure. Here, we revealed the exact position of the asterion and sinus complex by combining preoperative image information and intraoperative cranial landmarks, and analyzed their clinic-image relationship. Methods Ninety-four patients who underwent removal of vestibular schwannoma (VS) through retrosigmoid craniotomies were enrolled in the series. To determine the exact location of the sigmoid sinus and the transverse sinus and sigmoid sinus junction (TSSJ), we used preoperative images, such as computed tomography (CT) and/or magnetic resonance imaging (MRI) combined with intraoperative anatomical landmarks. The distance between the asterion and the sigmoid sinus was measured using MRI T1 sequences with gadolinium and/or the CT bone window. Results In 94 cases of retrosigmoid craniotomies, the asterion lay an average of 12.71 mm on the posterior to the body surface projection to the TSSJ. Intraoperative cranial surface landmarks were used in combination with preoperative image information to identify the distance from the asterion to the sigmoid sinus at the transverse sinus level, allowing for an appropriate initial burr hole (the margin of the TSSJ). Conclusion By combining intraoperative anatomical landmarks and preoperative image information, the margin of the TSSJ, in particular, the inferior margin of the transverse sinus, can be well and thoroughly identified in the retrosigmoid approach.

Endoscopic-Assisted Keyhole Middle Cranial Fossa Approach for Small Vestibular Schwannomas.

The classical middle cranial fossa approach (MCFA) for vestibular schwannoma (VS) removal often requires a large incision and craniotomy, excessive temporal lobe manipulation, and a longer recovery. We describe a keyhole MCFA (KMCFA) with endoscopic assistance that allows for adequate access with minimal temporal lobe manipulation, resulting in a fast recovery and an invisible scar. Eight sides of four cadaveric heads were dissected through the endoscopic-assisted KMCFA to access the internal auditory canal (IAC). Furthermore, five patients with intracanalicular VS underwent tumor removal with the endoscopic-assisted KMCFA. During the endoscopic-assisted KMCFA with fine instruments, a 3-cm supra-auricular incision and a 2-cm diameter keyhole craniotomy achieved exposure of the entire length of the IAC in all cadaveric dissections without unintended violation of the cochlea, semicircular canal, and facial nerve. The gross tumor was totally removed in five patients with no major postoperative complications. The surgical time was reduced, the hearing outcomes were similar to those of the classical MCFA, and the scar was invisible 1 month after the surgery. The endoscopic-assisted KMCFA permits intracanalicular VS removal in a safe, efficient, and cosmetic way. For small intracanalicular VSs, this approach can replace the classical MCFA when indicated.

전정신경초종수술을 위한 경미로접근법에서 컴퓨터 단층촬영 3차원영상합성의 유용성

Background : The purpose of this study was to evaluate the clinical utility of preoperative three-dimensional temporal bone reconstruction in patients for translabyrinthine removal of vestibular schwannoma.&#x0D; Materials and Methods : Prior to commencement of the translabyrinthine approach, critical anatomical structures were traced and three-dimensionally reconstructed using computed tomography (CT) scans of the normal temporal bone. Two patients diagnosed with vestibular schwannoma via magnetic resonance imaging were evaluated in this study.&#x0D; Results : Anatomical reconstruction allowed sequential planning of the translabyrinthine approach. The patient-tailored, preoperative image-guided approach prevented iatrogenic damage by predicting a high jugular bulb or a narrow sinodural angle.&#x0D; Conclusions : Three-dimensional reconstruction illuminates the translabyrinthine approach and identifies difficulties that may be encountered at each step, thus preventing confusion.&#x0D;

Remembering what the doctor said: how much of medical information will the patient remember?

Introduction. Patients must be fully informed about their disease, about different variants of the treatment of their disease, complications and prognosis to make decisions to accept the treatment. The most important they should be able to remember this information.The aim of the study was studying the level of learned information by patients about the upcoming surgery “removal of vestibular schwannoma”. Materials and methods. 44 patients with vestibular schwannoma were included in this prospective study. Average age was 39,8 + 7,2 years, gender distribution was 16 males and 28 females. Education: secondary special – 56,82, and higher – 43,18 %. We used scales for evaluation “Checklist. Surgery to removal of vestibular schwannoma” developed by authors, State-Trait Anxiety Inventory (STAI) in the adaptation by Y.L. Hanin, assessment of depression – The Hospital Anxiety and Depression Scale by Zigmond A.S., Snaith R.P. (HADS). R-Studio (Version 1.0.1532009–2017 RStudio) was used for statistical analisis.Results. Patients were able to remember correctly 24,8 % of medical information on the next day after consultation by a neurosurgeon on average. We got negative correlation between anxiety, depression to the level of information assimilated by patients (r = –0,52; r = –0,47; r = –0,85, respectively). The higher level of anxiety and depression before surgery led to decrease remembering of medical information by the patients.Conclusion. The level of remembering of the medical information by the patient about their disease was low. Quantity of the remembering information depends on the level of anxiety and depression of patients. It is necessary to increase remembering of medical information by patients because of it is allowing to improve the results of treatment.

A prediction model for recurrence after translabyrinthine surgery for vestibular schwannoma: toward personalized postoperative surveillance.

PurposeThe aim of this study is to compute and validate a statistical predictive model for the risk of recurrence, defined as regrowth of tumor necessitating salvage treatment, after translabyrinthine removal of vestibular schwannomas to individualize postoperative surveillance.MethodsThe multivariable predictive model for risk of recurrence was based on retrospectively collected patient data between 1995 and 2017 at a tertiary referral center. To assess for internal validity of the prediction model tenfold cross-validation was performed. A ‘low’ calculated risk of recurrence in this study was set at < 1%, based on clinical criteria and expert opinion.ResultsA total of 596 patients with 33 recurrences (5.5%) were included for analysis. The final prediction model consisted of the predictors ‘age at time of surgery’, ‘preoperative tumor growth’ and ‘first postoperative MRI outcome’. The area under the receiver operating curve of the prediction model was 89%, with a C-index of 0.686 (95% CI 0.614–0.796) after cross-validation. The predicted probability for risk of recurrence was low (< 1%) in 373 patients (63%). The earliest recurrence in these low-risk patients was detected at 46 months after surgery.ConclusionThis study presents a well-performing prediction model for the risk of recurrence after translabyrinthine surgery for vestibular schwannoma. The prediction model can be used to tailor the postoperative surveillance to the estimated risk of recurrence of individual patients. It seems that especially in patients with an estimated low risk of recurrence, the interval between the first and second postoperative MRI can be safely prolonged.