Schwannoma Patients Research Articles

MRI classification and discrimination of spinal schwannoma and meningioma based on deep learning

Backgroud Schwannoma (SCH) and meningiomas (MEN) are the two most common primary spinal cord tumors. Differentiating between them preoperatively remains a clinical challenge due to the substantial overlap in their clinical presentation and imaging characteristics. Objective The objective of this study is to facilitate early diagnosis of patients and reduce clinician stress by constructing a deep learning-based classification model for automatic diagnosis of schwannoma and meningiomas using magnetic resonance images (MRI). Methods We retrospectively collected MRI images of 74 patients with pathologically confirmed schwannoma and meningiomas from 2015 to 2020 at a local hosipital, and constructed a CNN model based on the PyTorch's deep learning framework for the discrimination between the two. First, a modified feature fusion CNN model (ResNet34-SKConv) was trained by introducing a selective convolutional kernel module into the original CNN model. The introduction of the selective convolutional kernel module enhances the network's focus on tumor features and effectively improves the network's performance. Finally, the trained model was used to process all the MRI image slices to achieve the classification of SCH and MEN patients by the voting prediction method. Results Using the 5-fold cross-validation method, this new ResNet34-SKConv model achieves a classification accuracy of 92.32%, a specificity of 95.87%, and a F1-score of 93.54, respectively. Conclusion This study demonstrated that a classification model using a deep learning network can be effective in achieving differential diagnosis of SCH and MEN. Thus, the new method has great potential for developing new computer-aided diagnosis and applications with future clinical practice.

Correlation of Immunomodulatory Cytokines with Tumor Volume and Cerebrospinal Fluid in Vestibular Schwannoma Patients.

Sporadic vestibular schwannomas (VSs) often exhibit slow or negligible growth. Nevertheless, some VSs increase significantly in volume within a few months or grow continuously. Recent evidence indicates a role of inflammation in promoting VS growth. Therefore, our study aimed to identify cytokines, which are associated with larger VSs. The expression of different cytokines in VS tumor samples and VS primary cultures was investigated. Additionally, the concentration of cytokines in cell culture supernatants of VS primary cultures and cerebrospinal fluid (CSF) of VS patients and healthy controls were determined. Correlation analysis of cytokine levels with tumor volume, growth rate, Koos grade, age, and hearing was examined with Spearman's-rank test. The mRNA expression of CC-chemokine ligand (CCL) 18, growth differentiation factor (GDF) 15, and interferon regulatory factor 4 correlated positively with tumor volume. Moreover, the amount of GDF15 in the cell culture supernatant of primary cells correlated positively with tumor volume. The concentrations of the cytokines CCL2, CCL5, and CCL18 and transforming growth factor beta (TGFB) 1 in the CSF of the patients were significantly different from those in the CSF controls. Inhibition of immune cell infiltration could be a putative approach to prevent and control VS growth.

Factors Affecting Speech Discrimination After Vestibular Schwannoma Resection.

Investigate the relationship between word recognition score (WRS) and pure tone average (PTA) after hearing preservation surgery for vestibular schwannomas (VS) as well as evaluate the consistency of hearing classification systems. A retrospective chart review was performed. This study included patients from a single academic tertiary referral hospital. Patients with VS and serviceable hearing who underwent hearing preservation surgery 2014-2023. Patients excluded for neurofibromatosis 2 and lacking pre/postop audiograms. All patients underwent resection of vestibular schwannoma. Pre/postop WRS, PTA, and AAO-HNS, Gardner-Robertson (GR), and WRS Class (WRSC) hearing classifications. Seventy-five patients were included. Average preop and postop PTA and WRS were 26 ± 12 dB, 79 ± 39 dB, 92 ± 12%, and 33 ± 43%, respectively. Postop PTAs were distributed along the complete testable decibel range, while the postop WRS displayed a bimodal distribution, with WRS >50% or <20%. Worsening intraop ABR changes were significantly associated with poorer hearing outcomes ( p = 0.005). With increasing Koos grades, intraop ABRs were significantly more likely to exhibit changes ( p = 0.005). AAO-HNS and GR classified patients nearly identically, while the WRSC resulted in more class I and fewer class II. The cutoff of serviceable hearing was comparable across all classification systems. Effects on the brainstem component of Koos 3-4 tumors may particularly disturb speech processing. This effect seems amplified by surgical dissection. AAO-HNS, GR, and WRSC hearing classifications are comparable in describing serviceable hearing in vestibular schwannoma patients.

Reduced Cochlear MRI Signal and Hearing Outcomes in Conservatively Managed Vestibular Schwannoma Patients.

This study aimed to determine if hypointense cochlear magnetic resonance imaging (MRI) constructive interference in steady-state (CISS) signal correlates with hearing outcomes in conservatively managed vestibular schwannoma (VS) patients. Retrospective review of 657 cases from 1992 to 2020. Tertiary academic referral center. A retrospective review was performed to identify conservatively managed VS patients with appropriate baseline MRI, audiology, and at least 12-month audiological follow-up. Patients were excluded if they progressed to surgery or radiotherapy in less than 12 months, bilateral tumors, or surgery on the contralateral ear. Conservatively managed patients with CISS imaging studies and audiology testing. Primary outcome measure change in pure-tone average (PTA) and word recognition score (WRS). Secondary outcome measures tumor size, presence of lateral fluid cap, or cystic changes. A total of 92 individuals (47% male, 58 ± 11.6 yr) met the inclusion criteria, with 36 (39%) of patients demonstrating abnormal cochlear CISS signal. At baseline, abnormal cochlear CISS signal was associated with higher intracanalicular (IC) length (7.9 versus 6.6 mm, p = 0.0177) and lower WRS (55.7 versus 78.8 dBHL, p = 0.0054). During follow-up, individuals with abnormal cochlear CISS signal had significantly higher PTA (62.4 versus 46.4 dBHL, p = 0.0010). After adjusting for baseline covariates, abnormal cochlear CISS signal was consistently associated with a greater increase in PTA of 8.3 dBHL (95% confidence interval, 2.9-13.7; p = 0.0032) from baseline when compared with the normal group. Abnormal cochlear signal on MRI CISS sequences is associated with poorer hearing outcomes in conservatively managed VS patients.

Hearing loss and its association with the proteome of perilymph, cerebrospinal fluid, and tumor tissue in patients with vestibular schwannoma

This study examined the association between hearing loss in sporadic vestibular schwannoma patients and the proteome of perilymph (PL), cerebrospinal fluid (CSF), and vestibular schwannoma. Intraoperative sampling of PL and of CSF, and biopsy of vestibular schwannoma tissue, was performed in 32, 32, and 20 patients with vestibular schwannoma, respectively. Perilymph and CSF in three patients with meningioma and normal hearing were also sampled. The proteomes were identified by liquid chromatography coupled to high-resolution tandem mass spectrometry. Preoperative hearing function of the patients was evaluated with pure tone audiometry, with mean values at frequencies of 500, 1000, 2000, and 4000 Hz (PTA4) in the tumor-affected ear used to delineate three hearing groups. Analysis of the PL samples revealed significant upregulation of complement factor H-related protein 2 (CFHR2) in patients with severe to profound hearing loss after false discovery rate correction. Pathway analysis of biofunctions revealed higher activation scores in the severe/profound hearing loss group of leukocyte migration, viral infection, and migration of cells in PL. Upregulation of CFHR2 and activation of these pathways indicate chronic inflammation in the cochlea of vestibular schwannoma patients with severe to profound hearing loss compared with patients with normal hearing or mild hearing loss.

Age, preoperative tumor volume and widening of the internal acoustic meatus are independent factors associated with poor preoperative hearing in vestibular schwannoma patients – results of a single-center retrospective analysis

Preoperative hearing function shows wide variations among patients diagnosed with vestibular schwannoma. Besides the preoperative tumor size there are other factors that influence the preoperative hearing function that are frequently discussed. A comprehensive analysis of a large cohort of vestibular schwannomas has the potential to describe new insights and influence the preoperative management. We analyzed clinical factors, imaging data and the expression of the proliferation marker MIB1 as potential influencing factors on the preoperative hearing function in a retrospective cohort of 523 primary sporadic vestibular schwannomas. The results of the preoperative audiometry were quantified using the Gardner-Robertson Score. Uni- and multivariate analyses were performed. Serviceable hearing (Gardner-Robertson class 1 or 2) was documented in 391 patients (74.8%). Factors associated with non-serviceable hearing (Gardner-Robertson class 3–5) were patients of older age (p < 0.0001), larger preoperative tumor volume (p = 0.0013) and widening of the internal acoustic meatus compared to the healthy side (p = 0.0353). Gender and differences in the expression of the proliferation marker MIB1 had no influence on preoperative hearing. In the multivariate nominal logistic regression older age (OR 27.60 (CI 9.17–87.18), p < 0.0001), larger preoperative tumor volume (OR 20.20 (CI 3.43–128.58), p = 0.0011) and widening of the internal acoustic canal (OR 7.86 (CI 1.77–35.46), p = 0.0079) remained independent factors associated with non-serviceable hearing. Widening of the internal acoustic canal is an independent factor for non-serviceable preoperative hearing in vestibular schwannoma patients together with older age and larger preoperative tumor volume.

Single-cell transcriptomic atlas reveals increased regeneration in diseased human inner ear balance organs

Mammalian inner ear hair cell loss leads to permanent hearing and balance dysfunction. In contrast to the cochlea, vestibular hair cells of the murine utricle have some regenerative capacity. Whether human utricular hair cells regenerate in vivo remains unknown. Here we procured live, mature utricles from organ donors and vestibular schwannoma patients, and present a validated single-cell transcriptomic atlas at unprecedented resolution. We describe markers of 13 sensory and non-sensory cell types, with partial overlap and correlation between transcriptomes of human and mouse hair cells and supporting cells. We further uncover transcriptomes unique to hair cell precursors, which are unexpectedly 14-fold more abundant in vestibular schwannoma utricles, demonstrating the existence of ongoing regeneration in humans. Lastly, supporting cell-to-hair cell trajectory analysis revealed 5 distinct patterns of dynamic gene expression and associated pathways, including Wnt and IGF-1 signaling. Our dataset constitutes a foundational resource, accessible via a web-based interface, serving to advance knowledge of the normal and diseased human inner ear.

Role of artificial intelligence in ocular tumors: A systematic review.

e15070 Background: Integrating oncology and artificial intelligence (AI) shows significant potential in improving treatments and early detection of ocular tumors. This systematic review aims to strengthen existing evidence regarding the application of AI in diagnosing and treating ocular tumors. Methods: We systematically searched PubMed, Embase, Web of Science, Scopus, and Google Scholar until January 15, 2024. Inclusion criteria comprised original peer-reviewed human studies (retrospective or prospective) investigating AI approaches in patients with ocular tumors such as retinoblastoma, uveal melanoma, conjunctival melanoma, and choroidal melanoma. The quality of the literature was assessed using JBI checklists. The eligibility criteria involved assessing studies that explored the application of AI in ocular tumor detection, classification, and treatment planning. We employed a rigorous screening process, and subsequent data extraction focused on key characteristics, including tumor types, sample sizes, AI input data specifications, and study aims. Exclusion criteria encompassed studies not meeting the inclusion criteria, lacking relevant outcome measures, exhibiting insufficient methodological quality, or inadequate reporting. Results: The initial database search yielded 903 records, of which 37 studies (retrospective = 24 and prospective = 13) were included. Most studies selected the retinoblastoma (n = 12) and uveal melanoma (n = 14). Other studies utilized other types of ocular tumors, including ocular metastasis (n = 2), ocular surface squamous neoplasia (n = 2), and ocular lymphoma (n = 2). The conjunctival melanoma, choroidal melanoma, intraocular melanoma, cavernous hemangioma, and schwannoma patients were utilized once. The AI-based models were employed for the classification (n = 22), prognosis prediction (n = 6), lesion segmentation (n = 5), and predicting the gene expression (n = 4) tasks. The data types used Included magnetic resonance imaging (MRI), computed tomography (CT), whole-slide imaging (WSI), clinical data, and fundus images. A meta-analysis was precluded because of the significant heterogeneity observed across the included studies in terms of demographics, study design, interventions, and outcome measures. Conclusions: Although imaging and patient presentation have played a crucial role in ocular tumor diagnostics, AI presents promising results in prediction, prognosis, and disease management. Meanwhile, AI's primary role has been in classification, demonstrating significant success. Additionally, continued exploration of less-discussed eye tumors is essential for enhancing AI's predictive and therapeutic capabilities. The absence of reported evaluation criteria and low evaluation parameter rates in certain studies underscores the importance of standardized reporting practices for robust assessments in future ocular oncology research.

Vestibular Schwannoma Management: Patient Perspectives and Health Literacy

Objective: To assess medical decision-making, reasons for attrition, and health literacy among vestibular schwannoma (VS) patients last seen in clinic more than 2 years ago. Study Design: Survey. Setting: Tertiary skull base center. Patients: Adults with sporadic VS last evaluated more than 2 years ago. Methods: Survey including Brief Health Literacy Screen (BHLS), a validated 3-question measure of health literacy, and open-ended questions on care; retrospective chart review. Main Outcome Measures: BHLS score, patient reasons for attrition. Results: Of 1011 patients contacted, 205 (20.3%) patients responded and met all criteria for analysis. At initial evaluation, mean patient age was 50.6 ± 12.8 years, roughly half (51.4%) were female, and the majority (80.2%) identified as White. At the time of the survey, 48 (23%) continued to observe their tumor. The remaining 160 (76.9%) patients previously underwent treatment (surgery and/or radiation). Of those treated, 34 (21.3%) underwent intervention elsewhere. Symptoms since the last patient visit did not differ between observed and treated patients. About 94.7% of the cohort displayed high health literacy (BHLS &gt; 9), though rates of inadequate health literacy were higher among observed patients (12.5% versus 3.1% in those treated). The most common reasons for opting not to follow-up included counseling issues, personal decisions, and social/life stressors (including the COVID-19 pandemic). Conclusions: Despite being a highly health-literate cohort, patients cited multiple reasons for attrition. Regardless of whether they were observed or treated, patients described follow-up visits as burdensome and perceived them to be of minimal benefit.

국내 안면신경초종의 임상 양상

This study aimed to conduct a systematic review of facial nerve schwannoma cases in Korea, spanning from 1996 to 2023. A systematic literature search identified 22 relevant articles covering 73 facial nerve schwannoma patients. Postoperative evaluations assessed improvements, stability, or worsening of facial paralysis symptoms, with the follow-up period ranging from 3 days to 73 months. The most common symptoms were facial palsy, affecting 50.7% of patients, followed by hearing loss and parotid mass. Site distribution indicated the mastoid segment as the most common, followed by the tympanic segment, the parotid segment, the geniculate ganglion, the internal auditory canal, the labyrinthine segment, the greater superficial petrosal nerve, the canalicular segment, the chorda tympani nerve, the cerebellopontine angle, the cisternal segment, and the middle cranial fossa. Postoperative evaluation demonstrated improvement in 24%, no change in 47%, and worsening in 29% of cases. While surgical removal remains essential for complete recovery, our findings suggest a need for careful consideration, as only a minority of patients benefited from the procedure. This study provides a comprehensive overview of facial nerve schwannoma in the Korean population, contributing valuable insights for clinical practice.

P.134 Long-term quality of life deterioration in vestibular schwannoma patients treated with radiotherapy: a matched cohort with surveillance, radiation and surgery

Background: There is an absence of studies evaluating longitudinal quality of life (QoL) amongst vestibular schwannomas (VS) with matched tumor and patient characteristics between treatment groups. We present novel findings of 12 yearlong follow-up of patient QoL and symptomatology outcomes in this matched cohort study. Methods: Symptomatology and 36-Item Short Form Health Survey (SF36) between 2000-2017 in VS patients managed at a single tertiary centre was conducted. Radiation (R) and active surveillance (A) groups were matched for tumor size and age against the surgery (S) group. Results: 14 A patients, 24 R patients, 49 S patients met matching and inclusion criteria. Mean age, tumor diameter and follow up was 69.1 years, 21.6mm and 12.0 years respectively. Mental component summary (MCS) scores deteriorated significantly in the radiation group (3.1 S, 3.7 A, -3.5 R, p-value 0.008). Physical component summary scores remained stable at follow up (-0.2 S, 0.00 S, -4.0 R, p-value 0.227). Various symptoms resolved statistically in surgery goup, whereas tinnitus on follow up was higher with radiation (40.8% S, 66.7% R, p-value 0.038). Conclusions: Surgery group demonstrated improvements in long term QoL with good symptom resolution, whilst radiation group demonstrated small but significant deterioration over time.

The Role of Peripheral Inflammatory Markers and Coagulation Factors in Patients with Central Nervous System (CNS) Immune Disease and Glioma

Gliomas are associated with high rates of disability and mortality, and currently, there is a lack of specific and sensitive biomarkers for diagnosis. The ideal biomarkers should be detected early through noninvasive methods. Our research aims to develop a rapid, convenient, noninvasive diagnostic method for gliomas, as well as for grading and differentiation. We retrospectively collected data from patients who underwent surgery for glioma, trigeminal neuralgia/hemifacial spasmschwannoma, and those diagnosed with multiple sclerosis at our institution from January 2018 to December 2020. Inflammatory markers and coagulation factor levels were collected on admission, and neutrophil count (NLR), (WBC count minus neutrophil count) / lymphocyte count, platelet count / lymphocyte count, lymphocyte count / monocyte count, and albumin count [g/L]+total lymphocyte count× 5 were calculated for patients. Analyze the significance of biomarkers in the diagnosis and grading of gliomas, the diagnosis of MS, and the differential diagnosis of them. We evaluated 155 healthy individuals, 64trigeminal neuralgia/hemifacial spasm patients, 47 MS patients, 316 schwannoma patients, and 814 with glioma patients. Compared with healthy controls and MS group, the preoperative levels of NLR, (WBC count minus neutrophil count) / lymphocyte count, D-dimer, Fibrinogen, Antithrobin, and Factor VIII of glioma patients were significantly higher in glioma patients and positively correlated with the grade of glioma. Conversely, 0020 lymphocyte count / Monocyte count and albumin count [g/L]+total lymphocyte count× 5 were significantly lower and negatively correlated with glioma grading. ROC curves confirmed that for the diagnosis of glioma, NLR showed a maximum area under the curve value of 0.8616 (0.8322-0.8910), followed by D-dimer and Antithrombin, with area under the curve values of 0.8205 (0.7601-0.8809) and 0.8455 (0.8153-0.8758), respectively. NLR and d-dimer also showed great sensitivity in the diagnosis of MS and differential diagnosis with gliomas. Our study demonstrated that multiple inflammatory markers and coagulation factors could be utilized as biomarkers for the glioma diagnosis, grading, and differential diagnosis of MS. Furthermore, the combination of these markers exhibited high sensitivity and specificity.

A rare case with atypical findings: schwannoma of the radial nerve

A 53-year-old male complained of weakness in the dorsum of the 5-4-3rd fingers of the right hand. The musculus extensor digitorum communis was heavy and the musculus extensor indices proprius was light involved in the needle electroneuromyography study. Radial nerve ultrasonography showed a mass(schwannoma) which located on the radial nerve course after the lateral epicondyle at the elbow level. In conclusion, we should consider radial nerve schwannoma in patients with radial nerve injury and when there is an atypical involvement of the muscles innervated by the radial nerve, we should utilize ultrasonography for evaluation.

Audiological Characteristics of Vestibular Schwannoma Patients With Normal Pure-Tone Audiometry.

To investigate the audiological characteristics of vestibular schwannoma (VS) patients with normal pure-tone audiometry (PTA) results. A retrospective study. Forty-two VS patients with normal PTA results from October 2016 to October 2022 were included. Normal PTA was defined when the hearing threshold is ≤25 dB hearing loss (HL) in each test frequency and the PTA is ≤25 dB HL. Results of multiple audiological tests such as the auditory brainstem response (ABR), distortion product otoacoustic emission (DPOAE), multiple auditory steady-state responses threshold (ASSR), and speech discrimination score were retrospectively reviewed. Demographic data of these patients were also been collected. According to our results, the ABR and average ASSR threshold of the affected side were statistically significantly higher in VS patients with normal PTA. ABR waveforms on the affected side also showed more abnormalities. The DPOAE pass rates of the affected side were lower than the unaffected side while the amplitude and signal-to-noise ratio rate was also lower. In addition, we used magnetic resonance imaging 3-dimensional reconstruction images to measure the volume of tumors in these patients. We also found that higher ABR threshold means lager tumor size in patients with normal PTA. VS patients with normal PTA result cannot be assumed to have no impairment of hearing function. ABR, DPOAE, and ASSR results showed the characteristic changes in the affect ear. ABR threshold has the highest sensitivity for hearing abnormalities and is strong relative with tumor size in patients with normal PTA.

Comparison of quality of life in vestibular schwannoma patients managed with observation, radiotherapy or microsurgery.

In decision making regarding the management of vestibular schwannomas, alongside clinical outcomes, an understanding of patient reported health-related quality of life measures is key. Therefore, the aim of this research is to compare health-related quality of life in vestibular schwannoma patients treated with active observation, stereotactic radiotherapy and microsurgical excision. A cross-sectional study of patients diagnosed with unilateral sporadic vestibular schwannomas between 1995 and 2015 at a specialist tertiary centre was conducted. Patients completed the Penn Acoustic Neuroma Quality of Life questionnaire and handicap inventories for dizziness, hearing and tinnitus. Of 234 patients, 136 responded (58.1 per cent). Management modality was: 86 observation, 23 stereotactic radiotherapy and 25 microsurgery. Females reported significantly worse dizziness; males reported significantly worse physical disability. Patients less than 65 years old reported significantly worse tinnitus and pain scores. Overall, quality of life was higher in the observation group. Conservative management, where appropriate, is favourable with higher quality-of-life outcomes in this cohort. This must be weighed against the risks of a growing tumour.

Psychological factors and long-term tinnitus handicap in vestibular schwannoma patients after retrosigmoid microsurgery – a cross-sectional study

Objective This study aimed to investigate the connection between psychological factors and postoperative tinnitus in vestibular schwannoma (VS) patients following retrosigmoid microsurgery. Design Cross-sectional study. Study sample Ninety-three VS patients participated, completing questionnaires on demographics, tinnitus severity (THI-12), personality traits (TIPI-G), dizziness impact (DHI), perceived health benefits (GBI), somatisation tendencies (SOMS-2), and psychological distress (HADS-D). Our analysis involved Mann-Whitney U-tests, Spearman’s rank-order correlations, and false discovery rate correction. Results Most participants reported postoperative tinnitus (77/93), with 41 experiencing it preoperatively. Emotional stability correlated negatively with tinnitus presence, while tinnitus severity was associated with emotional distress. Preoperative somatisation tendencies were also positively linked to tinnitus severity. Postoperative Tinnitus was further linked to reduced perceived health benefits and increased anxiety and depression levels. Notably, age and gender showed no significant associations. Conclusion This study uncovers the interplay between postoperative tinnitus and psychological factors in VS patients, highlighting emotional and cognitive dimensions. Tailored psychological interventions addressing tinnitus‘s psychosomatic impact may enhance patients quality of life.

Patient Characteristics Impacting Adherence to Serial Observation for Vestibular Schwannomas.

To examine patient characteristics that impact serial observation adherence amongvestibular schwannoma (VS) patients. Retrospective chart review. Single tertiary care center. We selected for VS patients from 201 to 2020 who elected for serial observation as initial management. Patients under 18, with previous management, bilateral or intralabyrinthine VS, and neurofibromatosis type 2 were excluded. Demographics, tumor characteristics, and follow-up status were extracted. Single and multiple logistic regression was used to identify patient characteristics impacting follow-up. We identified 507 VS patients who chose serial observation as initial management. Most were female (56.0%), white (73.0%), and married (72.8%). The mean age was 59.3 and most had private insurance (56.4%). Median Charlson Comorbidity Index was 2.00. Mean pure tone audiometry (PTA) average was 41.7 Hz. Average tumor size was 9.04 mm. Of 507 patients, 358 (70.6%) returned for at least one follow-up. On multiple logistic regression analysis, patients with private insurance (odds ratio [OR]: 0.39, confidence interval [CI]: 0.22-0.68; P = .001), racial minority background (OR: 0.54, CI: 0.35-0.83; P = .005), worse PTA averages (OR: 0.99, CI: 0.98-1.00; P = .044), and older age at diagnosis (OR: 0.97, CI: 0.95-1.00; P = .038) were less likely to follow-up. Private health insurance, racial minority background, worse PTA average, and older age were associated with decreased follow-up amongadult VS patients electing serial observation. Patients with these characteristics may require additional support to ensure serial observation adherence.

Transcanal transpromontorial approach for vestibular schwannoma: experience of a single center.

The expanded transpromontorial transcanal approach (ExpTTA) represents a recent addition to the surgical approaches available for the treatment of vestibular schwannoma. An initial purely endoscopic version has been complemented by the use of the microscope and it is now one of the possible surgical options for small to medium-sized vestibular schwannomas with a predominantly intracanalar development. This is a series of 54 patients who underwent microsurgical resection of sporadic, unilateral vestibular schwannoma, mainly Koos I-II with non-serviceable hearing, between January 2016 and January 2023 using the expanded transcanal transpromontorial approach. We describe the surgical technique, focusing on anatomical landmarks, and analyzing its advantages and shortcomings. Retrospective analysis of clinical outcomes is presented, including early and late complications. The mean follow-up was 46.7months. We achieved gross total resection of the lesion in all cases, confirmed on the first follow-up MRI at least 6months after each procedure. We did not record any intraoperative complication nor disease recurrence. We recorded two postoperative severe facial nerve palsies, one of which was permanent. No cases of disabling vertigo or imbalance were reported, and all patients reported full recovery of autonomy in daily activities. Three cases of otoliquorrhea were managed conservatively successfully. The transcanal transpromontorial approach combines the advantages of endoscopy with the possibilities provided by microsurgery. Our experience confirms its safety in terms of surgical complications and facial nerve outcome. This approach is amongst the treatment options for small-medium schwannomas in patients with impaired hearing, especially in young patients, ensuring radical resection, disease control, and minimal morbidity.

Navigating Uncharted Waters: Comparative Analysis of Clinical Progression and Outcomes in Vestibular Schwannoma Patients with Papilledema and without Hydrocephalus, Versus Those without Papilledema and Hydrocephalus: A Comprehensive Institutional Insight

Papilledema's association with hydrocephalus (HCP)-linked larger vestibular schwannoma (VS) is established but cases lacking concurrent HCP require further investigation. This retrospective comparative observational study, conducted from July 2018 to July 2023, examined 120 VS patients undergoing surgery. Patients were categorized into Group 1 (papilledema without HCP) and Group 2 (no papilledema or HCP), with comprehensive data analyzed. In this study, Group 1 (14 patients with papilledema) and Group 2 (106 patients without papilledema or HCP) were compared. Group 1 was younger (mean age 27.21±11.73years) than Group 2 (mean age 54.66±11.44years). Both groups had similar symptom durations and tumor detection times. Group 1 had increased vascularity (P= 0.001), elevated cisterna magna protein levels (P= 0.001), and a higher incidence of neurofibromatosis 2 (P= 0.003). They also experienced longer surgeries (P= 0.001) and more blood loss (P= 0.001), leading to extended postoperative complications. Group 2 showed improved postsurgery visual outcomes (P= 0.001), better Glasgow Outcome Scores (P= 0.001), enhanced facial nerve preservation (P= 0.002), and improved hearing on follow-up (P= 0.003). Logistic regression analysis highlighted prolonged surgery duration (P= 0.057) and papilledema (P= 0.0001) as significant factors influencing visual improvement. Patients with VS require preoperative fundoscopy evaluation due to potential visual loss and papilledema, even without HCP. Early treatment initiation enhances visual and hearing outcomes. Meticulous surgery is vital given the lesion's hypervascular nature and adherence to surrounding structures. Preoperative embolization may aid in preserving neurovascular structures. In developing countries with higher blindness rates, judicious noncontrast computed tomography brain evaluation is crucial for timely detection and treatment initiation of lesions like VS.

CoNeS: Conditional neural fields with shift modulation for multi-sequence MRI translation

Multi-sequence magnetic resonance imaging (MRI) has found wide applications in both modern clinical studies and deep learning research. However, in clinical practice, it frequently occurs that one or more of the MRI sequences are missing due to different image acquisition protocols or contrast agent contraindications of patients, limiting the utilization of deep learning models trained on multi-sequence data. One promising approach is to leverage generative models to synthesize the missing sequences, which can serve as a surrogate acquisition. State-of-the-art methods tackling this problem are based on convolutional neural networks (CNN) which usually suffer from spectral biases, resulting in poor reconstruction of high-frequency fine details. In this paper, we propose Conditional Neural fields with Shift modulation (CoNeS), a model that takes voxel coordinates as input and learns a representation of the target images for multi-sequence MRI translation. The proposed model uses a multi-layer perceptron (MLP) instead of a CNN as the decoder for pixel-to-pixel mapping. Hence, each target image is represented as a neural field that is conditioned on the source image via shift modulation with a learned latent code. Experiments on BraTS 2018 and an in-house clinical dataset of vestibular schwannoma patients showed that the proposed method outperformed state-of-the-art methods for multi-sequence MRI translation both visually and quantitatively. Moreover, we conducted spectral analysis, showing that CoNeS was able to overcome the spectral bias issue common in conventional CNN models. To further evaluate the usage of synthesized images in clinical downstream tasks, we tested a segmentation network using the synthesized images at inference. The results showed that CoNeS improved the segmentation performance when some MRI sequences were missing and outperformed other synthesis models. We concluded that neural fields are a promising technique for multi-sequence MRI translation.