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Stephen Johnson, Hideyuki Kano, Andrew Faramand, Ajay Niranjan, John C. Flickinger, and L. Dade Lunsford

V estibular schwannomas (VSs) are cerebellopontine angle brain tumors arising from the vestibular or eighth cranial nerve. 16 Vestibular dysfunction and hearing dysfunction are typical symptoms that lead to brain imaging and subsequent diagnosis. As tumors grow, additional symptoms such as trigeminal sensory dysfunction (9%) or facial neuropathy (6%) may ensue. The widespread use of MRI 13 , 15 has led to earlier and sometimes incidental detection of VS. As such, management options have evolved over the last 30 years. Some newly diagnosed patients may elect

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Georges Fischer, Catherine Fischer, and Joël Rémond

T he arguments put forward in the old debate regarding the most appropriate route for acoustic neurinoma surgery have evolved over the past few years. Until recently, in the large series treated by qualified surgeons using the translabyrinthine route 13, 23, 31 or the suboccipital route, 10, 25, 29 the mortality rate ranged from 1 % to 5% and the rate of success in preserving facial nerve function was 80% to 90%. Since 1985, overall results have been improved steadily and hearing preservation has increasingly been documented. 2, 7–9, 14, 17, 20, 22, 25

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Jason Gurewitz, Zane Schnurman, Aya Nakamura, Ralph E. Navarro, Dev N. Patel, Sean O. McMenomey, J. Thomas Roland Jr., John G. Golfinos, and Douglas Kondziolka

H earing loss is the most common presenting symptom for patients with vestibular schwannomas (VSs), and more than 90% of patients with VS have some level of auditory dysfunction when assessed. 1–3 Preservation of hearing is a frequent primary consideration when choosing between management options or surgical approaches. 4 Many studies have investigated hearing outcomes after intervention with resection or stereotactic radiosurgery (SRS), and factors affecting postprocedure hearing have been well demonstrated, including tumor size, location, and origin

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Amr M. N. El-Shehaby, Wael A. Reda, Khaled M. Abdel Karim, Ahmed M. Nabeel, Reem M. Emad Eldin, and Sameh R. Tawadros

O ne of every 10 intracranial tumors arises in the cerebellopontine angle (CPA), most of which are vestibular schwannomas (VSs), comprising 80%–85%, and less commonly meningiomas, accounting for 10%–15%. 1 , 5 , 45 Because of the close proximity of CPA meningiomas to critical neurovascular structures, resection is surgically challenging. Stereotactic radiosurgery (SRS) as an adjuvant or alternative treatment for skull base meningiomas has demonstrated high efficacy and safety. 32 , 36 , 40 , 42 , 47 However, the presence of the hearing apparatus in the

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Christian Scheller, Andreas Wienke, Marcos Tatagiba, Alireza Gharabaghi, Kristofer F. Ramina, Oliver Ganslandt, Barbara Bischoff, Cordula Matthies, Thomas Westermaier, Gregor Antoniadis, Maria Teresa Pedro, Veit Rohde, Kajetan von Eckardstein, Thomas Kretschmer, Johannes Zenk, and Christian Strauss

V estibular schwannomas (VSs) account for 6%–8% of all intracranial tumors. Treatment options for VS include microsurgical removal or stereotactic radiosurgery (SRS). 12 The goal of modern VS surgery is total tumor removal with preservation of facial and cochlear nerve function. 11 So far, the stability of hearing preservation and the regeneration potential of the cochlear nerve after VS surgery have been analyzed retrospectively. 2 , 3 , 8 , 12 , 17 Long-term follow-ups after SRS showed serviceable hearing rates in 44 patients with VS at 1, 3, 5, 7

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Michael E. Sughrue, Rajwant Kaur, Ari J. Kane, Martin J. Rutkowski, Isaac Yang, Lawrence H. Pitts, Tarik Tihan, and Andrew T. Parsa

V estibular schwannomas are histologically benign lesions with an unpredictable natural history. 11 , 18 , 20 While some tumors can remain dormant for many years without causing problems, others grow rapidly and cause hearing loss and occasionally other forms of neurological impairment. 8 , 11 , 20 Some patients with small, nongrowing tumors lose their hearing, for reasons that are not well understood. 37 Because we cannot reliably predict future hearing loss in these patients, the formal indications for treatment of VS are broad, 11 , 20 and they

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Raymund L. Yong, Brian D. Westerberg, Charles Dong, and Ryojo Akagami

T umor size is one of the major determinants of hearing preservation after surgery for vestibular schwannoma. 4 , 10 In 1995, the Committee on Hearing and Equilibrium of the AAO-HNS published guidelines to make uniform the measurement of vestibular schwannomas. The committee recommended that size be calculated as the square root of the product of 2 perpendicular maximum diameters using axial computed tomography or MR imaging, with one maximum diameter taken parallel to the petrous ridge and the other at a right angle to this. 5 The intracanalicular

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Marcos Tatagiba, Madjid Samii, Cordula Matthies, Mowaffak El Azm, and Robert Schonmayr

T he challenging goal in acoustic neurinoma microsurgery, namely preservation of hearing, has been achieved in an increasing number of patients in recent years. 17, 20, 21 The chances of saving useful hearing (defined as a threshold < 70 dB and discrimination > 15% 20 ) have a direct relationship to tumor size and the preoperative level of hearing. 22 With the suboccipital approach, the approximate overall rate of hearing preservation is about 30%. 13 In patients with good preoperative threshold and discrimination values, and small tumor sizes (< 3 cm

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Nicolas Massager, Ouzi Nissim, Carine Delbrouck, Isabelle Delpierre, Daniel Devriendt, Françoise Desmedt, David Wikler, Jacques Brotchi, and Marc Levivier

V estibular schwannomas are relatively rare tumors that result from benign proliferations of Schwann cells that form the myelin sheath of the eighth cranial nerve. 1 , 8 The advent and widespread availability of MR imaging in the last decade has allowed VSs to be diagnosed more frequently and at earlier stages of tumor evolution. The most frequent presenting symptoms of VSs include decreased hearing, tinnitus, and/or gait disturbances. 1 Current treatment options for VSs include observation, microsurgical removal, fractionated radiation therapy, or

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Madjid Samii, Venelin Gerganov, and Amir Samii

T he treatment of VS has evolved dramatically during the last decades. Total tumor removal and a good quality of life postoperatively have become the generally accepted treatment goals. Preservation of neurological functions, especially facial nerve function and hearing, are the most important predictors of the quality of life. Treatment options for VS include microsurgical removal via one of several operative approaches or stereotactic radiosurgery. 9 , 12 , 18 , 22 , 24 , 28 Different authors claim to achieve the goals of VS treatment in a constantly