Clinical features of intracranial vestibular schwannomas

Huang,Xiang; Xu,Jian; Xu,Ming; Zhou,Liang‑Fu; Zhang,Rong; Lang,Liqin; Xu,Qiwu; Zhong,Ping; Chen,Mingyu; Wang,Ying; Zhang,Zhenyu

doi:10.3892/ol.2012.1011

Clinical features of intracranial vestibular schwannomas

Authors:
- Xiang Huang
- Jian Xu
- Ming Xu
- Liang‑Fu Zhou
- Rong Zhang
- Liqin Lang
- Qiwu Xu
- Ping Zhong
- Mingyu Chen
- Ying Wang
- Zhenyu Zhang
View Affiliations

Affiliations: Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, P.R. China
Published online on: October 31, 2012 https://doi.org/10.3892/ol.2012.1011
Pages: 57-62

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of the present study was to discuss the clinical features of intracranial vestibular schwannomas and to evaluate the symptoms and signs as well as their correlation with tumor extension. The records of 1,009 patients who were treated in Shanghai Huashan Hospital were reviewed retrospectively. According to the Samii classification of 1997, the patients were grouped into a T3 and a T4 group based on the radiological findings. We focused our analysis on the incidence of subjective disturbances versus objective morbidity, and symptomatology versus tumor size and extension. Of the 1,009 cases, 424 patients (42.0%) were defined as T3 while 585 patients (58%) were defined as T4. The most frequent clinical symptoms were hearing loss (85.8%), facial numbness (48.9%), ataxia (44.6%), tinnitus (40.1%), deafness (26.3%) and facial paralysis (21.1%). The ratios of gender, vertigo and facial paralysis were significantly different between the T3 and T4 groups (P<0.05); however, none of the clinical symptoms had a positive likelihood ratio (PLR) greater than 10 for T4 prediction. The most frequent cranial nerve disturbance was associated with the cochlear nerve (92.6%) and trigeminal nerve (53.5%). Disturbance of the facial nerve was more severe in T3 than T4 patients (P<0.05). Hearing deficit, facial paresthesia, ataxia and tinnitus are key symptoms of huge vestibular schwannomas. Cochlear, trigeminal and facial nerves were the most commonly affected cranial nerves in cases of large tumors. Gender and tumor size were associated with tumor extension. Although the predictive value was limited, the symptoms of vertigo, facial paralysis and hearing loss may be indicators of tumor growth.

View Figures

View References

1	Evans DG, Moran A, King A, Saeed S, Gurusinghe N and Ramsden R: Incidence of vestibular schwannoma and neurofibromatosis 2 in the north west of england over a 10-year period: higher incidence than previously thought. Otol Neurotol. 26:93–97. 2005.PubMed/NCBI
2	Nikolopoulos TP, Fortnum H, O’Donoghue G and Baguley D: Acoustic neuroma growth: a systematic review of the evidence. Otol Neurotol. 31:478–485. 2010. View Article : Google Scholar : PubMed/NCBI
3	Zhou LF, Chen XC and Shi YQ: Modern Neurosurgery. Fudan Press; Shanghai: 2001
4	Samii M, Gerganov V and Samii A: Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg. 105:527–535. 2006. View Article : Google Scholar : PubMed/NCBI
5	Goksu N, Bayazit Y and Kemaloglu Y: Endoscopy of the posterior fossa and endoscopic dissection of acoustic neuroma. Neurosurg Focus. 6:e151999. View Article : Google Scholar : PubMed/NCBI
6	Tringali S, Bertholon P, Chelikh L, Jacquet C, Prades JM and Martin C: Hearing preservation after modified translabyrinthine approach performed to remove a vestibular schwannoma. Ann Otol Rhinol Laryngol. 113:152–155. 2004. View Article : Google Scholar
7	Sanna M, Khrais T, Russo A, Piccirillo E and Augurio A: Hearing preservation surgery in vestibular schwannoma: the hidden truth. Ann Otol Rhinol Laryngol. 113:156–163. 2004. View Article : Google Scholar : PubMed/NCBI
8	Chee GH, Nedzelski JM and Rowed D: Acoustic neuroma surgery: the results of long-term hearing preservation. Otol Neurotol. 24:672–676. 2003. View Article : Google Scholar : PubMed/NCBI
9	Brackmann DE, Owens RM, Friedman RA, et al: Prognostic factors for hearing preservation in vestibular schwannoma surgery. Am J Otol. 21:417–424. 2000. View Article : Google Scholar : PubMed/NCBI
10	Lassaletta L, Fontes L, Melcon E, Sarria MJ and Gavilan J: Hearing preservation with the retrosigmoid approach for vestibular schwannoma: Myth or reality? Otolaryngol Head Neck Surg. 129:397–401. 2003. View Article : Google Scholar : PubMed/NCBI
11	Beenstock M: Predicting the stability and growth of acoustic neuromas. Otol Neurotol. 23:542–549. 2002. View Article : Google Scholar : PubMed/NCBI
12	Yamakami I, Oka N and Yamaura A: Intraoperative monitoring of cochlear nerve compound action potential in cerebellopontine angle tumour removal. J Clin Neurosci. 10:567–570. 2003. View Article : Google Scholar : PubMed/NCBI
13	Matthies C and Samii M: Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation. Neurosurgery. 40:1–9, (discussion 9–10), 1997.
14	Smouha EE, Yoo M, Mohr K and Davis RP: Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm. Laryngoscope. 115:450–454. 2005. View Article : Google Scholar
15	Selesnick SH and Johnson G: Radiologic surveillance of acoustic neuromas. Am J Otol. 19:846–849. 1998.PubMed/NCBI
16	Yoshimoto Y: Systematic review of the natural history of vestibular schwannoma. J Neurosurg. 103:59–63. 2005. View Article : Google Scholar : PubMed/NCBI
17	Rosenberg SI: Natural history of acoustic neuromas. Laryngoscope. 110:497–508. 2000.
18	Ogawa K, Kanzaki J, Ogawa S, Yamamoto M, Ikeda S and Shiobara R: The growth rate of acoustic neuromas. Acta Otolaryngol Suppl. 487:157–163. 1991. View Article : Google Scholar : PubMed/NCBI
19	Stangerup SE, Caye-Thomasen P, Tos M and Thomsen J: The natural history of vestibular schwannoma. Otol Neurotol. 27:547–552. 2006. View Article : Google Scholar : PubMed/NCBI
20	Fucci MJ, Buchman CA, Brackmann DE and Berliner KI: Acoustic tumor growth: Implications for treatment choices. Am J Otol. 20:495–499. 1999.PubMed/NCBI
21	Walsh RM, Bath AP, Bance ML, Keller A, Tator CH and Rutka JA: The role of conservative management of vestibular schwannomas. Clin Otolaryngol Allied Sci. 25:28–39. 2000. View Article : Google Scholar : PubMed/NCBI
22	Artz JC, Timmer FC, Mulder JJ, Cremers CW and Graamans K: Predictors of future growth of sporadic vestibular schwannomas obtained by history and radiologic assessment of the tumor. Eur Arch Otorhinolaryngol. 266:641–646. 2009. View Article : Google Scholar : PubMed/NCBI
23	Gibson WP: Hypothetical mechanism for vertigo in Meniere’s disease. Otolaryngol Clin North Am. 43:1019–1027. 2010.
24	Samii M and Matthies C: Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve - preservation and restitution of function. Neurosurgery. 40:684–694, (discussion 694–685), 1997.
25	Arts HA, Telian SA, El-Kashlan H and Thompson BG: Hearing preservation and facial nerve outcomes in vestibular schwannoma surgery: results using the middle cranial fossa approach. Otol Neurotol. 27:234–241. 2006. View Article : Google Scholar : PubMed/NCBI
26	Martin TP: Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm. Laryngoscope. 115:17042005. View Article : Google Scholar : PubMed/NCBI
27	Tschudi DC, Linder TE and Fisch U: Conservative management of unilateral acoustic neuromas. Am J Otol. 21:722–728. 2000.PubMed/NCBI
28	Flint D, Fagan P and Panarese A: Conservative management of sporadic unilateral acoustic neuromas. J Laryngol Otol. 119:424–428. 2005. View Article : Google Scholar : PubMed/NCBI
29	Herwadker A, Vokurka EA, Evans DG, Ramsden RT and Jackson A: Size and growth rate of sporadic vestibular schwannoma: predictive value of information available at presentation. Otol Neurotol. 26:86–92. 2005. View Article : Google Scholar : PubMed/NCBI
30	Huang X, Xu J and Zhong P: The clinical feature of intracranial vestibular schwannomas-A retrospective review of 1009 vestibular schwannomas in single hospital. Acta Neurochirurgica. 153:1833–1905. 2011.