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Current Trends in the Management of Vestibular Schwannoma
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Current Trends in the Management of Vestibular Schwannoma

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: 15 August 2024 | Viewed by 2114

Special Issue Editors

Prof. Dr. Thierry Mom

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Guest Editor
Department of Otolaryngology Head Neck Surgery, University Hospital Center, Hospital Gabriel Montpied, 58, Rue Montalembert, 63000 Clermont-Ferrand, France
Interests: otology; neurotology; otoneurosurgery; cochlear implants and other auditory implants; audiology
Prof. Dr. Olivier Sterkers

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Guest Editor
Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, 75013 Paris, France
Interests: deafness; inner ear; gene therapy; regeneration
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The management of vestibular schwannomas has undergone drastic changes in the last decades. From the initial aim of complete removal whatever the functional cost, considering vestibular schwannomas as lethal tumors at the same level of cancers, most pluridisciplinary teams now aim at controlling the tumor with a minimum loss of function. From a surgical standpoint, total tumor removal has progressively been replaced by near-total or sub-total resection, followed by regular scanning, to avoid as much facial paralysis as possible, which is a devastating condition.

Hearing preservation, which requires intraoperative hearing monitoring, is being increasingly considered by the surgical team because of patient demand. As a consequence, therapeutic strategies have considerably evolved. While most teams only consider treatment for growing tumors, some challenging cases could be optimally managed sooner, in particular by surgery.

I am convinced that this Special Issue focused on the current management of vestibular schwannomas will be of high interest, not only for specialized otolaryngologists but also for general practitioners.

Prof. Dr. Thierry Mom
Prof. Dr. Olivier Sterkers
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • vestibular schwannoma
  • hearing preservation
  • hearing rehabilitation
  • intraoperative hearing monitoring
  • intraoperative facial monitoring

Published Papers (3 papers)

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Research

15 pages, 2448 KiB  
Article
Pathophysiology of Postoperative Hearing Disorders after Vestibular Schwannoma Resection: Insights from Auditory Brainstem Response and Otoacoustic Emissions
by Idir Djennaoui, Mathilde Puechmaille, Chloé Trillat, Justine Bécaud, Nicolas Saroul, Toufic Khalil, Paul Avan and Thierry Mom
J. Clin. Med. 2024, 13(7), 1927; https://doi.org/10.3390/jcm13071927 - 27 Mar 2024
Viewed by 488
Abstract
Background: In order to better understand the pathophysiology of surgically induced hearing loss after vestibular schwannoma (VS) surgery, we postoperatively analyzed the hearing status in a series of patients where hearing was at least partially preserved. Methods: Hearing was assessed through [...] Read more.
Background: In order to better understand the pathophysiology of surgically induced hearing loss after vestibular schwannoma (VS) surgery, we postoperatively analyzed the hearing status in a series of patients where hearing was at least partially preserved. Methods: Hearing was assessed through tonal audiometry, speech discrimination score, maximum word recognition score (dissyllabic word lists—MaxIS), otoacoustic emissions (OAEs), and auditory brainstem response (ABR). The magnetic resonance imaging (MRI) tumor characterization was also noted. Results: In a series of 24 patients operated on for VS over 5 years, depending on the results of this triple hearing exploration, we could identify, after surgery, patients with either a myelin alteration or partial damage to the acoustic fibers, others with a likely partial cochlear ischemia, and some with partial cochlear nerve ischemia. One case with persisting OAEs and no preoperative ABR recovered hearing and ABR after surgery. Long follow-up (73 ± 57 months) revealed a mean hearing loss of 30 ± 20 dB with a drastic drop of MaxIS. MRI revealed only 25% of fundus invasion. Conclusion: a precise analysis of hearing function, not only with classic audiometry but also with ABR and OEAs, allows for a better understanding of hearing damage in VS surgery. Full article
(This article belongs to the Special Issue Current Trends in the Management of Vestibular Schwannoma)
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9 pages, 710 KiB  
Article
Hearing Outcomes from Gamma Knife Treatment for Intracanalicular Vestibular Schwannomas with Good Initial Hearing
by Philippine Toulemonde, Nicolas Reyns, Michael Risoud, Pierre-Emmanuel Lemesre, Frédéric Gabanou, Marc Baroncini, Jean-Paul Lejeune, Rabih Aboukais and Christophe Vincent
J. Clin. Med. 2024, 13(6), 1685; https://doi.org/10.3390/jcm13061685 - 14 Mar 2024
Viewed by 533
Abstract
Background: The objective of this study was to describe the long-term hearing outcomes of gamma knife treatment for unilateral progressing vestibular schwannomas (VS) presenting with good initial hearing using audiologic data. Methods: A retrospective review was performed between 2010 and 2020 to select [...] Read more.
Background: The objective of this study was to describe the long-term hearing outcomes of gamma knife treatment for unilateral progressing vestibular schwannomas (VS) presenting with good initial hearing using audiologic data. Methods: A retrospective review was performed between 2010 and 2020 to select patients with progressing unilateral VS and good hearing (AAO-HNS class A) treated with stereotactic gamma knife surgery (GKS). Their audiograms were analyzed along with treatment metrics and patient data. Results: Hearing outcomes with a median follow-up of 5 years post-treatment showed statistically significant loss of serviceable hearing: 34.1% of patients maintained good hearing (AAO-HNS class A), and 56.1% maintained serviceable hearing (AAO-HNS class A and B). Non-hearing outcomes are favorable with excellent tumor control and low facial nerve morbidity. Conclusions: Hearing declines over time in intracanalicular VS treated with GKS, with a significant loss of serviceable hearing after 5 years. The mean cochlear dose and the presence of cochlear aperture obliteration by the tumor are the main statistically significant factors involved in the hearing outcomes. Full article
(This article belongs to the Special Issue Current Trends in the Management of Vestibular Schwannoma)
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12 pages, 2636 KiB  
Article
Monitoring Cochlear Nerve Action Potential for Hearing Preservation in Medium/Large Vestibular Schwannoma Surgery: Tips and Pitfalls
by Baptiste Hochet, Hannah Daoudi, Etienne Lefevre, Yann Nguyen, Isabelle Bernat, Olivier Sterkers, Ghizlene Lahlou and Michel Kalamarides
J. Clin. Med. 2023, 12(21), 6906; https://doi.org/10.3390/jcm12216906 - 2 Nov 2023
Cited by 1 | Viewed by 810
Abstract
The diagnosis of large vestibular schwannomas (VS) with retained useful hearing has become increasingly common. Preservation of facial nerve (FN) function has improved using intraoperative EMG monitoring, hearing preservation remains challenging, with the recent use of cochlear nerve action potential (CNAP) monitoring. This [...] Read more.
The diagnosis of large vestibular schwannomas (VS) with retained useful hearing has become increasingly common. Preservation of facial nerve (FN) function has improved using intraoperative EMG monitoring, hearing preservation remains challenging, with the recent use of cochlear nerve action potential (CNAP) monitoring. This prospective longitudinal series of VS with useful hearing operated on using a retrosigmoid approach included 37 patients with a mean largest extrameatal VS. diameter of 25 ± 8.7 mm (81% of Koos stage 4). CNAP was detected in 51% of patients, while auditory brainstem responses (ABR) were present in 22%. Patients were divided into two groups based on the initial intraoperative CNAP status, whether it was present or absent. FN function was preserved (grade I–II) in 95% of cases at 6 months. Serviceable hearing (class A + B) was preserved in 16% of the cases, while 27% retained hearing with intelligibility (class A–C). Hearing with intelligibility (class A–C) was preserved in 42% of cases when CNAP could be monitored in the early stages of VS resection versus 11% when it was initially absent. Changes in both the approach to the cochlear nerve and VS resection are mandatory in preserving CNAP and improve the rate of hearing preservation. Full article
(This article belongs to the Special Issue Current Trends in the Management of Vestibular Schwannoma)
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