Dynamics of tumor evolution after Gammaknife radiosurgery for sporadic vestibular schwannoma: defining volumetric patterns characterizing individual trajectory.

Background: Definition of tumor control and treatment failure after Gammaknife radiosurgery (GKRS) for vestibular schwannoma (VS) is still debated. The lack of knowledge on the dynamics of tumor evolution can lead to misinterpretation and subsequent inappropriate second treatment. The aim of this study was to evaluate the post-GKRS dynamics of evolution of tumor volume, and characterize volumetric patterns.

Assessing Tumor Volume for Sporadic Vestibular Schwannomas: A Comparison of Methods of Volumetry.

Introduction: The size of vestibular schwannomas (VS) is a major factor guiding the initial decision of treatment and the definition of tumor control or failure. Accurate measurement and standardized definition are mandatory; yet no standard exist. Various approximation methods using linear measures or segmental volumetry have been reported.

Long-Term Hearing Outcome After Radiosurgery for Vestibular Schwannoma: A Systematic Review and Meta-Analysis.

Background: Stereotactic radiosurgery (SRS) is one of the main treatment options in the management of small to medium size vestibular schwannomas (VSs), because of high tumor control rate and low cranial nerves morbidity. Series reporting long-term hearing outcome (>3 years) are scarce.

Objective: To perform a systematic review of the literature and meta-analysis, with the aim of focusing on long-term hearing preservation after SRS.

Place of Gamma Knife Stereotactic Radiosurgery in Grade 4 Vestibular Schwannoma Based on Case Series of 86 Patients with Long-Term Follow-Up.

Introduction: Grade IV vestibular schwannoma (Koos classification) is generally considered to be an indication for microsurgical resection or combined radiosurgery-microsurgery. However, the place of Gamma Knife stereotactic surgery (GK-SRS), either as first-line treatment or when progression of residual tumor compresses the brainstem, has not been clearly evaluated. This article reports the results of a large case series of patients with grade 4 vestibular schwannoma treated by GK-SRS.

Audiological results of endoscopic surgical repair of the long process of incus.

Objective: The purpose of this study is to evaluate our experience with endoscopic repair of ossicular discontinuity at the incudostapedial joint, with or without an intact stapes suprastructure, and present our hearing results. We classify results based on the causative pathology, the type of ossiculoplasty, and type of lesion. We demonstrate the ability to endoscopically place a total ossicular replacement prosthesis (TORP), measuring 4.

Radiosurgery for vestibular schwannomas.

This article investigates the role of radiosurgery and stereotactic radiotherapy in the management of vestibular schwannomas (VS), reviewing the authors' own prospective cohort and the current literature. For patients with large Stage IV VS (according to the Koos classification), a combined approach with deliberate partial microsurgical removal followed by radiosurgery to the residual tumor is proposed. The authors' cohort is unique with respect to the size of the population and the length of the follow-up, and demonstrates the efficacy and safety of VS radiosurgery, with particular regard to its high rate of hearing preservation.

Longitudinal analysis of hearing before and after radiosurgery for vestibular schwannoma.

Object: The aim of this study was to perform an accurate analysis of changes in hearing in patients with vestibular schwannoma (VS) who have undergone Gamma Knife surgery (GKS) and distinguish the impact of radiosurgery from the natural course of hearing deterioration due to the tumor itself.

Methods: This study was a retrospective review of prospectively collected patient data. A group of 154 patients with unilateral nonsurgically treated VS was conservatively monitored for more than 6 months and then treated with GKS between July 1997 and September 2005.

Wait-and-see strategy compared with proactive Gamma Knife surgery in patients with intracanalicular vestibular schwannomas.

Object: The roles of the wait-and-see strategy and proactive Gamma Knife surgery (GKS) in the treatment paradigm for small intracanalicular vestibular schwannomas (VSs) is still a matter of debate, especially when patients present with functional hearing. The authors compare these 2 methods.

Methods: Forty-seven patients (22 men and 25 women) harboring an intracanalicular VS were followed prospectively.

Open surgical reconstruction of the internal carotid artery aneurysm at the base of the skull.

Objectives: Aneurysms of the internal carotid artery (ICA) at the base of the skull are uncommon dangerous lesions whose management remains unclear. The aim of this retrospective study is to report a standardized surgical technique of ICA reconstruction with long-term results.

Methods: Between 1988 and 2005, 13 patients (11 men; age 18 to 76 years, mean 42.

Repeat gamma knife surgery for regrowth of vestibular schwannomas.

Objective: Gamma knife surgery (GKS) has become established as a minimally invasive treatment modality for patients with vestibular schwannomas. Treatment failure and/or tumor regrowth, however, is occasionally encountered, and microsurgical resection is usually warranted in such cases. The role of repeat GKS in these situations is still unclear.

Vestibular schwannomas: complications of microsurgery.

Current microsurgical treatment of vestibular schwannomas usually brings satisfactory results for the patients. However, transient or permanent complications may occur, especially when treating large tumors. Precise information about these potential complications has to be given to the patient at the time of the surgical decision.

Microsurgical removal of vestibular schwannomas after failed previous microsurgery.

Recurrent and regrowing large vestibular schwannomas (VSs) may require another microsurgical procedure. Little is known about the incidence and the consequences of this second surgical procedure. We reviewed our own 10 reoperated cases during a 20-year period.

Surgical removal of vestibular schwannoma after failed gamma knife radiosurgery.

One of the main criticisms of vestibular schwannoma (VS) radiosurgery is that the risk of surgical morbidity is increased for patients whose tumor progresses in cases of failed procedures. The authors reviewed the French neurosurgical experience of operated patients after failed Gamma Knife radiosurgery (GKR). From July 1992 to December 2000, 23 unilateral VS out of the 1,000 treated patients have undergone a microsurgical procedure after failed GKR.

Hearing preservation in patients with unilateral vestibular schwannoma after gamma knife surgery.

Introduction: The majority of patients still lose the functionality of their hearing in spite of the technical advances in microsurgery. Our aim was to evaluate the hearing preservation potential of Gamma Knife Surgery. We have reviewed our experience and the literature in order to evaluate the probability to obtain such functional preservation and the factors influencing it.

Morphological changes of vestibular schwannomas after radiosurgical treatment: pitfalls and diagnosis of failure.

Rationale: Evaluate the morphological changes following radiosurgery in order to better define failure parameters.

Methods: 332 non-neurofibromatosis type 2 vestibular schwannomas not previously treated surgically or radiosurgically were subjected to Gamma Knife radiosurgery between 1992 and 2004 at the Gamma Knife Center in Marseille with at least three sequential MRI scans after radiosurgery. Five length measurements were systematically obtained.

Recurrence of vestibular schwannomas after surgery.

The issue of recurrence of vestibular schwannomas is poorly studied by the surgical literature and is probably underestimated. Our own long-term retrospective analysis after translabyrinthine approach has indicated a 9.2% recurrence rate.

The wait and see strategy for intracanalicular vestibular schwannomas.

To refine our therapeutic policy for intracanalicular tumors, we reviewed our series of patients who where initially treated conservatively. Forty-seven patients (22 men and 25 women) harboring an intracanalicular vestibular schwannoma were followed prospectively. Mean age at the time of inclusion was 54.

Translabyrinthine approach for vestibular schwannomas: operative technique.

For large vestibular schwannomas (VSs) for which removal is the primary therapy, the goals are complete tumor resection and maintenance of normal neurological function. The authors analyzed their results about facial nerve preservation, extent of resection and complications following resection of large VSs via a widened translabyrinthine approach. Between 1991 and 2001, 110 patients with a unilateral large VS (Koos stage IV) were operated on using the same technique in the same institution.

Benefit of the Vibrant Soundbridge device in patients implanted for 5 to 8 years.

Objectives: To assess audiological performance, satisfaction rate, and side effects of 100 patients who have been using the middle ear implant Vibrant Soundbridge (VSB) for 5 to 8 yr when compared with data collected from 3 to 18 mo postsurgery.

Design: Audiological testing and subjective evaluation using self-assessment scales were performed in 77 out of the 100 patients using the VSB for 5 to 8 years. The results were compared to data collected 3 months (audiological testing) and 18 months (self-assessment scales) after surgery.

Management of invasive juvenile nasopharyngeal angiofibromas: the role of a multimodality approach.

Objective: Juvenile nasopharyngeal angiofibromas involving the cranial base and intracranial compartment are challenging tumors. We reviewed our experience of these tumors and analyzed the efficacy of a multimodality management.

Methods: Between 1981 and 2000, 15 extensive juvenile nasopharyngeal angiofibromas (Fisch Grade III or IV) were treated at our institution.

Modern management of vestibular schwannomas.

Within the last 3 decades, microsurgery and stereotactic radiosurgery (SRS) have become well-established management options for vestibular schwannomas (VSs). Advancement in the management of VSs can be separated into three periods: the microsurgical pioneer period, the demonstration of SRS as a first-line therapy for small and medium-sized VSs, and currently, a period of SRS maturity based on a large worldwide patient accrual. The Marseille SRS experience includes 1,500 patients, with 1,000 patients having follow-up longer than 3 years.

Aberrant internal carotid artery in the temporal bone: imaging findings and management.

Objectives: To describe the clinical and radiological features of the vascular anomaly aberrant internal carotid artery (ICA) in the temporal bone and to discuss management strategies.

Design: Retrospective study.

Patients: Sixteen cases of aberrant ICA were diagnosed between 1982 and 2003.

First isolation of Bacteroides thetaiotaomicron from a patient with a cholesteatoma and experiencing meningitis.

A 45-year-old man with a cholesteatoma experienced purulent meningitis. Microbial analysis of cerebrospinal fluid yielded in pure culture a gram-negative bacillus. Phenotypic methods were suggestive of a Bacteroides distasonis or either a Bacteroides thetaiotaomicron or Bacteroides ovatus infection.