Are stage IV vestibular schwannomas preoperatively different from other stages?

Objective: The aim of this study was to focus on the clinical and paraclinical symptoms of patients suffering from Stage IV vestibular schwannomas (VSs).

Patients: In this prospective study, we included 734 patients who have VS and candidates for operation.

Main Outcome Measures: Patients were classified as having Stage I, II, III, or IV tumors according to Tos criteria as evaluated by magnetic resonance imaging. PREOPERATIVE CLINICAL EVALUATION: We recorded the occurrence of complaints (%) and duration (yr) of hearing loss, tinnitus, and balance disorder. Preoperative paraclinical evaluation included pure-tone (PTA) and speech audiometry, auditory brainstem response (ABR) patterns, and vestibular deficit at videonystamography (VNG). Continuous variables were compared between Stage IV and other stages using analysis of variance. Qualitative variables expressed as a percentage of presence were compared between Stage IV and other stages using percentage comparison.

Results: Quantitative Parameters. Patients with Stage IV VS were significantly younger as compared with patients with other stages. Stage IV hearing loss was greater compared with other stages at 250 and 500 Hz but smaller at 2,000 and 8,000 Hz. We found no difference in the loss of PTA between Stage IV and the other stages. Speech discriminancy score was smaller in Stage IV. The durations of hearing loss, tinnitus, and balance disorders were similar whatever the tumor stage. Auditory brainstem response patterns showed no difference in Wave III latency between Stage IV VS and other stages, whereas Wave V latency and V-I interval were higher in Stage IV. Both ABR threshold and VNG caloric deficit were higher in Stage IV VS compared with other stages. Qualitative Parameters. The percentage of patients with Stage IV was lower than that with Stages II and III. The percentage of men and women was similar in all stages. The occurrence of hearing loss was similar in all stages, whereas that of tinnitus was lower in Stage IV compared with Stages I and II. In contrast, the occurrence of balance disorder was higher in Stage IV compared with all other stages.

Conclusion: In clinical and paraclinical manifestation, Stage IV VS is different from the other stages. The PTA differences may be attributed to the younger age. Occurrence of clinical symptoms, ABR, and VNG pattern can be explained by the fact that Stage IV develops rapidly in the vestibular, rather than the cochlear nerve and by the fact that larger tumors can be cerebellar compression. This has been confirmed by the higher occurrence of balance disorders in Stage IV and the lower occurrence of tinnitus with similar hearing loss in all stages.