Use of a Novel Clinical Decision-Making Tool in Vestibular Schwannoma Treatment.

Objective: To determine the usefulness of a personalized tool and its effect on the decision-making process for those with vestibular schwannoma (VS).

Study Design: Prospective study.

Setting: Single institution, academic tertiary care lateral skull base surgery program.

Management of Vestibular Schwannoma with Normal Hearing.

Introduction: This work aimed to study the management of vestibular schwannoma (VS) patients with normal hearing (NH).

Methods: A retrospective study was undertaken in a Quaternary referral center for skull base pathologies. Among 4,000 VS patients 162 met our strict audiological criteria for NH.

Vestibular schwannoma removal through expanded transcanal transpromontorial approach: a multicentric experience.

Purpose: Expanded Transcanal Transpromontorial Approach (ExpTTA) is an endomicroscopic technique that allow surgical excision of small and symptomatic neuromas limited to the internal auditory canal (IAC) or minimally invasive the cerebellopontine angle (CPA). ExpTTA is a safer alternative to the exclusive endoscopic technique as it allows a wider surgical field and better management of the auditory porus and CPA.

Methods: We report a retrospective case series of 34 patients who underwent ExpTTA between 2017 and 2022 at the ENT Departments of the University Hospital of Modena, Bologna and Verona.

Distinct immune signature predicts progression of vestibular schwannoma and unveils a possible viral etiology.

Background: The management of sub-totally resected sporadic vestibular schwannoma (VS) may include observation, re-resection or irradiation. Identifying the optimal choice can be difficult due to the disease's variable progression rate. We aimed to define an immune signature and associated transcriptomic fingerprint characteristic of rapidly-progressing VS to elucidate the underpinnings of rapidly progressing VS and identify a prognostic model for determining rate of progression.

Is the intra-operative morphology of the cochlear nerve a good predictor of the results of simultaneous ipsilateral cochlear implantation in vestibular schwannoma surgery?

Objective: There are currently no guidelines for simultaneous vestibular schwannoma surgery and cochlear implantation. This paper therefore provides our experience and our results regarding predictive parameters of good hearing.

Methods: Morphological appearance of the cochlear nerve after tumour resection was used as the main criterion for implantation in the case series.

Novel Multiportal Approach to the Internal Auditory Canal for Hearing-Preserving Surgery: Feasibility Assessment in Dissections.

Objective: State-of-the-art, minimally invasive endoscopic transcanal surgery of the internal auditory canal (IAC) sacrifices the cochlea with complete hearing loss. With a combination of the transcanal infracochlear and transmastoid retrolabyrinthine approaches, we aim to preserve hearing and enable minimally invasive surgical treatment of vestibular schwannoma. In this study, we investigate the anatomical indications and the feasibility of both approaches in dissections, in human whole head specimens.

Surgical management of skull base meningiomas and vestibular schwannomas.

Purpose Of Review: The aim of this study is to discuss surgical management of meningiomas and schwannomas of skull base.

Recent Findings: Meningiomas and schwannomas are typically benign neoplasm with a good prognosis after surgery. Patients should be treated individually related to several features: size and localization of tumor and its proximity with deep critical neurovascular structures, neurological status, age and comorbidity.

Cochlear Implantation Outcomes in Patients With Retrocochlear Pathology: A Systematic Review and Pooled Analysis.

Objective: To review the current literature regarding cochlear implantation in patients with retrocochlear pathologies and extract speech perception scores between 6 months and 1 year after surgery.

Databases Reviewed: PubMed/MEDLINE, Embase and Cochrane CENTRAL via Ovid, CINAHL Complete via Ebsco, and Web of Science.

Methods: The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Machine Learning to Predict Hearing Preservation After Middle Cranial Fossa Approach for Sporadic Vestibular Schwannomas.

Objective: Predict hearing preservation after middle cranial fossa approach for vestibular schwannomas.

Study Design: Application of machine learning algorithms, including classification and regression trees and random forest models to observational data.

Setting: Single-tertiary referral center.

Endoscopic Endonasal Eustachian Tube Obliteration as a Treatment for Tension Pneumocephalus After Translabyrinthine Resection of Vestibular Schwannoma.

Objective: Cerebrospinal fluid leak and pneumocephalus are rare but potentially devastating complications associated with translabyrinthine resection of cerebellopontine angle masses. Persistent pneumocephalus despite proximal eustachian tube (ET) obliteration is rare. We describe, to our knowledge, the first report of successful management of tension pneumocephalus by endoscopic endonasal ET obliteration using a novel V-loc (Covidien; Medtronic, Minneapolis, MN) suture technique.

Incidental finding of metastatic prostatic adenocarcinoma of cerebellopontine angle presenting as acoustic neuroma: A case report and review of literature.

Introduction: Brain metastases from carcinoma of prostate are rare and only few cases with brain metastases preceding the diagnosis of carcinoma of prostate have been reported in the literature. Lesions of brain metastasis from prostate cancer had a large variety of imaging presentations and it is very difficult to distinguish them from the other types of brain occupying lesions. We report one case of metastatic prostatic adenocarcinoma of cerebellopontine angle presenting as acoustic neuroma, as the first clinical evidence of metastatic carcinoma of the prostate.

Staged and Combined Approach for Resection of Giant Posterior Fossa and Temporal Bone Schwannoma.

Vestibular schwannomas have an estimated incidence of 1.09/100,000 people, representing 6%-10% of intracranial tumors. Rarer giant vestibular schwannomas are defined by an extrameatal diameter of ≥4 cm and can be difficult to treat because of displacement and compression of local neurovasculature and the potential for multicompartment involvement.

Hearing Preservation After Intervention in Vestibular Schwannoma.

Objective: This study aimed to assess the durability of audiological outcomes after radiation and surgery in the management of vestibular schwannoma.

Study Design: Retrospective review.

Setting: Tertiary academic center.

Dispersed Bone Spicules as a Cause of Postoperative Headache after Retrosigmoid Vestibular Schwannoma Surgery: A Myth?

 Dispersion of bone dust in the posterior fossa during retrosigmoid craniectomy for vestibular schwannoma (VS) resection could be a source of meningeal irritation and lead to development of persistent postoperative headaches (POH). We aim to determine risk factors, including whether the presence of bone spicules that influence POH after retrosigmoid VS resection.  Present study is a retrospective case series.

Endoscopic Endonasal Eustachian Tube Obliteration for Cerebrospinal Fluid Rhinorrhea: A Case Series and Scoping Review.

Background: Endoscopic endonasal eustachian tube obliteration (EEETO) is a valuable option for treating cerebrospinal fluid rhinorrhea (CSFR) after lateral skull base surgery. Several small case series describe different techniques because of the rarity of this indication.

Objective: To review available literature on EEETO focusing on technique and factors affecting success.

Augmented Reality for Retrosigmoid Craniotomy Planning.

While medical imaging data have traditionally been viewed on two-dimensional (2D) displays, augmented reality (AR) allows physicians to project the medical imaging data on patient's bodies to locate important anatomy. We present a surgical AR application to plan the retrosigmoid craniotomy, a standard approach to access the posterior fossa and the internal auditory canal. As a simple and accurate alternative to surface landmarks and conventional surgical navigation systems, our AR application augments the surgeon's vision to guide the optimal location of cortical bone removal.

Expanded transcanal transpromontorial approach for acoustic neuroma removal.

Axial sections from preoperative magnetic resonance imaging without contrast, showing a cone-shaped lesion of the internal auditory canal, extending toward the most lateral part of the cerebello-pontine angle. (A) T1-weighted high-resolution isotropic volume excitation (THRIVE) sequence; (B) T1-weighted sequence; (C) Fluid attenuated inversion recovery (FLAIR) sequence. Laryngoscope, 133:282-286, 2023.

The "Deep Subarcuate Fossa" sign and three types of anomalous subarcuate loops encountered during vestibular schwannoma removal.

Background: An anomalous subarcuate loop (SL) of the anteroinferior cerebellar artery (AICA) is a rare anatomic variation, which increases the complexity and risk of vestibular schwannoma (VS) removal. However, preoperative diagnosis of this anomaly remains difficult. The aim of this study was to report three types of anomalous SLs encountered during VS removal and to describe the "Deep Subarcuate Fossa (SF)" sign and its significance in the diagnosis and treatment of an osseous-penetrating SL.

Wait and Scan Management of Intra-canalicular Vestibular Schwannomas: Analysis of Growth and Hearing Outcome.

Objective: To report on the results of intracanalicular vestibular schwannomas (ICVS) that were managed by wait and scan and to analyze the possible predictors of tumor growth and hearing deterioration throughout the observation period.

Study Design: A retrospective case series.

Setting: Quaternary referral center for skull base pathologies.

A 2 and 5-Year Longitudinal Analysis of 671 Consecutive Patients Diagnosed with Unilateral Vestibular Schwannoma.

Objective: To analyse the 2 and 5-year outcomes of a cohort of patients with newly diagnosed vestibular schwannoma patients.

Study Design: Longitudinal cohort study.

Setting: Tertiary skull base referral unit.

Association of Postoperative Sigmoid Sinus Occlusion and Cerebrospinal Fluid Leak in Translabyrinthine Surgery.

Objective: To characterize the incidence of sigmoid sinus occlusion (SSO) following translabyrinthine (TL) surgery for posterior fossa tumor resection and determine the association with cerebrospinal fluid (CSF) leak.

Study Design: Retrospective case series.

Setting: Tertiary referral center.

Pediatric vestibular schwannoma without evidence of neurofibromatosis: consecutive 18 microsurgical experiences.

Purpose: Sporadic vestibular schwannoma (VS) is rare in children in contrast to adults, and detailed investigations of case series of these patients using a single fixed protocol are scarce. This study presents our surgical experience of pediatric VSs without clinical evidence of neurofibromatosis type 2 (NF2) at the initial diagnosis.

Methods: Among 1385 consecutive sporadic VS surgeries, 18 pediatric patients (1.

Resection of Intracochlear Schwannomas With Immediate Cochlear Implantation.

Introduction: Intralabyrinthine schwannomas, including the intracochlear variety, are rare benign tumors. They can cause a number of symptoms and have the potential to grow to involve other critical structures of the inner ear and skull base. While surgical resection is feasible, there is typically permanent hearing dysfunction as a result of resection and subsequent fibrosis.