Evaluation of Reported Malignant Transformation of Vestibular Schwannoma: De Novo and After Stereotactic Radiosurgery or Surgery.

ObjectiveTo critically analyze each reported case of malignant transformation of vestibular schwannoma (VS) after either stereotactic radiosurgery (SRS) or microsurgery (MS).Data sourcesWe searched the Pubmed/Medline database using the relevant key words vestibular schwannoma, acoustic neuroma, malignant, transformation, radiation, induced, stereotactic, radiosurgery, malignancy, GammaKnife, and CyberKnife and combinations thereof.Study selectionInclusion criteria for malignant transformation of VS after SRS included histopathology of initially benign VS, subsequent histopathology confirming malignant VS, reasonable latency period between malignancy and benign diagnoses.Data extractionA neurotologist and a skull base neurosurgeon independently assessed each case report for quality, entry, exclusion criteria, and comparability of extracted data.Data synthesisWe calculated median age, latency times, and survival times for each case report.ResultsMalignant transformation has been documented to occur after either SRS or MS. Eight cases were included that showed histopathologic evidence of malignant transformation after SRS and MS. Four cases of malignant transformation were included that demonstrated malignant transformation after MS only. Malignant transformation of VS can also occur de novo, and de novo malignant VSs are also encountered, which can confound a causal inference from either SRS or MS. Eighteen cases of primary malignant VS were included. Studies that were identified but not included in the review are summarized and tabulated. We found 12 studies of malignant transformation associated with NF2.ConclusionThe potential mechanism leading to malignant transformation of VS seems more obvious for SRS and is less understood for MS. Given a low incidence of de novo malignant schwannoma, the possibility that these are spontaneous events in either setting cannot be ruled out. Risk of malignant transformation of VS after either SRS or MS is not zero; however, the magnitude of this risk is probably minimal based on the evidence from eight histopathologically confirmed cases

Evaluation of Reported Malignant Transformation of Vestibular Schwannoma: De Novo and After Stereotactic Radiosurgery or Surgery.

ObjectiveTo critically analyze each reported case of malignant transformation of vestibular schwannoma (VS) after either stereotactic radiosurgery (SRS) or microsurgery (MS).Data sourcesWe searched the Pubmed/Medline database using the relevant key words vestibular schwannoma, acoustic neuroma, malignant, transformation, radiation, induced, stereotactic, radiosurgery, malignancy, GammaKnife, and CyberKnife and combinations thereof.Study selectionInclusion criteria for malignant transformation of VS after SRS included histopathology of initially benign VS, subsequent histopathology confirming malignant VS, reasonable latency period between malignancy and benign diagnoses.Data extractionA neurotologist and a skull base neurosurgeon independently assessed each case report for quality, entry, exclusion criteria, and comparability of extracted data.Data synthesisWe calculated median age, latency times, and survival times for each case report.ResultsMalignant transformation has been documented to occur after either SRS or MS. Eight cases were included that showed histopathologic evidence of malignant transformation after SRS and MS. Four cases of malignant transformation were included that demonstrated malignant transformation after MS only. Malignant transformation of VS can also occur de novo, and de novo malignant VSs are also encountered, which can confound a causal inference from either SRS or MS. Eighteen cases of primary malignant VS were included. Studies that were identified but not included in the review are summarized and tabulated. We found 12 studies of malignant transformation associated with NF2.ConclusionThe potential mechanism leading to malignant transformation of VS seems more obvious for SRS and is less understood for MS. Given a low incidence of de novo malignant schwannoma, the possibility that these are spontaneous events in either setting cannot be ruled out. Risk of malignant transformation of VS after either SRS or MS is not zero; however, the magnitude of this risk is probably minimal based on the evidence from eight histopathologically confirmed cases

Transcanal Micro-Osteotome Only Technique for Excision of Exostoses

ObjectivesTo evaluate the outcomes and complications of transcanal excision of exostoses using micro-osteotomes, without a postauricular incision or the use of the drill.Study designA retrospective chart review of patients undergoing exostoses excision.SettingTertiary Care Medical Center.Subjects and methodsAll of the patients underwent surgical removal of the exostoses using only a 1 or 2 mm micro-osteotomes. Patients were followed postoperatively and associated complications were evaluated.ResultsOne-hundred thirty-eight ears in 106 patients were treated for obstructive exostosis. The average age of patients was 43 ± 16 years. Of these, 99 were man (93%) and 7 were woman (7%). A majority of the patients (84%, n = 89) had 90 to 100% obstruction of the ear canal. Complete ear canal healing was observed in 80% of patients by 3 weeks. All but one patient had healed by 6 weeks postoperatively. There were 9 (6.5%) slit tympanic membrane perforations that healed with intraoperative gelfoam or fascia myringoplasty. One patient had an anterior canal mobilization which required Xeroform packing for 3 weeks for stabilization. There were no postoperative vertigo, facial paresis, conductive/sensorineural hearing loss, soft tissue stenoses, and no skin grafting required.ConclusionsThis is the first study to report a series of patients performing solely a transcanal approach using micro-osteotomes for removing exostoses. Results indicate that it is a safe procedure with low complication rate and expeditious healing. Patients with 100% obstruction can have this procedure performed with no significant increase in morbidity

Visual consequences of electronic reader use: a pilot study

BackgroundWith the increasing prevalence of electronic readers (e-readers) for vocational and professional uses, it is important to discover if there are visual consequences in the use of these products. There are no studies in the literature quantifying the incidence or severity of eyestrain, nor are there clinical characteristics that may predispose to these symptoms with e-reader use.PurposeThe primary objective of this pilot study was to assess the degree of eyestrain associated with e-reader use compared to traditional paper format. The secondary outcomes of this study were to assess the rate of eyestrain associated with e-reader use and identify any clinical characteristics that may be associated with the development of eyestrain.MethodsForty-four students were randomly assigned to study (e-reader iPAD) and control (print) groups. Participant posture, luminosity of the room, and reading distance from reading device were measured during a 1-h session for both groups. At the end of the session, questionnaires were administered to determine symptoms.ResultsSignificantly higher rates of eyestrain (p = 0.008) and irritation (p = 0.011) were found among the iPAD study group as compared to the print 'control' group. The study group was also 4.9 times more likely to report severe eyestrain (95 % CI [1.4, 16.9]). No clinical characteristics predisposing to eyestrain could be identified.ConclusionsThese findings conclude that reading on e-readers may induce increased levels of irritation and eyestrain. Predisposing factors, etiology, and potential remedial interventions remain to be determined

Risk Recall of Complications Associated with Vestibular Schwannoma Treatment

ObjectiveTo assess the risk recall of complications among patients who underwent different vestibular schwannoma (VS) treatments.Study designPatients with VS completed a voluntary and anonymous survey.SettingSurvey links were distributed via the Acoustic Neuroma Association (ANA) website, Facebook, and email list.Subjects and methodsSurveys were distributed to ANA members from January to March 2017. Of the 3200 ANA members with a VS diagnosis at the time of survey distribution, 789 (25%) completed the survey.ResultsSubjects reported the following incidence of posttreatment complications: imbalance (60%), hearing issues (51%), dry eyes (30%), headache (29%), and facial weakness (27%). Overall, 188 (25%) recalled remembering all the risks associated with their treatment. Among those in the surgical cohort (52%) who experienced balance issues, facial weakness, cerebrospinal fluid leak, meningitis, and stroke, 73%, 91%, 77%, 67%, and 33% claimed recall of these associated risks. Among those in the radiosurgery cohort (28%) who experienced balance issues, facial weakness, and hydrocephalus, 56%, 52%, and 60% recalled discussions of those risks. Patients with higher-level education (P = .026) and those who underwent surgery (P = .001) had a significantly higher risk recall ratio, while sex, age, and tumor size were not significant contributing factors.ConclusionNot all patients with VS who experienced treatment complications recalled remembering those risks being discussed with them. Patients with higher education and those who underwent surgery had a better recall of risks associated with different treatment modalities. The risk recall ratio of patients experiencing complications ranged 33% to 91%, suggesting an opportunity for decision-making and discussion improvement

Tympanic Membrane and Ossicular-Sparing Modified Lateral Temporal Bone Resection.

A modified lateral temporal bone resection (mLTBR) is a unique technique that spares the tympanic membrane (TM) and ossicles in select patients with squamous cell carcinoma (SCCa). The records of 5 patients with SCCa of the temporal bone with negative frozen-section biopsy at the tympanic annulus were reviewed. The mean follow-up time for the patients was 29.2 months. One patient received postoperative radiation due to cervical nodal extracapsular spread. All patients were recurrence free as of the most recent follow-up (range, 8-50 months). Postoperative audiometry demonstrated an average conductive hearing loss of 9 dB (range, 0-17 dB). The mLTBR with sparing of the TM can be an effective alternative to the traditional lateral temporal bone resection (LTBR) with better hearing results for patients with SCCa involving the bony external auditory canal. In the short term, oncologic results of mLTBR appear equivalent to the LTBR. However, long-term follow-up is needed for >5-year outcomes

Tympanic Membrane and Ossicular-Sparing Modified Lateral Temporal Bone Resection.

A modified lateral temporal bone resection (mLTBR) is a unique technique that spares the tympanic membrane (TM) and ossicles in select patients with squamous cell carcinoma (SCCa). The records of 5 patients with SCCa of the temporal bone with negative frozen-section biopsy at the tympanic annulus were reviewed. The mean follow-up time for the patients was 29.2 months. One patient received postoperative radiation due to cervical nodal extracapsular spread. All patients were recurrence free as of the most recent follow-up (range, 8-50 months). Postoperative audiometry demonstrated an average conductive hearing loss of 9 dB (range, 0-17 dB). The mLTBR with sparing of the TM can be an effective alternative to the traditional lateral temporal bone resection (LTBR) with better hearing results for patients with SCCa involving the bony external auditory canal. In the short term, oncologic results of mLTBR appear equivalent to the LTBR. However, long-term follow-up is needed for >5-year outcomes