Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function ...Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function in patients with acoustic neuroma.Methods A total of 110 patients with acoustic neuroma who underwent surgery through the retrosigmoid sinus approach were included.Clinical data and raw features from four MRI sequences(T1-weighted,T2-weighted,T1-weighted contrast enhancement,and T2-weighted-Flair images)were analyzed.Spearman correlation analysis along with least absolute shrinkage and selection operator regression were used to screen combined clinical and radiomic features.Nomogram,machine learning,and convolutional neural network(CNN)models were constructed to predict the prognosis of facial nerve function on the seventh day after surgery.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate model performance.A total of 1050 radiomic parameters were extracted,from which 13 radiomic and 3 clinical features were selected.Results The CNN model performed best among all prediction models in the test set with an area under the curve(AUC)of 0.89(95%CI,0.84–0.91).Conclusion CNN modeling that combines clinical and multi-sequence MRI radiomic features provides excellent performance for predicting short-term facial nerve function after surgery in patients with acoustic neuroma.As such,CNN modeling may serve as a potential decision-making tool for neurosurgery.展开更多
Objective To report the authors' experiences in hearing preservation during acoustic neuroma (AN) resection procedures. Methods Two cases of AN removal via retrosigmoid approach were reviewed. Hearing preservation...Objective To report the authors' experiences in hearing preservation during acoustic neuroma (AN) resection procedures. Methods Two cases of AN removal via retrosigmoid approach were reviewed. Hearing preservation was attempted in the aid of endoscopic technique along with continuous monitoring of the compound action potential (CAP) and auditory brainstem response(ABR) during the surgery. Results The tumor in Case 1 was 1.5 cm in diameter. The average pure-tone hearing threshold was 30 dB HL and ABR was normal. Waves I, III and V of ABR were present following tumor removal. At 7th month follow-up, audiometric thresholds and ABR inter-peak intervals had recovered to pre-operative levels, with normal facial nerve function. The patient in Case 2 had bilateral AN. The tumors measured 4.0 cm(left) and 5.0 cm (right) on MRI scans. The AN on the right side was removed first, followed by removal of the left AN four months later. Intraoperative CAP monitoring was employed during removal of the left AN. While efforts to preserve the cochlear nerve were not successful, CAPs were still present after tumor removal. Conclusions Intraoperatively recorded CAPs are not reliable in predicting postoperative hearing outcomes. In contrast, ABRs are an indicator of function of the peripheral auditory pathway. Presence of waves I, III and V following tumor removal may represent preservation of useful hearing.展开更多
Acoustic Neuroma (AN) arises from the eighth cranial nerve. It primarily involves the vestibular branch of the nerve and is therefore also called vestibular schwannoma(VS). To the date, diagnosis and surgical treatmen...Acoustic Neuroma (AN) arises from the eighth cranial nerve. It primarily involves the vestibular branch of the nerve and is therefore also called vestibular schwannoma(VS). To the date, diagnosis and surgical treatment of AN have advanced significantly. Along with advances in audiology and imaging technologies, cases of diagnosed AN have been increasing, making it a common展开更多
Objective: To determine the best follow-up period with regard to curative effect for acoustic neuroma treated with a gamma knife. Methods: Sixty cases of acoustic neuroma were treated with a gamma knife. The follow-up...Objective: To determine the best follow-up period with regard to curative effect for acoustic neuroma treated with a gamma knife. Methods: Sixty cases of acoustic neuroma were treated with a gamma knife. The follow-up period was from 3 to 102 months. Changes in the lesions and peripheral tissues and clinical symptoms were compared and the curative effectiveness of gamma knife treatment was evaluated. Results: The highest total effective rate (92.3%) was in the third period. There was a significant difference in the tumor size postoperatively. There was no edema in the peripheral tissues surrounding the tumor. It was not obvious that clinical symptoms changed. Conclusion: In this report, the best follow-up period was 24-36 months. Gamma knife treatment was still effective after 60 months post-operation.展开更多
Objective To evaluate the long-term facial nerve funtion of patients following microsurgical removal of large and huge acoustic neuroma,and to indentify the factors that influence these outcomes. Methods A retrospecti...Objective To evaluate the long-term facial nerve funtion of patients following microsurgical removal of large and huge acoustic neuroma,and to indentify the factors that influence these outcomes. Methods A retrospective review was performed,which included 176 consecutive patients with a展开更多
Background Although various monitoring techniques have been used routinely in the treatment of the lesions in the skull base, iatrogenic facial paresis or paralysis remains a significant clinical problem. The aim of t...Background Although various monitoring techniques have been used routinely in the treatment of the lesions in the skull base, iatrogenic facial paresis or paralysis remains a significant clinical problem. The aim of this study was to investigate the effect of intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation on preservation of facial nerve function. Method From January to November 2005, 19 patients with large acoustic neuroma were treated using intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation （TCEMEP） for preservation of facial nerve function. The relationship between the decrease of MEP amplitude after tumor removal and the postoperative function of the facial nerve was analyzed. Results MEP amplitude decreased more than 75% in 11 patients, of which 6 presented significant facial paralysis （H-B grade 3）, and 5 had mild facial paralysis （H-B grade 2）. In the other 8 patients, whose MEP amplitude decreased less than 75%, 1 experienced significant facial paralysis, 5 had mild facial paralysis, and 2 were normal. Conclusions Intraoperative TCEMEP can be used to predict postoperative function of the facial nerve. The decreased MEP amplitude above 75 % is an alarm point for possible severe facial paralysis.展开更多
Sporadic vestibular schwannoma (acoustic neuroma) is a benign tumor arising from cochleovestibular nerve. Nowadays, various specialties and medical centers are treating this dis-ease, and the multidisciplinary collabo...Sporadic vestibular schwannoma (acoustic neuroma) is a benign tumor arising from cochleovestibular nerve. Nowadays, various specialties and medical centers are treating this dis-ease, and the multidisciplinary collaboration is the trend. In an effort to promote a uniform stan-dard for reporting clinical results, even for treatment indications, the mainly controversies were posed and discussed during the 7th International Conference on acoustic neuroma, and the agreement was summarized by the Committee of this conference. The main symptoms grading and tumor stage should note its name of classification for making them comparable. The goal of the modern managements for vestibular schwannoma is to improve the quality of life with lower mortality, lower morbidity and better neurological function preservation. The experience of surgical team and their preference might be a major factor for the outcome. Because of lack-ing of long-term follow-up large data after radiotherapy, and with the development of microsur-gery, radiotherapy is now less recommended except for recurrent cases or elderly patients.展开更多
Background Small acoustic neuromas seldom result in typical vestibular symptoms, despite the tumor arising from the vestibular nerve. In this study, we have shown that abnormal gait in eleven patients with small acous...Background Small acoustic neuromas seldom result in typical vestibular symptoms, despite the tumor arising from the vestibular nerve. In this study, we have shown that abnormal gait in eleven patients with small acoustic neuroma could be detected in gait analysis by the use of tactile sensor. Patients displayed no oculomotor abnormality and had tumors less than 10 mm from the porus acoustics. Methods Gait related parameters including the coefficients of variations （CV） of stance, swing, double support, area ratio of trajectories of center of force （TCOF）, in addition to the foot pressure difference between both feet, were used for assessment of gait.展开更多
Neuropathic pain is chronic pain generated by disorders of the peripheral and central nervous system, including skull base tumours. A skull base tumour can be any type of tumour that forms in the skull base, and this ...Neuropathic pain is chronic pain generated by disorders of the peripheral and central nervous system, including skull base tumours. A skull base tumour can be any type of tumour that forms in the skull base, and this includes vestibular schwannomas which arise from the sheath of the inner ear vestibulocochlear nerve(eighth cranial nerve). Growth of the tumour, surgical resection, and/or stereotactic radiotherapy may result incompression and/or irritation of the fifth cranial nerve(trigeminal nerve) resulting in facial pain and/or numbness. Non-trigeminal afferent input may contribute to the wide constellation of symptoms seen in orofacial pain patients. The purpose of this report was to develop a decision tool to guide the recognition and treatment of neuropathic pain in this specialized population. Recommendations for treatment are based on evidence presented in Canadian and international neuropathic treatment guidelines. Algorithms are included for assessment and treatment of adult patients with agents that are recognized to have analgesic efficacy within the broad context of neuropathic pain.展开更多
We present a case of a patient with progressive unilateral sensorineural hearing loss and tinnitus with internal auditory canal enhancement on magnetic resonance imaging (MRI) secondary to isolated cochlear neuritis f...We present a case of a patient with progressive unilateral sensorineural hearing loss and tinnitus with internal auditory canal enhancement on magnetic resonance imaging (MRI) secondary to isolated cochlear neuritis from varicella reactivation. MRI following antiviral treat-ment showed resolution of enhancement. Varicella reactivation is commonly seen in the form of Ramsay Hunt syndrome, which is known to produce abnormal MRI enhancement from facial and vestibulocochlear neuritis;however, its characteristic clinical signs aid the diagnosis. This case is unique in that the only manifestation of varicella infection was unilateral hearing loss. This case outlines the importance of maintaining a broad differential diagnosis in the evaluation of unilateral hearing loss as well as recognizing the limited specificity of MRI.展开更多
Neurofibromatosis type 2 （NF-2） is one of the most common single gene disorders in the nervous system.For approximately 96% of patients with NF-2 present with bilateral Schwannomas involving the eighth cranial nerve...Neurofibromatosis type 2 （NF-2） is one of the most common single gene disorders in the nervous system.For approximately 96% of patients with NF-2 present with bilateral Schwannomas involving the eighth cranial nerves, which may be accompanied by Schwannomas involving other cranial, spinal or peripheral nerves, NF-2 is also referred to as ＂bilateral acoustic neuromas＂. Due to progression of tumors, surgery or radiotherapy, patients with bilateral acoustic neuromas will eventually suffer profound or total hearing loss, resulting in decrease of quality of life （QOL）.展开更多
文摘Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function in patients with acoustic neuroma.Methods A total of 110 patients with acoustic neuroma who underwent surgery through the retrosigmoid sinus approach were included.Clinical data and raw features from four MRI sequences(T1-weighted,T2-weighted,T1-weighted contrast enhancement,and T2-weighted-Flair images)were analyzed.Spearman correlation analysis along with least absolute shrinkage and selection operator regression were used to screen combined clinical and radiomic features.Nomogram,machine learning,and convolutional neural network(CNN)models were constructed to predict the prognosis of facial nerve function on the seventh day after surgery.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate model performance.A total of 1050 radiomic parameters were extracted,from which 13 radiomic and 3 clinical features were selected.Results The CNN model performed best among all prediction models in the test set with an area under the curve(AUC)of 0.89(95%CI,0.84–0.91).Conclusion CNN modeling that combines clinical and multi-sequence MRI radiomic features provides excellent performance for predicting short-term facial nerve function after surgery in patients with acoustic neuroma.As such,CNN modeling may serve as a potential decision-making tool for neurosurgery.
文摘Objective To report the authors' experiences in hearing preservation during acoustic neuroma (AN) resection procedures. Methods Two cases of AN removal via retrosigmoid approach were reviewed. Hearing preservation was attempted in the aid of endoscopic technique along with continuous monitoring of the compound action potential (CAP) and auditory brainstem response(ABR) during the surgery. Results The tumor in Case 1 was 1.5 cm in diameter. The average pure-tone hearing threshold was 30 dB HL and ABR was normal. Waves I, III and V of ABR were present following tumor removal. At 7th month follow-up, audiometric thresholds and ABR inter-peak intervals had recovered to pre-operative levels, with normal facial nerve function. The patient in Case 2 had bilateral AN. The tumors measured 4.0 cm(left) and 5.0 cm (right) on MRI scans. The AN on the right side was removed first, followed by removal of the left AN four months later. Intraoperative CAP monitoring was employed during removal of the left AN. While efforts to preserve the cochlear nerve were not successful, CAPs were still present after tumor removal. Conclusions Intraoperatively recorded CAPs are not reliable in predicting postoperative hearing outcomes. In contrast, ABRs are an indicator of function of the peripheral auditory pathway. Presence of waves I, III and V following tumor removal may represent preservation of useful hearing.
文摘Acoustic Neuroma (AN) arises from the eighth cranial nerve. It primarily involves the vestibular branch of the nerve and is therefore also called vestibular schwannoma(VS). To the date, diagnosis and surgical treatment of AN have advanced significantly. Along with advances in audiology and imaging technologies, cases of diagnosed AN have been increasing, making it a common
文摘Objective: To determine the best follow-up period with regard to curative effect for acoustic neuroma treated with a gamma knife. Methods: Sixty cases of acoustic neuroma were treated with a gamma knife. The follow-up period was from 3 to 102 months. Changes in the lesions and peripheral tissues and clinical symptoms were compared and the curative effectiveness of gamma knife treatment was evaluated. Results: The highest total effective rate (92.3%) was in the third period. There was a significant difference in the tumor size postoperatively. There was no edema in the peripheral tissues surrounding the tumor. It was not obvious that clinical symptoms changed. Conclusion: In this report, the best follow-up period was 24-36 months. Gamma knife treatment was still effective after 60 months post-operation.
文摘Objective To evaluate the long-term facial nerve funtion of patients following microsurgical removal of large and huge acoustic neuroma,and to indentify the factors that influence these outcomes. Methods A retrospective review was performed,which included 176 consecutive patients with a
基金the National Natural Science Foundation of China (No.30571899)
文摘Background Although various monitoring techniques have been used routinely in the treatment of the lesions in the skull base, iatrogenic facial paresis or paralysis remains a significant clinical problem. The aim of this study was to investigate the effect of intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation on preservation of facial nerve function. Method From January to November 2005, 19 patients with large acoustic neuroma were treated using intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation （TCEMEP） for preservation of facial nerve function. The relationship between the decrease of MEP amplitude after tumor removal and the postoperative function of the facial nerve was analyzed. Results MEP amplitude decreased more than 75% in 11 patients, of which 6 presented significant facial paralysis （H-B grade 3）, and 5 had mild facial paralysis （H-B grade 2）. In the other 8 patients, whose MEP amplitude decreased less than 75%, 1 experienced significant facial paralysis, 5 had mild facial paralysis, and 2 were normal. Conclusions Intraoperative TCEMEP can be used to predict postoperative function of the facial nerve. The decreased MEP amplitude above 75 % is an alarm point for possible severe facial paralysis.
文摘Sporadic vestibular schwannoma (acoustic neuroma) is a benign tumor arising from cochleovestibular nerve. Nowadays, various specialties and medical centers are treating this dis-ease, and the multidisciplinary collaboration is the trend. In an effort to promote a uniform stan-dard for reporting clinical results, even for treatment indications, the mainly controversies were posed and discussed during the 7th International Conference on acoustic neuroma, and the agreement was summarized by the Committee of this conference. The main symptoms grading and tumor stage should note its name of classification for making them comparable. The goal of the modern managements for vestibular schwannoma is to improve the quality of life with lower mortality, lower morbidity and better neurological function preservation. The experience of surgical team and their preference might be a major factor for the outcome. Because of lack-ing of long-term follow-up large data after radiotherapy, and with the development of microsur-gery, radiotherapy is now less recommended except for recurrent cases or elderly patients.
基金This work was supported by grants from the National Natural Science Foundation of China （No. 30540080） and Society for the Promotion of International Oto-Rhino-Laryngology （SPIO） of Japan.
文摘Background Small acoustic neuromas seldom result in typical vestibular symptoms, despite the tumor arising from the vestibular nerve. In this study, we have shown that abnormal gait in eleven patients with small acoustic neuroma could be detected in gait analysis by the use of tactile sensor. Patients displayed no oculomotor abnormality and had tumors less than 10 mm from the porus acoustics. Methods Gait related parameters including the coefficients of variations （CV） of stance, swing, double support, area ratio of trajectories of center of force （TCOF）, in addition to the foot pressure difference between both feet, were used for assessment of gait.
文摘Neuropathic pain is chronic pain generated by disorders of the peripheral and central nervous system, including skull base tumours. A skull base tumour can be any type of tumour that forms in the skull base, and this includes vestibular schwannomas which arise from the sheath of the inner ear vestibulocochlear nerve(eighth cranial nerve). Growth of the tumour, surgical resection, and/or stereotactic radiotherapy may result incompression and/or irritation of the fifth cranial nerve(trigeminal nerve) resulting in facial pain and/or numbness. Non-trigeminal afferent input may contribute to the wide constellation of symptoms seen in orofacial pain patients. The purpose of this report was to develop a decision tool to guide the recognition and treatment of neuropathic pain in this specialized population. Recommendations for treatment are based on evidence presented in Canadian and international neuropathic treatment guidelines. Algorithms are included for assessment and treatment of adult patients with agents that are recognized to have analgesic efficacy within the broad context of neuropathic pain.
文摘We present a case of a patient with progressive unilateral sensorineural hearing loss and tinnitus with internal auditory canal enhancement on magnetic resonance imaging (MRI) secondary to isolated cochlear neuritis from varicella reactivation. MRI following antiviral treat-ment showed resolution of enhancement. Varicella reactivation is commonly seen in the form of Ramsay Hunt syndrome, which is known to produce abnormal MRI enhancement from facial and vestibulocochlear neuritis;however, its characteristic clinical signs aid the diagnosis. This case is unique in that the only manifestation of varicella infection was unilateral hearing loss. This case outlines the importance of maintaining a broad differential diagnosis in the evaluation of unilateral hearing loss as well as recognizing the limited specificity of MRI.
文摘Neurofibromatosis type 2 （NF-2） is one of the most common single gene disorders in the nervous system.For approximately 96% of patients with NF-2 present with bilateral Schwannomas involving the eighth cranial nerves, which may be accompanied by Schwannomas involving other cranial, spinal or peripheral nerves, NF-2 is also referred to as ＂bilateral acoustic neuromas＂. Due to progression of tumors, surgery or radiotherapy, patients with bilateral acoustic neuromas will eventually suffer profound or total hearing loss, resulting in decrease of quality of life （QOL）.
