AIM: To evaluate the most important factors of quality of life in patients after vestibular schwannoma surgery. MATERIALS AND METHODS: Patients with unilateral sporadic occurrence of vestibular schwannoma who underwent surgery via suboccipital-retrosigmoid approach were included in the prospective study (2018-2021). Patients after previous Leksell gamma knife irradiation (or other methods of stereotactic radiosurgery) were excluded. Quality of life was assessed using 10 validated questionnaires that were distributed preoperatively, 3 months and 1 year after the surgery. RESULTS: A total of 76 patients were included in the study, complete data were analysed in 43 of them (response rate 57%). Grade III and IV represented up to 70% of all tumors. Patients with larger tumors had a significantly higher risk of postoperative facial nerve paresis, liquorrhea and lower probability of hearing preservation. Patients with smaller tumors and those, who suffered from headaches before surgery had more frequent and severe headaches after surgery. Postoperative headaches were associated with higher incidence of anxiety and tinnitus. More frequent anxiety was also identified in patients with preoperative serviceable hearing who became deaf after surgery. Nevertheless, tinnitus and hearing impairment appeared to have less impact on overall quality of life compared to headaches and facial nerve function. CONCLUSION: According to our results, tumor size, postoperative function of the facial nerve and occurrence of postoperative headaches had the greatest influence on the overall postoperative quality of life in patients after vestibular schwannoma surgery.

• MeSH
• bolesti hlavy MeSH
• kvalita života MeSH
• lidé MeSH
• prospektivní studie MeSH
• tinnitus * MeSH
• vestibulární schwannom * chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The accurate identification and preservation of the facial nerve (FN) during vestibular schwannoma (VS) surgery is crucial for maintaining facial function. Investigating the application of diffusion tensor imaging (DTI) in preoperative planning for large VS surgery is provided. PubMed, Cochrane Library, Science Direct, ISI Web of Science, Embase, and additional sources were searched to identify cohort studies about the preoperative DTI usage for the FN tracking before large VS (≥ 2.5 cm) surgery published between 1990 and 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed; the Newcastle-Ottawa Scale was used to assess the risk of bias and to evaluate limitations based on selection/outcome biases. A total of 8 publications yielding 149 VS (mean size 3.66 ± 0.81 cm) were included. Surgical concordance with preoperative DTI FN tracking was 91.67% (range 85-100%). Overall DTI reliability was 88.89% (range 81.81-95.83%). Larger tumor size predicted either DTI inaccurate finding or complete DTI failure (p = 0.001). VS size above > 3.5 cm was associated with a higher risk of DTI failure (p = 0.022), with a higher risk of inaccurate DTI finding preoperatively (p = 0.033), and with a higher House-Brackman score postoperatively (p = 0.007). Application of DTI in larger VS surgery is a valuable FN identification along with electrophysiological monitoring and neuronavigation, therefore also in its preservation and in lowering risk of complications. DTI represents a valuable adjunct to electrophysiological monitoring and neuronavigation in FN identification, applicable not only for smaller, but also larger VS.

• MeSH
• lidé MeSH
• nervus facialis diagnostické zobrazování   chirurgie   patologie   MeSH
• poranění nervus facialis * etiologie   MeSH
• reprodukovatelnost výsledků MeSH
• vestibulární schwannom * diagnostické zobrazování   chirurgie   komplikace   MeSH
• zobrazování difuzních tenzorů metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• systematický přehled MeSH

Vestibular schwannoma is the most common benign neoplasm of the cerebellopontine angle. Its first symptoms include hearing loss, tinnitus, and vestibular symptoms, followed by cerebellar and brainstem symptoms, along with palsy of the adjacent cranial nerves. However, the clinical picture has unpredictable dynamics and currently, there are no reliable predictors of tumor behavior. Hence, it is desirable to have a fast routine method for analysis of vestibular schwannoma tissues at the molecular level. The major objective of this study was to verify whether a technique using in-sample specific protein digestion with trypsin would have the potential to provide a proteomic characterization of these pathological tissues. The achieved results showed that the use of this approach with subsequent liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis of released peptides allowed a fast identification of a considerable number of proteins in two differential parts of vestibular schwannoma tissue as well as in tissues of control healthy samples. Furthermore, mathematical analysis of MS data was able to discriminate between pathological vestibular schwannoma tissues and healthy tissues. Thus, in-sample protein digestion combined with LC-MS/MS separation and identification of released specific peptides followed by mathematical analysis appears to have the potential for routine characterization of vestibular schwannomas at the molecular level. Data are available via ProteomeXchange with identifier PXD045261.

• MeSH
• chromatografie kapalinová metody   MeSH
• lidé MeSH
• peptidové fragmenty * analýza   chemie   metabolismus   MeSH
• peptidy metabolismus   MeSH
• proteolýza MeSH
• proteomika metody   MeSH
• tandemová hmotnostní spektrometrie metody   MeSH
• trypsin chemie   MeSH
• vestibulární schwannom * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: Vestibular schwannoma surgery leads to acute unilateral vestibular loss. In some patients, however, the process of post-operatively initiated central compensation proceeds more rapidly than in others. This study aimed to evaluate post-operative vestibular function and correlate it with morphological findings of MRI scans. METHODS: The study included 29 patients who underwent surgery for vestibular schwannoma. Vestibular function was analysed post-operatively by video head impulse test (vHIT). Subjective symptoms were evaluated using validated questionnaires. All patients underwent MRI 3 months post-operatively, and the presence of the facial and vestibulocochlear nerves in the internal auditory canal was assessed. RESULTS: The vestibulo-ocular reflex gain measured by the vHIT correlated positively with audiological findings. Subjective perception of vestibular disorder did not correlate with objectively measured vestibular impairment or with MRI findings. CONCLUSIONS: After the resection of vestibular schwannoma, some patients may still have preserved vestibular function as measured by vHIT. The preserved function does not correlate with subjective symptoms. Patients with partially deteriorated vestibular function showed lower sensitivity to combined stimuli.

• MeSH
• lidé MeSH
• pulsní rotační test MeSH
• vestibulární aparát * MeSH
• vestibulární nemoci * MeSH
• vestibulární schwannom * MeSH
• vestibulookulární reflex fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Cílem práce je podat přehled o současných možnostech vestibulární rehabilitace u pacientů po operaci vestibulárního schwannomu. Resekce nádoru vede obvykle ke vzniku jednostranné akutní periferní či kombinované vestibulární léze způsobené přerušením větví vestibulárního nervu a případně i poškozením mozečku. Léze se projevuje u pacientů poruchami stability, závratí, oscilopsií a vegetativním doprovodem. Lidský organizmus na tuto situaci reaguje zahájením mechanizmu centrální kompenzace, v níž hraje zásadní úlohu mozeček. Cílem vestibulární rehabilitace je tyto mechanizmy posílit a rekonvalescenci pacientů nejen zrychlit, ale zároveň dosáhnout i lepších funkčních výsledků, neboť ne všichni pacienti jsou schopni lézi dostatečně zkompenzovat. Vestibulární rehabilitace v sobě v současné době zahrnuje kromě specifických vestibulárních cvičení také možnosti využití prehabituace a virtuální reality. Díky prehabituaci, tedy předoperační chemické labyrintektomii pomocí intratympanálně podaného gentamicinu, dochází k časovému oddělení vzniku vestibulární léze od vlastního chirurgického výkonu a tím možnosti dosažení vestibulární kompenzace ještě před samotnou resekcí vestibulárního schwannomu. V poslední dekádě se nástroje pro využití virtuální reality stávají cenově dostupné, a tím pádem i v širší praxi použitelné. Prostřednictvím virtuální reality mohou být pacienti vystavováni scénám, které posilují 3D optokinetickou stimulaci, čímž se rozšiřují možnosti posilování centrálních kompenzačních mechanizmů a tím dochází ke zlepšení kvality života pacientů.

This review aims to summarize the current vestibular rehabilitation options in patients after vestibular schwannoma surgery. Resection of the tumor usually leads to unilateral acute peripheral or combined vestibular loss caused by a surgical lesion to the branches of the vestibular nerve and less frequently also a lesion in the cerebellum. In patients, the vestibular lesion manifests as postural instability, vertigo, oscillopsia and vegetative symptoms. Human organisms react to this state using the process of central compensation with a significant role of the cerebellum. The goal of vestibular rehabilitation is to support this process and thus make recovery faster and more efficient since not all patients are capable of sufficient restoration of vestibular function. Currently, vestibular rehabilitation includes, apart from the specific vestibular exercise, modern techniques using virtual reality space and prehabituation. Due to prehabituation, i.e., preoperative chemical labyrinthectomy with intratympanically installed gentamicin, the timing of the origin of the acute vestibular loss and surgical procedure is separated. Therefore, there is a chance of achieving vestibular compensation before vestibular schwannoma removal. In the last decade, the tools for virtual reality have become less expensive and more available in medical care. Virtual reality is a technique used for generating an environment that can strengthen three-dimensional optokinetic stimulation, subsequently the process of central compensation and finally it may improve patients’ quality of life.

• Klíčová slova
• vestibulární rehabilitace,
• MeSH
• fyzioterapie v předoperační přípravě MeSH
• lidé MeSH
• neurorehabilitace * metody   MeSH
• pooperační péče MeSH
• vestibulární schwannom * chirurgie   MeSH
• virtuální realita MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

The incidence of sporadic vestibular schwannoma has significantly increased over the past few decades. However, there is no method currently available to accurately predict the risk of subsequent tumor growth. The difference in the management of five patient groups has been evaluated: wait and scan, conversion to microsurgery, conversion to stereoradiotherapy, sterioradiotherapy, and microsurgery. In total, 463 patients with vestibular schwannoma have been consulted in our department from 2010 through 2016. Of the 250 patients initially indicated for observation, 32.4% were later indicated for active treatment. Younger patients were more frequently indicated for surgery (mean age 48 years) compared to older patients, who were more often indicated for stereoradiotherapy (mean age 62 years). Tumor growth was observed more often in patients under 60 years of age and in patients with tumors greater than 10 mm. In elderly patients, including those with larger tumors, a conservative approach is the optimal solution. If tumor growth occurs in the wait-and-scan strategy, it is still possible to continue with a conservative approach in some situations. The duration of follow-up scans is still a matter of debate, as tumors can begin to grow after 5 years from the initial diagnosis.

• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Currently, it is possible to preserve the auditory nerve in a large number of cases, but the preservation of the hearing itself is unpredictable. Apart from wait and scan strategy and stereoradiotherapy, hearing after vestibular schwannoma surgery is considered to remain stable even in long-term follow-up. MATERIALS AND METHODS: Twenty-eight patients had preserved hearing after retrosigmoid suboccipital microsurgery of the vestibular schwannoma between 2008 and 2014. A standard audiological protocol was performed together with an magnetic resonance imaging evaluation of the fluid content of the inner ear. RESULTS: The mean difference in pure-tone average between the direct and final postsurgical examination was 12.758 dB ( p = 2.5E - 06). The word recognition score deteriorated by 17.45% ( p = 0.03516). The mean American Academy of Otolaryngology-Head and Neck Surgery score on the second examination was 2.5, and that on the second examination was 3.111 ( p = 0.00483). There was no significant deterioration in the healthy ear.The signal intensity ratio in the basal turn of the cochlea increased by an average of 0.13 points ( p < 0.05).Patients with persistent tumor or nodular enhancement in the internal acoustic meatus deteriorated significantly in hearing according to the American Academy of Otolaryngology-Head and Neck Surgery scale compared with patients without any finding in the meatus ( p = 0.01299). CONCLUSIONS: There is a discrete but gradual deterioration of the hearing in the postoperative period. Hearing impairment is more pronounced in patients with a nodular process in the internal acoustic meatus, regardless of whether it is growth active. After surgery, the pathological content of the inner ear normalizes (evaluated on T2 magnetic resonance imaging sequences).

• MeSH
• kochlea MeSH
• lidé MeSH
• nedoslýchavost * etiologie   MeSH
• retrospektivní studie MeSH
• sluch MeSH
• vestibulární schwannom * chirurgie   MeSH
• vnitřní ucho * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Vestibular schwannoma is the most common benign neoplasm of the cerebellopontine angle. It arises from Schwann cells of the vestibular nerve. The first symptoms of vestibular schwannoma include hearing loss, tinnitus, and vestibular symptoms. In the event of further growth, cerebellar and brainstem symptoms, along with palsy of the adjacent cranial nerves, may be present. Although hearing impairment is present in 95% of patients diagnosed with vestibular schwannoma, most tumors do not progress in size or have low growth rates. However, the clinical picture has unpredictable dynamics, and there are currently no reliable predictors of the tumor's behavior. The etiology of the hearing loss in patients with vestibular schwannoma is unclear. Given the presence of hearing loss in patients with non-growing tumors, a purely mechanistic approach is insufficient. A possible explanation for this may be that the function of the auditory system may be affected by the paracrine activity of the tumor. Moreover, initiation of the development and growth progression of vestibular schwannomas is not yet clearly understood. Biallelic loss of the NF2 gene does not explain the occurrence in all patients; therefore, detection of gene expression abnormalities in cases of progressive growth is required. As in other areas of cancer research, the tumor microenvironment is coming to the forefront, also in vestibular schwannomas. In the paradigm of the tumor microenvironment, the stroma of the tumor actively influences the tumor's behavior. However, research in the area of vestibular schwannomas is at an early stage. Thus, knowledge of the molecular mechanisms of tumorigenesis and interactions between cells present within the tumor is crucial for the diagnosis, prediction of tumor behavior, and targeted therapeutic interventions. In this review, we provide an overview of the current knowledge in the field of molecular biology and tumor microenvironment of vestibular schwannomas, as well as their relationship to tumor growth and hearing loss.

• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVES: Hearing preservation after vestibular schwannoma (VS) surgery remains a surgical challenge. In some patients with preserved inner ear function, hearing improvement is achievable. As it is currently impossible to determine which patients will present this outcome, predictions must rely on previously published reports. Our case report describes a patient who experienced hearing improvement from an unuseful level to a useful one after vestibular schwannoma surgery. METHODS: Surgery was performed via suboccipital retrosigmoid approach. The patient underwent a basic audiovestibular protocol before and after the surgery - pure tone and speech audiometry, otoacoustic emissions, auditory brainstem responses, electronystagmography - together with a detailed questionnaire study. Usefulness of hearing was evaluated using the AAO-HNS guidelines, supplemented by a frequency of 4 kHz. RESULTS: Hearing was preserved and even improved from an unuseful level to a useful one. Based on the available literature, the most informative predictive factors for such a result seem to be: sudden sensorineural hearing loss prior to surgery, elicitable otoacoustic emissions and the origin from the superior vestibular nerve. CONCLUSION: There are a limited number of studies on this topic and it is still impossible to regularly improve hearing in properly selected patients. Furthermore, the importance of postoperative hearing quality compared to other symptoms and complications remains debatable.

• MeSH
• audiometrie čistými tóny MeSH
• lidé MeSH
• retrospektivní studie MeSH
• sluch fyziologie   MeSH
• vestibulární schwannom * komplikace   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• kazuistiky MeSH
• přehledy MeSH

Úvod: Léze lícního nervu způsobuje vážné zdravotní komplikace a vede k celkovému zhoršení kvality života. Porucha funkce lícního nervu poměrně často vzniká jako pooperační komplikace nádorových onemocnění příušní žlázy a baze lební. Nechirurgické metody léčby se zaměřují zejména na dlouhodobou rehabilitaci obličejové mimiky a prevenci vzniku komplikací z důvodu lagoftalmu. Chirurgické metody umožňují přerušený lícní nerv rekonstruovat jak v jeho intrakraniálním průběhu, tak i po výstupu ze spánkové kosti. Metody: Retrospektivně jsme analyzovali výsledky rekonstrukčních operací lícního nervu provedených u pacientů pro jednostrannou lézi lícního nervu s odstupem 1 roku a minimálně 2 let od provedení rekonstrukce. Hodnocena byla etiologie paréz, interval mezi vznikem léze a rekonstrukční operací, délka sledování a technika rekonstrukce. Funkce lícního nervu byla hodnocena pomocí klasifikace dle House-Brackmanna. Výsledky: Soubor obsahoval celkem 73 pacientů, z nich u 53 byla hodnocena funkce lícního nervu. Nejčastější příčina léze byla iatrogenní obrna po operaci vestibulárního schwannomu. Primární rekonstrukce převažovaly nad operacemi odloženými. Nejlepších funkčních výsledků po 1 roce dosahovaly rekonstrukce přímé s interpozitními autologními štěpy z nervus auricularis magnus následované štěpy z nervus suralis. S odstupem 2 a více let to byly přímé end-to-end rekonstrukce bez štěpu, u kterých navíc nedošlo k selhání rekonstrukce ani v jednom případě. U interpozitních štěpů z nervus auricularis magnus bylo prokázáno, že s délkou štěpu se horší i výsledná funkce lícního nervu. Pro nervus suralis obdobná závislost prokázána nebyla. Statisticky významná závislost mezi výslednou funkcí lícního nervu a rekonstrukční technikou, pohlavím, věkem ani intervalem mezi vznikem léze a rekonstrukcí nebyla prokázána. Závěr: Lze konstatovat, že rekonstrukční operace vedly ke zlepšení funkce lícního nervu u 98 % pacientů. U 70 % pacientů bylo s odstupem více než 2 let od rekonstrukce dosaženo úrovně HB 3.

Introduction: A facial nerve lesion causes serious health complications and leads to a general deterioration of the quality of life. A facial nerve lesion relatively often occurs as a complication of surgery of the parotid gland and skull base tumors. Non-surgical methods focus mainly on long-term rehabilitation of facial muscles and prevention of eye complications due to lagophthalmos. Surgical methods allow reconstruction of the facial nerve during its intracranial course, as well as after exiting the temporal bone. Methods: We retrospectively analyzed the results of facial nerve reconstruction techniques performed for a unilateral facial nerve lesion after 1 year and with an interval of at least 2 years after anastomosis. The etiology of paresis, interval between the onset of lesion and reconstructive surgery, length of follow-up and reconstruction technique were evaluated. Facial nerve function was assessed using the House-Brackmann classification. Results: The cohort contained a total of 73 patients; facial nerve function was assessed in 53 of them. Iatrogenic lesions due to vestibular schwannoma removal predominated. The primary reconstruction of the facial nerve prevailed over postponed operations. Direct anastomosis with an interposition of the autologous graft from the great auricular nerve followed by a sural nerve graft achieved the best functional results after 1 year. The best results with an interval of at least 2 years were achieved in direct end-to-end anastomoses without graft, in which the reconstruction did not fail in either case. In the case of an interposition of the autologous graft from the great auricular nerve, it has been shown that facial nerve function worsens with the length of the graft. This correlation was not observed in grafts from the sural nerve. No statistically significant difference was found between the resulting function of the facial nerve and the reconstruction technique, sex, age and interval between the onset of lasion and reconstruction. Conclusion: Reconstructive surgeries resulted in improved facial nerve function in 98 % of patients. 70% of patients with an interval of at least 2 years after the surgery achieved HB grade III.

• MeSH
• anastomóza chirurgická MeSH
• dospělí MeSH
• faciální paralýza chirurgie   etiologie   rehabilitace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory obličeje komplikace   MeSH
• nervus facialis * chirurgie   patofyziologie   transplantace   MeSH
• retrospektivní studie MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH