Quantitative assessment of brainstem distortion in vestibular schwannoma and its implication in occurrence of hydrocephalus.

Autor: Kumar A; Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India., Behari S; Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India., Sardhara J; Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India., Mishra P; Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India., Singh V; Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India., Raiyani V; Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India., Bhaisora KS; Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India., Srivastava AK; Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Jazyk: angličtina
Zdroj: British journal of neurosurgery [Br J Neurosurg] 2022 Dec; Vol. 36 (6), pp. 686-692. Date of Electronic Publication: 2022 Mar 07.
DOI: 10.1080/02688697.2022.2047155
Abstrakt: Purpose: Anatomical distortion directly affects the clinical status of patients with vestibular schwannomas (VSs). It may vary for a given tumor size due to variability in posterior fossa anatomy. We aimed to quantitatively assess brainstem distortion (BSD) and review its role in occurrence of hydrocephalus associated with VSs.
Methods: Sixty-six patients with small (<3 cm, n =   8; 12.1%); large (3-4 cm; n =   26; 39.4%) and giant (>4 cm; n =   32; 48.5%) VSs were included. Cystic VSs were excluded. Tumor size, tumor-extent, linear displacement (LD; distance between line bisecting pons (line 1) and posterior fossa midline (line 2)) and angular distortion (AD; angle subtended between lines 1 and 2) in axial-T2-MRI section through pons, and their effect on hydrocephalus were assessed.
Results: Significant BSD occurred in a younger age ( p value = .004/.003), larger-sized tumor ( p value   =   .001/.002), hydrocephalus ( p value   =   .001/.001), trigeminal (V) nerve palsy ( p value   = .004/.003) and long tract signs ( p value   =   .001/.034). Tumors crossing midline had significant association with hydrocephalus ( p value =   .003). LD increased progressively even for 4-5 cm-sized tumors while AD stabilized. Receiver operating characteristic (ROC) curve revealed that diagnostic accuracy of LD (area under the ROC curve (AUROC): 78.9% (95% CI: 67.2%, 90.5%, p   <   .001)), AD (AUROC:77.6% (95% CI:65.8%, 89.5%, p   <   .001)) and LD × AD (AUROC:80.3% (95% CI: 69.2%, 91.2%, p   <   .001)) for predicting occurrence of hydrocephalus was better than tumor size (AUROC: 66.7% (95% CI: 53.5%, 79.9%, p   <   .05). Cut-off values of LD and AD for predicting occurrence of hydrocephalus were 6.25 mm and 14.6°, respectively. Hydrocephalus was significantly more when both LD  was greater than   6.25 mm and AD  was greater than  14.5° ( p value   =   .034). The role of LD and AD in influencing hydrocephalus was greater than categorization based on tumor size (Spearman's correlation coefficient: 0.535 and 0.248, respectively). Hydrocephalus occurred at a lesser cut-off value of LD and AD when compared to long tract signs.
Conclusions: LD and AD values in VSs have a significantly greater influence in the development of hydrocephalus compared to tumor size, and may aid, more reliably, in the prediction of hydrocephalus.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje