Intratumoral hemorrhage and fibrosis in vestibular schwannoma: A possible mechanism for hearing loss: Clinical article

Michael E. Sughrue, Rajwant Kaur, Ari J. Kane, Martin J. Rutkowski, Isaac Yang, Lawrence H. Pitts, Tarik Tihan, Andrew T. Parsa

Research output: Contribution to journalArticle

Abstract

Object. Vestibular schwannomas (VSs) are benign lesions with an unpredictable natural history. Perhaps the greatest barrier to predicting which patients need treatment is our poor understanding of how these tumors cause hearing loss in the first place. In this case-control study, the authors investigated the relationship between preoperative hearing loss and histological changes such as intratumoral microhemorrhage and extensive fibrosis. Methods. From a prospectively collected database, the authors selected all patients with VS who had undergone microsurgical resection as their initial treatment for histopathologically confirmed VS. Histological specimens obtained in 274 of these patients were systematically reviewed by a blinded neuropathologist who graded the extent of microhemorrhage and fibrosis in these tumors. The effect of these variables on preoperative hearing loss was studied using binary logistic regression. Results. On univariate analysis, patients with extensive intratumoral microhemorrhage or fibrosis (p < 0.0001), patients with larger tumors (p < 0.05), and patients 65 years of age or older (p < 0.05) were significantly more likely to have unserviceable hearing at the time of surgery. On multivariate analysis, only patients with extensive intratumoral microhemorrhage or fibrosis had an increased risk of having unserviceable hearing at the time of surgery (OR 3.72, 95% CI 1.3-10; p = 0.01). Older age and tumor size greater than 3 cm were not statistically significant risk factors for hearing loss, controlling for the effect of microhemorrhage and fibrosis. Conclusions. In this study, the authors have demonstrated a correlation between the extent of nonneoplastic histological changes, such as microhemorrhage and fibrosis, and hearing loss. This alternate hypothesis has the potential to explain many of the exceptions to previously described mechanisms of hearing loss in patients with VS. The advent of high-resolution MR imaging technology to identify microhemorrhages may provide a method to screen for patients with VS at risk for hearing loss.

Original languageEnglish (US)
Pages (from-to)386-393
Number of pages8
JournalJournal of neurosurgery
Volume114
Issue number2
DOIs
StatePublished - Feb 1 2011
Externally publishedYes

Fingerprint

Acoustic Neuroma
Hearing Loss
Fibrosis
Hemorrhage
Hearing
Neoplasms
Natural History
Case-Control Studies
Multivariate Analysis
Logistic Models
Databases
Technology

Keywords

  • Acoustic neuroma
  • Hearing
  • Hearing loss
  • Microhemorrhage
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Sughrue, M. E., Kaur, R., Kane, A. J., Rutkowski, M. J., Yang, I., Pitts, L. H., ... Parsa, A. T. (2011). Intratumoral hemorrhage and fibrosis in vestibular schwannoma: A possible mechanism for hearing loss: Clinical article. Journal of neurosurgery, 114(2), 386-393. https://doi.org/10.3171/2010.5.JNS10256

Intratumoral hemorrhage and fibrosis in vestibular schwannoma : A possible mechanism for hearing loss: Clinical article. / Sughrue, Michael E.; Kaur, Rajwant; Kane, Ari J.; Rutkowski, Martin J.; Yang, Isaac; Pitts, Lawrence H.; Tihan, Tarik; Parsa, Andrew T.

In: Journal of neurosurgery, Vol. 114, No. 2, 01.02.2011, p. 386-393.

Research output: Contribution to journalArticle

Sughrue, ME, Kaur, R, Kane, AJ, Rutkowski, MJ, Yang, I, Pitts, LH, Tihan, T & Parsa, AT 2011, 'Intratumoral hemorrhage and fibrosis in vestibular schwannoma: A possible mechanism for hearing loss: Clinical article', Journal of neurosurgery, vol. 114, no. 2, pp. 386-393. https://doi.org/10.3171/2010.5.JNS10256
Sughrue, Michael E. ; Kaur, Rajwant ; Kane, Ari J. ; Rutkowski, Martin J. ; Yang, Isaac ; Pitts, Lawrence H. ; Tihan, Tarik ; Parsa, Andrew T. / Intratumoral hemorrhage and fibrosis in vestibular schwannoma : A possible mechanism for hearing loss: Clinical article. In: Journal of neurosurgery. 2011 ; Vol. 114, No. 2. pp. 386-393.
@article{bd4b5f5e8f474f6585a7817307125346,
title = "Intratumoral hemorrhage and fibrosis in vestibular schwannoma: A possible mechanism for hearing loss: Clinical article",
abstract = "Object. Vestibular schwannomas (VSs) are benign lesions with an unpredictable natural history. Perhaps the greatest barrier to predicting which patients need treatment is our poor understanding of how these tumors cause hearing loss in the first place. In this case-control study, the authors investigated the relationship between preoperative hearing loss and histological changes such as intratumoral microhemorrhage and extensive fibrosis. Methods. From a prospectively collected database, the authors selected all patients with VS who had undergone microsurgical resection as their initial treatment for histopathologically confirmed VS. Histological specimens obtained in 274 of these patients were systematically reviewed by a blinded neuropathologist who graded the extent of microhemorrhage and fibrosis in these tumors. The effect of these variables on preoperative hearing loss was studied using binary logistic regression. Results. On univariate analysis, patients with extensive intratumoral microhemorrhage or fibrosis (p < 0.0001), patients with larger tumors (p < 0.05), and patients 65 years of age or older (p < 0.05) were significantly more likely to have unserviceable hearing at the time of surgery. On multivariate analysis, only patients with extensive intratumoral microhemorrhage or fibrosis had an increased risk of having unserviceable hearing at the time of surgery (OR 3.72, 95{\%} CI 1.3-10; p = 0.01). Older age and tumor size greater than 3 cm were not statistically significant risk factors for hearing loss, controlling for the effect of microhemorrhage and fibrosis. Conclusions. In this study, the authors have demonstrated a correlation between the extent of nonneoplastic histological changes, such as microhemorrhage and fibrosis, and hearing loss. This alternate hypothesis has the potential to explain many of the exceptions to previously described mechanisms of hearing loss in patients with VS. The advent of high-resolution MR imaging technology to identify microhemorrhages may provide a method to screen for patients with VS at risk for hearing loss.",
keywords = "Acoustic neuroma, Hearing, Hearing loss, Microhemorrhage, Vestibular schwannoma",
author = "Sughrue, {Michael E.} and Rajwant Kaur and Kane, {Ari J.} and Rutkowski, {Martin J.} and Isaac Yang and Pitts, {Lawrence H.} and Tarik Tihan and Parsa, {Andrew T.}",
year = "2011",
month = "2",
day = "1",
doi = "10.3171/2010.5.JNS10256",
language = "English (US)",
volume = "114",
pages = "386--393",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "2",

}

TY - JOUR

T1 - Intratumoral hemorrhage and fibrosis in vestibular schwannoma

T2 - A possible mechanism for hearing loss: Clinical article

AU - Sughrue, Michael E.

AU - Kaur, Rajwant

AU - Kane, Ari J.

AU - Rutkowski, Martin J.

AU - Yang, Isaac

AU - Pitts, Lawrence H.

AU - Tihan, Tarik

AU - Parsa, Andrew T.

PY - 2011/2/1

Y1 - 2011/2/1

N2 - Object. Vestibular schwannomas (VSs) are benign lesions with an unpredictable natural history. Perhaps the greatest barrier to predicting which patients need treatment is our poor understanding of how these tumors cause hearing loss in the first place. In this case-control study, the authors investigated the relationship between preoperative hearing loss and histological changes such as intratumoral microhemorrhage and extensive fibrosis. Methods. From a prospectively collected database, the authors selected all patients with VS who had undergone microsurgical resection as their initial treatment for histopathologically confirmed VS. Histological specimens obtained in 274 of these patients were systematically reviewed by a blinded neuropathologist who graded the extent of microhemorrhage and fibrosis in these tumors. The effect of these variables on preoperative hearing loss was studied using binary logistic regression. Results. On univariate analysis, patients with extensive intratumoral microhemorrhage or fibrosis (p < 0.0001), patients with larger tumors (p < 0.05), and patients 65 years of age or older (p < 0.05) were significantly more likely to have unserviceable hearing at the time of surgery. On multivariate analysis, only patients with extensive intratumoral microhemorrhage or fibrosis had an increased risk of having unserviceable hearing at the time of surgery (OR 3.72, 95% CI 1.3-10; p = 0.01). Older age and tumor size greater than 3 cm were not statistically significant risk factors for hearing loss, controlling for the effect of microhemorrhage and fibrosis. Conclusions. In this study, the authors have demonstrated a correlation between the extent of nonneoplastic histological changes, such as microhemorrhage and fibrosis, and hearing loss. This alternate hypothesis has the potential to explain many of the exceptions to previously described mechanisms of hearing loss in patients with VS. The advent of high-resolution MR imaging technology to identify microhemorrhages may provide a method to screen for patients with VS at risk for hearing loss.

AB - Object. Vestibular schwannomas (VSs) are benign lesions with an unpredictable natural history. Perhaps the greatest barrier to predicting which patients need treatment is our poor understanding of how these tumors cause hearing loss in the first place. In this case-control study, the authors investigated the relationship between preoperative hearing loss and histological changes such as intratumoral microhemorrhage and extensive fibrosis. Methods. From a prospectively collected database, the authors selected all patients with VS who had undergone microsurgical resection as their initial treatment for histopathologically confirmed VS. Histological specimens obtained in 274 of these patients were systematically reviewed by a blinded neuropathologist who graded the extent of microhemorrhage and fibrosis in these tumors. The effect of these variables on preoperative hearing loss was studied using binary logistic regression. Results. On univariate analysis, patients with extensive intratumoral microhemorrhage or fibrosis (p < 0.0001), patients with larger tumors (p < 0.05), and patients 65 years of age or older (p < 0.05) were significantly more likely to have unserviceable hearing at the time of surgery. On multivariate analysis, only patients with extensive intratumoral microhemorrhage or fibrosis had an increased risk of having unserviceable hearing at the time of surgery (OR 3.72, 95% CI 1.3-10; p = 0.01). Older age and tumor size greater than 3 cm were not statistically significant risk factors for hearing loss, controlling for the effect of microhemorrhage and fibrosis. Conclusions. In this study, the authors have demonstrated a correlation between the extent of nonneoplastic histological changes, such as microhemorrhage and fibrosis, and hearing loss. This alternate hypothesis has the potential to explain many of the exceptions to previously described mechanisms of hearing loss in patients with VS. The advent of high-resolution MR imaging technology to identify microhemorrhages may provide a method to screen for patients with VS at risk for hearing loss.

KW - Acoustic neuroma

KW - Hearing

KW - Hearing loss

KW - Microhemorrhage

KW - Vestibular schwannoma

UR - http://www.scopus.com/inward/record.url?scp=79551693096&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79551693096&partnerID=8YFLogxK

U2 - 10.3171/2010.5.JNS10256

DO - 10.3171/2010.5.JNS10256

M3 - Article

C2 - 20560722

AN - SCOPUS:79551693096

VL - 114

SP - 386

EP - 393

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 2

ER -