Laryngorhinootologie 2017; 96(S 01): S152-S182
DOI: 10.1055/s-0042-122386
Referat
© Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie des Vestibularisschwannoms – eine interdisziplinäre Herausforderung

Diagnosis and Management of Vestibular Schwannomas – An Interdisciplinary Challenge
Steffen Rosahl
1   Klinik für Neurochirurgie, HELIOS Klinikum Erfurt
,
Christopher Bohr
2   Hals-Nasen-Ohren-Klinik, Universitätsklinikum Erlangen
,
Michael Lell
3   Institut für Radiologie und Nuklearmedizin, Klinikum Nürnberg
,
Klaus Hamm
4   Cyberknifezentrum Mitteldeutschland, Erfurt
,
Heinrich Iro
2   Hals-Nasen-Ohren-Klinik, Universitätsklinikum Erlangen
› Author Affiliations
Further Information

Publication History

Publication Date:
16 October 2017 (online)

Zusammenfassung

Vestibularisschwannome wachsen langsam im inneren Gehörgang, im Kleinhirnbrückenwinkel, intracochleär und intralabyrinthär. Größere Tumoren verdrängen und komprimieren den Hirnstamm. Bei einer jährlichen Inzidenz von 1:100 000 repräsentieren Vestibularisschwannome 6–7% aller intrakraniellen Tumore und sind mit einem Anteil von 90% der häufigste Tumor im Kleinhirnbrückenwinkel. Magnetresonanztomografie (MRT), Audiometrie und Vestibularisdiagnostik sind die wesentlichen Säulen der klinisch-apparativen Untersuchungen.

Eine Übersicht über Tumorstadien, gebräuchliche Skalen zur Beurteilung der Fazialisfunktion und des Hörvermögens sowie eine kurze Darstellung aktueller Methoden der Vestibularisdiagnostik findet sich im ersten Teil dieses Referates.

Zentrales Anliegen in der Beratung und Behandlung von Patienten mit Vestibularisschwannomen ist heute die dauerhafte Aufrechterhaltung oder Verbesserung der Lebensqualität. Die Erhaltung neuronaler Funktion steht dabei im Vordergrund, die Behandlungskonzepte – Beobachtung, Operation, stereotaktische Bestrahlung und Kombinationen – werden an die individuelle Situation des Patienten angepasst. Wichtig für die Qualitätskontrolle und die Verbesserung der Behandlungsergebnisse ist dabei der beständige, interdisziplinäre Dialog. In den vergangenen Monaten sind in nationalen und internationalen Zeitschriften zahlreiche Übersichtsarbeiten zum Thema Vestibularisschwannome erschienen. Auch anlässlich des HNO-Kongresses 2017 erscheint ein Sonderheft zu diesem Thema. Aus diesem Grund soll dieses Manuskript von der traditionellen Form im Sinne einer Literaturübersicht und der Zusammenfassung der aktuellen Behandlungsstandards bewusst abweichen. Das vorliegende Referat wurde daher als eine interdisziplinäre Fallsammlung konzipiert, in der für jedes Stadium der Erkrankung anhand von Beispielen Verlaufsbeobachtungen sowie mikrochirurgische und radiotherapeutische Möglichkeiten des Managements gezeigt werden. Daraus wird eine Systematik in Form von Entscheidungskaskaden und klinischen Behandlungspfaden entwickelt. Wesentliche Kriterien bei der Entscheidungsfindung zur Behandlung sind die Größe des Tumors, seine Wachstumsgeschwindigkeit, das Hörvermögen des Patienten bzw. die Wahrscheinlichkeit einer möglichst vollständigen Resektion unter Erhaltung der Hörfunktion und der Funktion des Fazialis, das Alter und Vorerkrankungen des Patienten, die möglichst gute Kontrolle der für die Lebensqualität so wichtigen Faktoren wie Vertigo und Tinnitus und letztlich auch die Neigung des Patienten. In die Entscheidung fließen Erfahrungen und Ergebnisse des jeweiligen Behandlungszentrums mit der einen oder anderen Behandlungsmodalität ein.

Die aktuellen Literaturbefunde zu Fazialisfunktion, Hörvermögen, Schwindel, Tinnitus und Kopfschmerzen im Rahmen des natürlichen Verlaufes und von Behandlungen werden anschließend im Detail diskutiert und ihr Einfluss auf die Lebensqualität von Patienten mit Vestibularisschwannomen dargestellt. Das Symptom Schwindel spielt hier eine zentrale Rolle, weil es einer der wesentlichsten Prädiktoren von Lebensqualität und Arbeitsfähigkeit des Patienten ist.

Die pathognomonischen, bilateralen Vestibularisschwannome, die im Rahmen der Neurofibromatose Typ 2 auftreten, unterscheiden sich im biologischen Verhalten von spontanen, unilateralen Tumoren. Die Behandlung der Patienten mit diesen bilateralen Tumoren bedarf, schon wegen der oft zahlreichen weiteren intrakraniellen und spinalen Läsionen, eines multidisziplinären Teams. Als zusätzliche Off-Label-Behandlungsoption ist hier der Einsatz von Bevacizumab möglich, wodurch die Größe der Vestibularisschwannome über längere Zeiträume konstant gehalten und ein drohender Hörverlust verzögert werden kann. Eine Rehabilitation des Hörens kann bei NF-2-Patienten mittels Cochlea- und Hirnstammimplantaten möglich sein.

ABSTRACT

Vestibular schwannomas expand slowly in the internal auditory canal, in the cerebellopontine angle, inside the cochlear and the labyrinth. Larger tumors can displace and compress the brainstem. With an annual incidence of 1:100 000 vestibular schwannoma represent 6–7% of all intracranial tumors. In the cerebellopontine angle they are by far the most neoplasm with 90% of all lesions located in this region. Magnetic resonance imaging (MRI), audiometry, and vestibular diagnostics are the mainstays of the clinical workup for patients harboring tumors. The first part of this paper delivers an overview of tumor stages, the most common grading scales for facial nerve function and hearing as well as a short introduction to the examination of vestibular function.

Upholding or improving quality of life is the central concern in counseling and treating a patient with vestibular schwannoma. Preservation of neuronal function is essential and the management options – watchful waiting, microsurgery and stereotactic radiation – should be custom-tailored to the individual situation of the patient. Continuing interdisciplinary exchange is important to monitor treatment quality and to improve treatment results. Recently, several manuscripts and reviews have been published on the topic of vestibular schwanomma. On the occasion of the 88th annual meeting of the German Society of Oto-rhino-laryngology, Head and Neck surgery a special volume of the journal “HNO” will be printed. Hence this presentation has been designed to deviate from the traditional standard which commonly consists of a pure literature review. The current paper was conceptually woven around a series of interdisciplinary cases which outlines examples for every stage of the disease that show characteristic results for management options to date. Systematic clinical decision pathways have been deduced from our experience and from results reported in the literature. These pathways are graphically outlined after the case presentations. Important criteria for decision making are size and growth rate of the tumor, hearing of the patient and the probability of total tumor resection with preservation of hearing and facial nerve function, age and co-morbidity of the patient, best possible control of vertigo and tinnitus and last but not least the patient’s preference and choice. In addition to this, the experience and the results of a given center with each treatment modality will figure in the decision making process.

We will discuss findings that are reported in the literature regarding facial nerve function, hearing, vertigo, tinnitus, and headache and reflect on recent studies on their influence on the patient’s quality of life. Vertigo plays an essential role in this framework since it is an independent predictor of quality of life and a patient’s dependence on social welfare.

Pathognomonic bilateral vestibular schwannoma that occur in patients suffering from neurofibromatosis typ-2 (NF2) differ from spontaneous unilateral tumors in their biologic behavior. Treatment of neurofibromatosis type-2 patients requires a multidisciplinary team, especially because of the multitude of separate intracranial and spinal lesions.

Off-label chemotherapy with Bevacizumab can stabilize tumor size of vestibular schwannomas and even improve hearing over longer periods of time. Hearing rehabilitation in NF2 patients can be achieved with cochlea and auditory brainstem implants.

 
  • Literatur

  • 1 Böcker W, Denk H, Heitz PU, Moch H. Pathologie. 4 ed. Urban & Fischer Verlag/Elsevier GmbH; 2008
  • 2 Probst R, Grevers G, Iro H. Hals-Nasen-Ohren-Heilkunde. 3 ed. Stuttgart: Thieme; 2008
  • 3 Neurofibromatosis. Conference statement. National Institutes of Health Consensus Development Conference. Arch Neurol 1988; 45: 575-578
  • 4 Baser ME, Friedman JM, Joe H, Shenton A, Wallace AJ, Ramsden RT, Evans DG. Empirical development of improved diagnostic criteria for neurofibromatosis 2. Genet Med 2011; 13: 576-581
  • 5 Evans DG, Huson SM, Donnai D, Neary W, Blair V, Newton V, Harris R. A clinical study of type 2 neurofibromatosis. Q J Med 1992; 84: 603-618
  • 6 Gutmann DH, Aylsworth A, Carey JC, Korf B, Marks J, Pyeritz RE, Rubenstein A, Viskochil D. The diagnostic evaluation and multidisciplinary management of neurofibromatosis 1 and neurofibromatosis 2. JAMA 1997; 278: 51-57
  • 7 Lawson McLean A, Rosahl SK. Growth dynamics of intracranial tumors in patients with neurofibromatosis type 2. World Neurosurgery 2016; accepted for publication
  • 8 Lawson McLean AC, Rosahl SK. Growth dynamics of intramedullary spinal tumors in patients with neurofibromatosis type 2. Clin Neurol Neurosurg 2016; 146: 130-137
  • 9 Rosahl SK, Samii M. 2016. Tumore des Kleinhirnbrückenwinkels. In: Moskopp D, Wassmann M. eds (Hrsg.) Klinische Neurochirurgie. 2. Aufl. ed. Schattauer: Stuttgart-New York,; 461-472
  • 10 Hassepass F, Bulla SB, Aschendorff A, Maier W. Vestibularisschwannom-Epidemiologie und Diagnostik. HNO 2012; 60: 837-844
  • 11 Brown CM, Ahmad ZK, Ryan AF, Doherty JK. Estrogen receptor expression in sporadic vestibular schwannomas. Otol Neurotol 2011; 32: 158-162
  • 12 Darrouzet V, Martel J, Enee V, Bebear JP, Guerin J. Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope 2004; 114: 681-688
  • 13 Matthies C, Samii M. Management of 1 000 vestibular schwannomas (acoustic neuromas): clinical presentation. Neurosurgery 1997; 40: 1-9
  • 14 Stangerup SE, Tos M, Thomsen J, Caye-Thomasen P. True incidence of vestibular schwannoma?. Neurosurgery 2010; 67: 1335-1340
  • 15 Casselman JW, Kuhweide R, Deimling M, Ampe W, Dehaene I, Meeus L. Constructive interference in steady state-3DFT MR imaging of the inner ear and cerebellopontine angle. AJNR Am J Neuroradiol 1993; 14: 47-57
  • 16 Giesemann A, Hofmann E. Some remarks on imaging of the inner ear: options and limitations. Clin Neuroradiol 2015; 25 (Suppl. 02) 197-203
  • 17 Schmalbrock P. Comparison of three-dimensional fast spin echo and gradient echo sequences for high-resolution temporal bone imaging. J Magn Reson Imaging 2000; 12: 814-825
  • 18 Hajioff D, Raut VV, Walsh RM, Bath AP, Bance ML, Guha A, Tator CH, Rutka JA. Conservative management of vestibular schwannomas: third review of a 10-year prospective study. Clin Otolaryngol 2008; 33: 255-259
  • 19 Sheth SA, Kwon CS, Barker FG. The art of management decision making: from intuition to evidence-based medicine. Otolaryngol Clin North Am 2012; 45: 333-351 viii
  • 20 Stangerup SE, Caye-Thomasen P. Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin North Am 2012; 45: 257-268 vii
  • 21 Sughrue ME, Yang I, Aranda D, Lobo K, Pitts LH, Cheung SW, Parsa AT. The natural history of untreated sporadic vestibular schwannomas: a comprehensive review of hearing outcomes. J Neurosurg 2010; 112: 163-167
  • 22 Sekiya T, Hatayama T, Shimamura N, Suzuki S. A comprehensive classification system of vestibular schwannomas. J Clin Neurosci 2000; 7: 129-133
  • 23 Koos WT, Spetzler RF, Böck FW, Salah S. Microsurgery of cerebellopontine angle tumors. In Koos WT, Böck FW, Spetzler RF. eds (Hrsg.) Clinical Microneurosurgery. Stuttgart: Thieme; 1976: 91-112
  • 24 Samii M, Matthies C, Tatagiba M. Management of vestibular schwannomas (acoustic neuromas): auditory and facial nerve function after resection of 120 vestibular schwannomas in patients with neurofibromatosis 2. Neurosurgery 1997; 40: 696-705
  • 25 Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg 1995; 113: 9-180
  • 26 Gurgel RK, Jackler RK, Dobie RA, Popelka GR. A new standardized format for reporting hearing outcome in clinical trials. Otolaryngol Head Neck Surg 2012; 147: 803-807
  • 27 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93: 146-147
  • 28 Sanna M, Zini C, Mazzoni A, Gandolfi A, Pareschi R, Pasanisi E, Gamoletti R. Hearing preservation in acoustic neuroma surgery. Middle fossa versus suboccipital approach. Am J Otol 1987; 8: 500-506
  • 29 Wigand ME, Haid T, Berg M. The enlarged middle cranial fossa approach for surgery of the temporal bone and of the cerebellopontine angle. Arch Otorhinolaryngol 1989; 246: 299-302
  • 30 Briggs RJ, Luxford WM, Atkins Jr. JS, Hitselberger WE. Translabyrinthine removal of large acoustic neuromas. Neurosurgery 1994; 34: 785-790
  • 31 Chamoun R, MacDonald J, Shelton C, Couldwell WT. Surgical approaches for resection of vestibular schwannomas: translabyrinthine, retrosigmoid, and middle fossa approaches. Neurosurg Focus 2012; 33: E9
  • 32 Rosahl S, Esser D. Vestibular schwannoma-management and microsurgical results. HNO 2016
  • 33 Iro H, Zenk J. Chirurgie des inneren Gehörgangs. HNO OP Update 2010; 7-20
  • 34 Rosahl SK, Eßer D. Vestibularisschwannom – Chirurgische Techniken. HNO 2016; im Druck
  • 35 Samii M, Turel KE, Penkert G. Management of seventh and eighth nerve involvement by cerebellopontine angle tumors. Clin Neurosurg 1985; 32: 242-272
  • 36 Himes BT, Mallory GW, Abcejo AS, Pasternak J, Atkinson JL, Meyer FB, Marsh WR, Link MJ, Clarke MJ, Perkins W, Van Gompel JJ. Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position. J Neurosurg 2016; 1-7
  • 37 Metwali H, Samii M, Samii A, Gerganov V. The peculiar cystic vestibular schwannoma: a single-center experience. World Neurosurg 2014; 82: 1271-1275
  • 38 Lawson McLean AC, McLean AL, Rosahl SK. Evaluating vestibular schwannoma size and volume on magnetic resonance imaging: An inter- and intra-rater agreement study. Clin Neurol Neurosurg 2016; 145: 68-73
  • 39 Kliesch S, Vogelgesang S, Benecke R, Horstmann GA, Schroeder HW. Malignant brain oedema after radiosurgery of a medium-sized vestibular schwannoma. Cent Eur Neurosurg 2010; 71: 88-91
  • 40 Carlson ML, Tveiten OV, Driscoll CL, Goplen FK, Neff BA, Pollock BE, Tombers NM, Castner ML, Finnkirk MK, Myrseth E, Pedersen PH, Lund-Johansen M, Link MJ. Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls. J Neurosurg 2015; 122: 833-842
  • 41 Carlson ML, Tveiten OV, Yost KJ, Lohse CM, Lund-Johansen M, Link MJ. The minimal clinically important difference in vestibular schwannoma quality-of-life assessment: an important step beyond P<0,05. Otolaryngol Head Neck Surg 2015; 153: 202-208
  • 42 Breivik CN, Varughese JK, Wentzel-Larsen T, Vassbotn F, Lund-Johansen M. Conservative management of vestibular schwannoma – a prospective cohort study: treatment, symptoms, and quality of life. Neurosurgery 2012; 70: 1072-1080
  • 43 Carlson ML, Tveiten OV, Driscoll CL, Goplen FK, Neff BA, Pollock BE, Tombers NM, Lund-Johansen M, Link MJ. What drives quality of life in patients with sporadic vestibular schwannoma?. Laryngoscope 2015; 125: 1697-1702
  • 44 Sughrue ME, Yang I, Rutkowski MJ, Aranda D, Parsa AT. Preservation of facial nerve function after resection of vestibular schwannoma. Br J Neurosurg 2010; 24: 666-671
  • 45 Samii M, Matthies C. Management of 1 000 vestibular schwannomas (acoustic neuromas): the facial nerve – preservation and restitution of function. Neurosurgery 1997; 40: 684-694
  • 46 Samii M, Gerganov V, Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg 2006; 105: 527-535
  • 47 Samii M, Gerganov VM, Samii A. Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg 2010; 112: 860-867
  • 48 Gjuric M, Wigand ME, Wolf SR. Enlarged middle fossa vestibular schwannoma surgery: experience with 735 cases. Otol Neurotol 2001; 22: 223-230
  • 49 Ellenbogen JR, Waqar M, Kinshuck AJ, Jenkinson MD, Lesser TH, Husband D, Javadpour M. Linear accelerator radiosurgery for vestibular schwannomas: Results of medium-term follow-up. Br J Neurosurg 2015; 29: 678-684
  • 50 Combs SE, Engelhard C, Kopp C, Wiedenmann N, Schramm O, Prokic V, Debus J, Molls M, Grosu AL. Long-term outcome after highly advanced single-dose or fractionated radiotherapy in patients with vestibular schwannomas-pooled results from 3 large German centers. Radiother Oncol 2015; 114: 378-383
  • 51 Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D. Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 2013; 119 Suppl 195-199
  • 52 Teo M, Zhang M, Li A, Thompson PA, Tayag AT, Wallach J, Gibbs IC, Soltys SG, Hancock SL, Chang SD. The outcome of hypofractionated stereotactic radiosurgery for large vestibular schwannomas. World Neurosurg 2016; 93: 398-409
  • 53 Tveiten OV, Carlson ML, Goplen F, Vassbotn F, Link MJ, Lund-Johansen M. Long-term auditory symptoms in patients with sporadic vestibular schwannoma: an international cross-sectional study. Neurosurgery 2015; 77: 218-227
  • 54 Brackmann DE, Cullen RD, Fisher LM. Facial nerve function after translabyrinthine vestibular schwannoma surgery. Otolaryngol Head Neck Surg 2007; 136: 773-777
  • 55 Nadol Jr. JB, Levine R, Ojemann RG, Martuza RL, Montgomery WW, de Sandoval PK. Preservation of hearing in surgical removal of acoustic neuromas of the internal auditory canal and cerebellar pontine angle. Laryngoscope 1987; 97: 1287-1294
  • 56 Samii M, Matthies C. Management of 1 000 vestibular schwannomas (acoustic neuromas): hearing function in 1 000 tumor resections. Neurosurgery 1997; 40: 248-260
  • 57 Sheth SA, Kwon CS, Barker FG. The art of management decision making: from intuition to evidence-based medicine. Otolaryngol Clin North Am 2012; 45: 333-351 viii
  • 58 Satar B, Yetiser S, Ozkaptan Y. Impact of tumor size on hearing outcome and facial function with the middle fossa approach for acoustic neuroma: a meta-analytic study. Acta Otolaryngol 2003; 123: 499-505
  • 59 Vincent C, Bonne NX, Guerin C, Lebreton JP, Devambez M, Dubrulle F, Haddad E, Schapira S, Lejeune JP, Vaneecloo FM. Middle fossa approach for resection of vestibular schwannoma: impact of cochlear fossa extension and auditory monitoring on hearing preservation. Otol Neurotol 2012; 33: 849-852
  • 60 Myrseth E, Moller P, Wentzel-Larsen T, Goplen F, Lund-Johansen M. Untreated vestibular schwannomas: vertigo is a powerful predictor for health-related quality of life. Neurosurgery 2006; 59: 67-76
  • 61 Breivik CN, Nilsen RM, Myrseth E, Finnkirk MK, Lund-Johansen M. Working disability in Norwegian patients with vestibular schwannoma: vertigo predicts future dependence. World Neurosurg 2013; 80: e301-e305
  • 62 Andersen JF, Nilsen KS, Vassbotn FS, Moller P, Myrseth E, Lund-Johansen M, Goplen FK. Predictors of vertigo in patients with untreated vestibular schwannoma. Otol Neurotol 2015; 36: 647-652
  • 63 Samii M, Metwali H, Gerganov V. Efficacy of microsurgical tumor removal for treatment of patients with intracanalicular vestibular schwannoma presenting with disabling vestibular symptoms. J Neurosurg 2016; 1-6
  • 64 Carlson ML, Tveiten OV, Driscoll CL, Neff BA, Shepard NT, Eggers SD, Staab JP, Tombers NM, Goplen FK, Lund-Johansen M, Link MJ. Long-term dizziness handicap in patients with vestibular schwannoma: a multicenter cross-sectional study. Otolaryngol Head Neck Surg 2014; 151: 1028-1037
  • 65 Grauvogel J, Kaminsky J, Rosahl SK. The impact of tinnitus and vertigo on patient-perceived quality of life after cerebellopontine angle surgery. Neurosurgery 2010; 67: 601-609
  • 66 Kameda K, Shono T, Hashiguchi K, Yoshida F, Sasaki T. Effect of tumor removal on tinnitus in patients with vestibular schwannoma. J Neurosurg 2010; 112: 152-157
  • 67 Carlson ML, Tveiten OV, Driscoll CL, Boes CJ, Sullan MJ, Goplen FK, Lund-Johansen M, Link MJ. Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: a multicenter cross-sectional study. J Neurosurg 2015; 1-11
  • 68 Myrseth E, Pedersen PH, Moller P, Lund-Johansen M. Treatment of vestibular schwannomas. Why, when and how? Acta Neurochir (Wien ) 2007; 149: 647-660
  • 69 Stangerup SE, Caye-Thomasen P, Tos M, Thomsen J. Change in hearing during ̒wait and scan̓ management of patients with vestibular schwannoma. J Laryngol Otol 2008; 122: 673-681
  • 70 Stangerup SE, Tos M, Thomsen J, Caye-Thomasen P. Hearing outcomes of vestibular schwannoma patients managed with ‘wait and scan’: predictive value of hearing level at diagnosis. J Laryngol Otol 2010; 124: 490-494
  • 71 Lloyd SK, Evans DG. Neurofibromatosis type 2 service delivery in England. Neurochirurgie 2016
  • 72 Dirks MS, Butman JA, Kim HJ, Wu T, Morgan K, Tran AP, Lonser RR, Asthagiri AR. Long-term natural history of neurofibromatosis Type 2-associated intracranial tumors. J Neurosurg 2012; 117: 109-117
  • 73 Evers S, Verbaan D, Sanchez E, Peerdeman S. 3D volumetric measurement of neurofibromatosis type 2-associated meningiomas: association between tumor location and growth rate. World Neurosurg 2015; 84: 1062-1069
  • 74 Dewan R, Pemov A, Kim HJ, Morgan KL, Vasquez RA, Chittiboina P, Wang X, Chandrasekharappa SC, Ray-Chaudhury A, Butman JA, Stewart DR, Asthagiri AR. Evidence of polyclonality in neurofibromatosis type 2-associated multilobulated vestibular schwannomas. Neuro Oncol 2015; 17: 566-573
  • 75 Evans DG, Wallace A. An update on age related mosaic and offspring risk in neurofibromatosis 2 (NF2). J Med Genet 2009; 46: 792
  • 76 Heineman TE, Evans DG, Campagne F, Selesnick SH. In Silico analysis of NF2 gene missense mutations in neurofibromatosis type 2: from genotype to phenotype. Otol Neurotol 2015; 36: 908-914
  • 77 Abaza MM, Makariou E, Armstrong M, Lalwani AK. Growth rate characteristics of acoustic neuromas associated with neurofibromatosis type 2. Laryngoscope 1996; 106: 694-699
  • 78 Goutagny S, Bah AB, Henin D, Parfait B, Grayeli AB, Sterkers O, Kalamarides M. Long-term follow-up of 287 meningiomas in neurofibromatosis type 2 patients: clinical, radiological, and molecular features. Neuro Oncol 2012; 14: 1090-1096
  • 79 Nowak A, Dziedzic T, Czernicki T, Kunert P, Morawski K, Niemczyk K, Marchel A. Strategy for the surgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2. Neurol Neurochir Pol 2015; 49: 295-301
  • 80 Lee CH, Chung CK, Hyun SJ, Kim CH, Kim KJ, Jahng TA. A longitudinal study to assess the volumetric growth rate of spinal intradural extramedullary tumour diagnosed with schwannoma by magnetic resonance imaging. Eur Spine J 2015; 24: 2126-2132
  • 81 Ozawa H, Onoda Y, Aizawa T, Nakamura T, Koakutsu T, Itoi E. Natural history of intradural-extramedullary spinal cord tumors. Acta Neurol Belg 2012; 112: 265-270
  • 82 Han JH, Kim DG, Chung HT, Paek SH, Jung HW. Hearing outcomes after stereotactic radiosurgery for vestibular schwannomas: mechanism of hearing loss and how to preserve hearing. Adv Tech Stand Neurosurg 2016; 43: 3-36
  • 83 Kida Y, Kobayashi T, Tanaka T, Mori Y. Radiosurgery for bilateral neurinomas associated with neurofibromatosis type 2. Surg Neurol 2000; 53: 383-389
  • 84 Linskey ME, Lunsford LD, Flickinger JC. Tumor control after stereotactic radiosurgery in neurofibromatosis patients with bilateral acoustic tumors. Neurosurgery 1992; 31: 829-838
  • 85 Mathieu D, Kondziolka D, Flickinger JC, Niranjan A, Williamson R, Martin JJ, Lunsford LD. Stereotactic radiosurgery for vestibular schwannomas in patients with neurofibromatosis type 2: an analysis of tumor control, complications, and hearing preservation rates. Neurosurgery 2007; 60: 460-468
  • 86 Meijer OW, Vandertop WP, Lagerwaard FJ, Slotman BJ. Linear accelerator-based stereotactic radiosurgery for bilateral vestibular schwannomas in patients with neurofibromatosis type 2. Neurosurgery 2008; 62 5 Suppl A37-A42
  • 87 Phi JH, Kim DG, Chung HT, Lee J, Paek SH, Jung HW. Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2: tumor control and hearing preservation. Cancer 2009; 115: 390-398
  • 88 Rowe J, Radatz M, Kemeny A. Radiosurgery for type II neurofibromatosis. Prog Neurol Surg 2008; 21: 176-182
  • 89 Subach BR, Kondziolka D, Lunsford LD, Bissonette DJ, Flickinger JC, Maitz AH. Stereotactic radiosurgery in the management of acoustic neuromas associated with neurofibromatosis Type 2. J Neurosurg 2013; 119 Suppl: 815-822
  • 90 Vachhani JA, Friedman WA. Radiosurgery in patients with bilateral vestibular schwannomas. Stereotact Funct Neurosurg 2007; 85: 273-278
  • 91 Anderson BM, Khuntia D, Bentzen SM, Geye HM, Hayes LL, Kuo JS, Baskaya MK, Badie B, Basavatia A, Pyle GM, Tome WA, Mehta MP. Single institution experience treating 104 vestibular schwannomas with fractionated stereotactic radiation therapy or stereotactic radiosurgery. J Neurooncol 2014; 116: 187-193
  • 92 Rasmussen R, Claesson M, Stangerup SE, Roed H, Christensen IJ, Caye-Thomasen P, Juhler M. Fractionated stereotactic radiotherapy of vestibular schwannomas accelerates hearing loss. Int J Radiat Oncol Biol Phys 2012; 83: e607-e611
  • 93 Mautner VF, Nguyen R, Knecht R, Bokemeyer C. Radiographic regression of vestibular schwannomas induced by Bevacizumab treatment: sustain under continuous drug application and rebound after drug discontinuation. Ann Oncol 2010; 21: 2294-2295
  • 94 Plotkin SR, Singh MA, O’Donnell CC, Harris GJ, McClatchey AI, Halpin C. Audiologic and radiographic response of NF2-related vestibular schwannoma to erlotinib therapy. Nat Clin Pract Oncol 2008; 5: 487-491
  • 95 Plotkin SR, Stemmer-Rachamimov AO, Barker FG, Halpin C, Padera TP, Tyrrell A, Sorensen AG, Jain RK, di TE. Hearing improvement after bevacizumab in patients with neurofibromatosis type 2. N Engl J Med 2009; 361: 358-367
  • 96 Plotkin SR, Ardern-Holmes SL, Barker FG, Blakeley JO, Evans DG, Ferner RE, Hadlock TA, Halpin C. Hearing and facial function outcomes for neurofibromatosis 2 clinical trials. Neurology 2013; 81 (Suppl. 01) S25-S32
  • 97 Slusarz KM, Merker VL, Muzikansky A, Francis SA, Plotkin SR. Long-term toxicity of bevacizumab therapy in neurofibromatosis 2 patients. Cancer Chemother Pharmacol 2014; 73: 1197-1204
  • 98 Brackmann DE, Fayad JN, Slattery III WH, Friedman RA, Day JD, Hitselberger WE, Owens RM. Early proactive management of vestibular schwannomas in neurofibromatosis type 2. Neurosurgery 2001; 49: 274-280
  • 99 Slattery III WH, Fisher LM, Hitselberger W, Friedman RA, Brackmann DE. Hearing preservation surgery for neurofibromatosis Type 2-related vestibular schwannoma in pediatric patients. J Neurosurg 2007; 106 4 Suppl 255-260
  • 100 Flores LP. Surgical results of the Hypoglossal-Facial nerve Jump Graft technique. Acta Neurochir (Wien ) 2007; 149: 1205-1210
  • 101 May M, Sobol SM, Mester SJ. Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy. Otolaryngol Head Neck Surg 1991; 104: 818-825
  • 102 Slattery III WH, Cassis AM, Wilkinson EP, Santos F, Berliner K. Side-to-end hypoglossal to facial anastomosis with transposition of the intratemporal facial nerve. Otol Neurotol 2014; 35: 509-513
  • 103 Sleilati FH, Nasr MW, Stephan HA, Asmar ZD, Hokayem NE. Treating facial nerve palsy by true termino-lateral hypoglossal-facial nerve anastomosis. J Plast Reconstr Aesthet Surg 2010; 63: 1807-1812
  • 104 Yoleri L, Songur E, Yoleri O, Vural T, Cagdas A. Reanimation of early facial paralysis with hypoglossal/facial end-to-side neurorrhaphy: a new approach. J Reconstr Microsurg 2000; 16: 347-355