Optimized preoperative determination of nerve of origin in patients with vestibular schwannoma

Abstract In vestibular schwannoma (VS) patients hearing outcome and surgery related risks can vary and depend on the nerve of origin. Preoperative origin differentiation between inferior or superior vestibular nerve may influence the decision on treatment, and the selection of optimal treatment and...

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Autores principales:	Torsten Rahne, Stefan K. Plontke, Laura Fröhlich, Christian Strauss
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1c5bf1a6ad37437f82fa281576212dce
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spelling	oai:doaj.org-article:1c5bf1a6ad37437f82fa281576212dce2021-12-02T18:27:47ZOptimized preoperative determination of nerve of origin in patients with vestibular schwannoma10.1038/s41598-021-87515-12045-2322https://doaj.org/article/1c5bf1a6ad37437f82fa281576212dce2021-04-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-87515-1https://doaj.org/toc/2045-2322Abstract In vestibular schwannoma (VS) patients hearing outcome and surgery related risks can vary and depend on the nerve of origin. Preoperative origin differentiation between inferior or superior vestibular nerve may influence the decision on treatment, and the selection of optimal treatment and counselling modalities. A novel scoring system based on functional tests was designed to predict the nerve of origin for VS and was applied to a large number of consecutive patients. A prospective, double blind, cohort study including 93 patients with suspected unilateral VS was conducted at a tertiary referral centre. Preoperatively before tumor resection a functional test battery [video head-impulse test (vHIT) of all semicircular canals (SCC)], air-conducted cervical/ocular vestibular evoked myogenic potential tests (cVEMP, oVEMP), pure-tone audiometry, and speech discrimination was applied. Sensitivity and specificity of prediction of intraoperative finding by a preoperative score based on vHIT gain, cVEMP and oVEMP amplitudes and asymmetry ratios was calculated. For the prediction of inferior vestibular nerve origin, sensitivity was 73% and specificity was 80%. For the prediction of superior vestibular nerve origin, sensitivity was 60% and specificity was 90%. Based on the trade-off between sensitivity and specificity, optimized cut-off values of − 0.32 for cVEMP and − 0.11 for oVEMP asymmetry ratios and vHIT gain thresholds of 0.77 (anterior SCC), 0.84 (lateral SCC) and 0.80 (posterior SCC) were identified by receiver operator characteristic curves. The scoring system based on preoperative functional tests improves prediction of nerve of origin and can be applied in clinical routine.Torsten RahneStefan K. PlontkeLaura FröhlichChristian StraussNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Torsten Rahne Stefan K. Plontke Laura Fröhlich Christian Strauss Optimized preoperative determination of nerve of origin in patients with vestibular schwannoma
description	Abstract In vestibular schwannoma (VS) patients hearing outcome and surgery related risks can vary and depend on the nerve of origin. Preoperative origin differentiation between inferior or superior vestibular nerve may influence the decision on treatment, and the selection of optimal treatment and counselling modalities. A novel scoring system based on functional tests was designed to predict the nerve of origin for VS and was applied to a large number of consecutive patients. A prospective, double blind, cohort study including 93 patients with suspected unilateral VS was conducted at a tertiary referral centre. Preoperatively before tumor resection a functional test battery [video head-impulse test (vHIT) of all semicircular canals (SCC)], air-conducted cervical/ocular vestibular evoked myogenic potential tests (cVEMP, oVEMP), pure-tone audiometry, and speech discrimination was applied. Sensitivity and specificity of prediction of intraoperative finding by a preoperative score based on vHIT gain, cVEMP and oVEMP amplitudes and asymmetry ratios was calculated. For the prediction of inferior vestibular nerve origin, sensitivity was 73% and specificity was 80%. For the prediction of superior vestibular nerve origin, sensitivity was 60% and specificity was 90%. Based on the trade-off between sensitivity and specificity, optimized cut-off values of − 0.32 for cVEMP and − 0.11 for oVEMP asymmetry ratios and vHIT gain thresholds of 0.77 (anterior SCC), 0.84 (lateral SCC) and 0.80 (posterior SCC) were identified by receiver operator characteristic curves. The scoring system based on preoperative functional tests improves prediction of nerve of origin and can be applied in clinical routine.
format	article
author	Torsten Rahne Stefan K. Plontke Laura Fröhlich Christian Strauss
author_facet	Torsten Rahne Stefan K. Plontke Laura Fröhlich Christian Strauss
author_sort	Torsten Rahne
title	Optimized preoperative determination of nerve of origin in patients with vestibular schwannoma
title_short	Optimized preoperative determination of nerve of origin in patients with vestibular schwannoma
title_full	Optimized preoperative determination of nerve of origin in patients with vestibular schwannoma
title_fullStr	Optimized preoperative determination of nerve of origin in patients with vestibular schwannoma
title_full_unstemmed	Optimized preoperative determination of nerve of origin in patients with vestibular schwannoma
title_sort	optimized preoperative determination of nerve of origin in patients with vestibular schwannoma
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/1c5bf1a6ad37437f82fa281576212dce
work_keys_str_mv	AT torstenrahne optimizedpreoperativedeterminationofnerveoforigininpatientswithvestibularschwannoma AT stefankplontke optimizedpreoperativedeterminationofnerveoforigininpatientswithvestibularschwannoma AT laurafrohlich optimizedpreoperativedeterminationofnerveoforigininpatientswithvestibularschwannoma AT christianstrauss optimizedpreoperativedeterminationofnerveoforigininpatientswithvestibularschwannoma
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Optimized preoperative determination of nerve of origin in patients with vestibular schwannoma

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