Vestibular schwannomas are the most common tumors of the cerebellopontine angle (CPA), the junction between the cerebellum and the brainstem. They constitute around 8% of intracranial tumors. They are benign and arise from the vestibular nerve within the internal auditory canal growing from the canal into the CPA eventually causing brainstem compression. Their incidence is around 2.5 per 100,000. Around 70% of tumors do not grow following diagnosis but those that do or those that are already large at presentation are usually treated either with stereotactic radiosurgery or microsurgical resection.
Vestibular schwannomas have been extensively investigated over the years with nearly 10,000 peer reviewed papers relating to them on Pubmed. Despite this plethora of data there are very few books that assimilate the literature to provide a comprehensive, readable and contemporary overview of their management. This book aims to meet these requirements covering both sporadic and neurofibromatosis type 2 vestibular schwannomas.
The chapters within the book will cover all aspects of the diagnosis and management of vestibular schwannomas. Opening chapters provide a historical back drop, followed by current state of the art of molecular biology, histopathology and genomics relating to vestibular schwannomas. A comprehensive section related to the assessment of patients with vestibular schwannomas will highlight the multidisciplinary approach to the management of these tumors. This will set out some of the cutting edge research currently being undertaken in prediction of tumor growth using novel biological and radiological markers. The next section focuses on the treatment of vestibular schwannomas. This will make up the largest proportion of the book and will cover all treatment modalities from observation through to stereotactic radiosurgery and microsurgical resection. Lastly will be a section focusing on rehabilitation of neurological deficit arising as a result of the disease or its treatment.
1. History ofvestibular schwannoma management
Section I. Basic Science
2. Applied anatomy in vestibular schwannoma
3. Molecular biology and disease models of vestibular schwannomas: State of
the art
4. Pathology and tumor microenvironment of vestibular schwannoma
5. Genomics of vestibular schwannoma
6. Vestibular schwannomas: Key research questions and priorities
Section II. Assessment
7. Clinical evaluation and investigation of patients with a sporadic
vestibular schwannoma
8. Clinical evaluation and investigation of vestibular schwannoma in
NF2-related schwannomatosis
9. Vestibular schwannoma imaging and differential diagnosis
10. Clinical epidemiology of sporadic vestibular schwannomas
11. Clinical epidemiology of NF2-related schwannomatosis
Section III. Treatment
12. Surveillance management of vestibular schwannoma: present and future
strategies
13. Medical therapy for vestibular schwannomas
14. Translabyrinthine approach to the cerebellopontine angle
15. Retrosigmoid approach to vestibular schwannoma
16. Middle fossa approach to vestibular schwannomas
17. The retrolabyrinthine approach
18. Endoscopic vestibular schwannoma surgery
19. Vestibular schwannoma microsurgical technique
20. Outcomes following vestibular schwannoma surgery
21. Salvage resection and radiosurgery following failed primary treatment of
vestibular schwannomas
22. Hearing preservation surgery for vestibular schwannoma
23. Vestibular schwannoma, postsurgical complications
24. Anesthesia for excision of vestibular schwannoma
Section IV. Stereotactic radiosurgery for vestibular schwannomas
25. Gamma knife radiosurgery for vestibular schwannomas
26. LINAC stereotactic radiosurgery for vestibular schwannomas
27. Fractionated radiotherapy for vestibular schwannoma
28. Proton therapy for vestibular schwannomas
Section V. General Considerations
29. Decision making in sporadic VS
30. Decision making in NF2-related schwannomatosis
31. Management of vestibular schwannoma in the elderly
32. Subtotal versus total excision of vestibular schwannomas
33. Quality of life after treatment of vestibular schwannomas
34. The role of the clinical nurse specialist in managing vestibular
schwannoma
35. Vestibular schwannoma: Global perspectives
Section VI. Rehabilitation
36. Secondary trigeminal neuralgia due to vestibular schwannoma
37. Hearing rehabilitation in patients with vestibular schwannomas
38. Prevention and rehabilitation of facial palsy in patients with vestibular
schwannomas
39. Dizziness in vestibular schwannomas
40. Tinnitus and its management in patients with vestibular schwannoma
Professor Lloyd is a ConsultantSkull Base and Auditory Implant Surgeonat the Manchester Royal Infirmary, Royal Manchester Childrens Hospital and Salford Royal Hospital.He is Professor of Otology and Skull Base Surgeryat the University of Manchester and hisresearch interests include the natural history of vestibular schwannomas and NF2-related schwannomatosis. He is widely published in his field and is frequently invited to speak both nationally and internationally. He has held a number of high profile positions including president of the British Society of Otology and secretary to the British Skull Base Society. He is president elect of the Royal Society of Medicine Otology section and is a member of the European Academy of Otology and Neuro-Otology and the Politzer Society. He has been awarded the Dalby Prize by the Royal Society of Medicine. This prize recognises the individual that has made the greatest contribution to otological research over the last 5 years. He is also the director of the UKs leading advanced otology course and skull base course. He has been deputy editor of the Mediterranean Journal of Advanced Otology and is on the editorial board of Cochlear Implants International. He has published over 100 peer reviewed papers and 17 book chapters. He has also edited two books. He regularly reviews submissions to peer reviewed medical journals including the Lancet, Otology and Neurotology, Cochlear Implants International and Clinical Otolaryngology amongst others. He is an examiner for the Intercollegiate FRCS(ORL-HNS) examinations.
Dr. Pathmanaban is Professor of Neurosurgery in the Division of Neuroscience at the University of Manchester and Clinical Director of the Department of Neurosurgery at the Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, UK. He is an internationally renowned skull base surgeon and is referred complex cases from across the UK and internationally. He trained in London, Manchester, Oxford, and Toronto. He was the Marjorie Newsome visiting fellow at the Barrow Neurological Institute, USA following the award of the Norman Dott Gold Medal for the most outstanding performance amongst graduating Neurosurgeons in the UK and Ireland in 2015. He is a popular invited speaker on the global skull base circuit and is on the faculty of numerous advanced microsurgery and endoscopic training courses. He has a PhD in molecular and cellular Neuro-Oncology and is group-leader of the Surgical Neuro-Oncology Manchester (SNO-Man) Laboratory, where he works as part of a team focused on translational tumor microenvironment research, including a program of work on inflammatory biomarkers and therapeutic targets in vestibular Schwannoma. He is past-secretary and current treasurer of the British Skull Base Society and has served as the Skull Base Lead for the council of the Society of British Neurological Surgeons. He sits on the Clinical Neurosciences Council of The Royal Society of Medicine and is on the panel of question writers for The Joint Committee on Intercollegiate Examinations in Neurosurgery. Professor Evans is Professor of Medical Genetics at the University of Manchester. He is one of the worlds leading experts on breast cancer genetics and Neurofibromatosis type 2. He is an NIHR Senior Investigator and has published over 760 peer reviewed research publications; 276 as first or senior author. He has published over 126 reviews and chapters and has had a book published by Oxford University Press on familial cancer. He has an ISI web of knowledge H-index of 100 and a google scholar H-index of 139 having only published his first article in 1990. In the last 5 years he has raised over £35 million in grants for multicentre and local studies approximately £31 million to Manchester. He is Chief Investigator on two (£1.59 & £1 million) NIHR program grant (2009-2014 and 2016-2020) on breast cancer risk prediction and also has an NIHR RfPB grant as CI (2011). He has led a successful bid for a Nationally funded NF2 service (£7.5 million pa) that started in 2010. He is theme lead and cancer lead on the All Manchester NIHR Biomedical Research Centre worth £28.5 Million (2016-2020). He also leads the NICE Familial Breast Cancer Guideline Development Group.
