Acoustic neuroma staging: Difference between revisions
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=== Standardization of main symptoms grading === | === Standardization of main symptoms grading === | ||
For better description of patients' status then analyzing management strategy and outcome of the treatment, standardized grading for main symptoms have been made. Generally, the AAO-HNS Hearing | For better description of patients' status then analyzing management strategy and outcome of the treatment, standardized grading for main symptoms have been made. Generally, the AAO-HNS Hearing [[Classification]] System, House-Brackmann [[Neurological examination|Facial Nerve]] Grading System, [[Tinnitus]] Handicap Inventory and [[Dizziness]] Handicap Inventory are widely accepted and used for Acoustic neuroma. | ||
{| style="border: 3px; font-size; 190%; margin: 1px; width: 600px" align="center" | {| style="border: 3px; font-size; 190%; margin: 1px; width: 600px" align="center" | ||
! colspan="2" style="background: #5579FF; width: 600px:" | {{fontcolor|#FFF|Tinnitus grading system for acoustic neuromas}} | ! colspan="2" style="background: #5579FF; width: 600px:" | {{fontcolor|#FFF|Tinnitus grading system for acoustic neuromas}} | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | ||
I | I | ||
| style="padding: 10px 10px; background: #F5F5F5; " | No tinnitus | | style="padding: 10px 10px; background: #F5F5F5; " | No [[tinnitus]] | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | ||
III | III | ||
| style="padding: 10px 10px; background: #F5F5F5; " | Persistent or moderate tinnitus, can be heard every day | | style="padding: 10px 10px; background: #F5F5F5; " | Persistent or moderate [[tinnitus]], can be heard every day | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | ||
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! style="padding 10px 10px; background: #DCDCDC; " | | ! style="padding 10px 10px; background: #DCDCDC; " | | ||
IV | IV | ||
| style="padding 5px 5px; background: #F5F5F5; " |Persistent and severe dizziness or imbalance, disturbing daily life | | style="padding 5px 5px; background: #F5F5F5; " |Persistent and severe [[dizziness]] or [[Disequilibrium|imbalance]], disturbing daily life | ||
|} | |} | ||
=== Tumor size and stages === | === Tumor size and stages === | ||
Numerous stage grading system ave been reported according to tumor size, but also for the first step description of the tumor size is more important and have measured by the maximum diameter (means the one measured in cerebellopontine angle (CPA) along the long axis) of the tumor.<ref>{{Cite journal|last=Sterkers JM, Morrison GA, Sterkers O, El-Dine MM.|first=JM|date=1994|title=Preservation of facial, cochlear, and other nerve functions in acoustic neuroma treatment.|url=|journal=Otolaryngol Head Neck Surg|volume=|pages=|via=}}</ref><ref>{{Cite journal|last=Hitselberger WE, House WF|first=|date=1966|title=classification of acoustic neuromas|url=|journal=Arch Otolaryngol|volume=|pages=|via=}}</ref><ref>{{Cite journal|last=Koos WT, Day JD, Matula C, Levy DI|first=|date=|title=Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas|url=|journal=J Neurisurg|volume=|pages=|via=}}</ref> | Numerous stage grading system ave been reported according to tumor size, but also for the first step description of the tumor size is more important and have measured by the maximum diameter (means the one measured in [[cerebellopontine angle]] (CPA) along the long axis) of the [[tumor]].<ref>{{Cite journal|last=Sterkers JM, Morrison GA, Sterkers O, El-Dine MM.|first=JM|date=1994|title=Preservation of facial, cochlear, and other nerve functions in acoustic neuroma treatment.|url=|journal=Otolaryngol Head Neck Surg|volume=|pages=|via=}}</ref><ref>{{Cite journal|last=Hitselberger WE, House WF|first=|date=1966|title=classification of acoustic neuromas|url=|journal=Arch Otolaryngol|volume=|pages=|via=}}</ref><ref>{{Cite journal|last=Koos WT, Day JD, Matula C, Levy DI|first=|date=|title=Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas|url=|journal=J Neurisurg|volume=|pages=|via=}}</ref> | ||
{| style="border: 3px; font-size 190%; margin: 1px; width: 700px; align=“ left”" | {| style="border: 3px; font-size 190%; margin: 1px; width: 700px; align=“ left”" | ||
! colspan="6" style="background: #5579FF; width: 600px:" | {{fontcolor|#FFF|Main grading systems for acoustic neuromas}} | ! colspan="6" style="background: #5579FF; width: 600px:" | {{fontcolor|#FFF|Main grading systems for acoustic neuromas}} | ||
| Line 88: | Line 88: | ||
(Medium) | (Medium) | ||
! rowspan="2" style="padding: 10px 10px; background: #eee000; " | T3a | ! rowspan="2" style="padding: 10px 10px; background: #eee000; " | T3a | ||
! rowspan="2" style="padding: 10px 10px; background: #eee000; " | Tumor occupying CPA | ! rowspan="2" style="padding: 10px 10px; background: #eee000; " | [[Tumor]] occupying [[Cerebellopontine angle|CPA]] | ||
|- | |- | ||
! style="padding: 10px 10px; background: #ABCDEF; " | ≤20 mm | ! style="padding: 10px 10px; background: #ABCDEF; " | ≤20 mm | ||
| Line 98: | Line 98: | ||
! style="padding: 10px 10px; background: #ace123; " | Grade III | ! style="padding: 10px 10px; background: #ace123; " | Grade III | ||
! style="padding: 10px 10px; background: #eee000; " | T3b | ! style="padding: 10px 10px; background: #eee000; " | T3b | ||
! style="padding: 10px 10px; background: #eee000; " | Tumor occupying CPA and contacting | ! style="padding: 10px 10px; background: #eee000; " | [[Tumor]] occupying [[Cerebellopontine angle|CPA]] and contacting | ||
the brainstem without compression | the [[Brain stem|brainstem]] without compression | ||
|- | |- | ||
! style="padding: 10px 10px; background: #ABCDEF; " | ≤40 mm | ! style="padding: 10px 10px; background: #ABCDEF; " | ≤40 mm | ||
| Line 107: | Line 107: | ||
! rowspan="2" style="padding: 10px 10px; background: #ace123; " | Grade IV | ! rowspan="2" style="padding: 10px 10px; background: #ace123; " | Grade IV | ||
! style="padding: 10px 10px; background: #eee000; " | T4a | ! style="padding: 10px 10px; background: #eee000; " | T4a | ||
! style="padding: 10px 10px; background: #eee000; " | Tumor compressing the brainstem | ! style="padding: 10px 10px; background: #eee000; " | [[Tumor]] compressing the [[Brain stem|brainstem]] | ||
|- | |- | ||
! style="padding: 10px 10px; background: #ABCDEF; " | >40 mm | ! style="padding: 10px 10px; background: #ABCDEF; " | >40 mm | ||
| Line 114: | Line 114: | ||
(Giant) | (Giant) | ||
! style="padding: 10px 10px; background: #eee000; " | T4b | ! style="padding: 10px 10px; background: #eee000; " | T4b | ||
! style="padding: 10px 10px; background: #eee000; " | | ! style="padding: 10px 10px; background: #eee000; " | Sever [[Brain stem|brainstem]] displacement and deformation of fourth [[Ventricle (brain)|ventricle]] under [[tumor]] compression | ||
|- | |- | ||
! colspan="6" style="padding: 10px 10px; background: #DCDCDC; " |Main grading systems for acoustic neuromas. The classifications on the left side (blue area) are mainly based on tumor size, while those on the right side (yellow area) are based on the anatomical relationship around the tumor. Koos classification (green area) combines the tumor size and anatomical relationship for larger tumors. | ! colspan="6" style="padding: 10px 10px; background: #DCDCDC; " |Main grading systems for [[Acoustic neuroma|acoustic neuromas]]. The classifications on the left side (blue area) are mainly based on tumor size, while those on the right side (yellow area) are based on the [[Anatomy|anatomical]] relationship around the tumor. Koos classification (green area) combines the [[tumor]] size and anatomical relationship for larger tumors. IAC: Intracoustic canal | ||
|} | |} | ||
<ref>{{Cite journal|last=Hao Wu, Liwei Zhang, Dongyi Han, Ying Mao, Jun Yang, Zhaoyan Wang, Wang Jia, Ping Zhong, Huan Jia|first=|date=2016|title=Summary and consensus in 7th International Conference on acoustic neuroma: An update for the management of sporadic acoustic neuromas|url=|journal=World Journal of Otorhinolaryngology-Head and Neck Surgery|volume=|pages=|via=}}</ref> | <ref>{{Cite journal|last=Hao Wu, Liwei Zhang, Dongyi Han, Ying Mao, Jun Yang, Zhaoyan Wang, Wang Jia, Ping Zhong, Huan Jia|first=|date=2016|title=Summary and consensus in 7th International Conference on acoustic neuroma: An update for the management of sporadic acoustic neuromas|url=|journal=World Journal of Otorhinolaryngology-Head and Neck Surgery|volume=|pages=|via=}}</ref> | ||
Revision as of 15:53, 9 June 2018
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Acoustic neuroma Microchapters | |
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Diagnosis | |
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Treatment | |
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Case Studies | |
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Acoustic neuroma staging On the Web | |
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American Roentgen Ray Society Images of Acoustic neuroma staging | |
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Risk calculators and risk factors for Acoustic neuroma staging | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Acoustic neuroma staging have been reported in several articles. Standardization of main symptoms grading is another important staging for description of patients' status.
Staging
Standardization of main symptoms grading
For better description of patients' status then analyzing management strategy and outcome of the treatment, standardized grading for main symptoms have been made. Generally, the AAO-HNS Hearing Classification System, House-Brackmann Facial Nerve Grading System, Tinnitus Handicap Inventory and Dizziness Handicap Inventory are widely accepted and used for Acoustic neuroma.
| Tinnitus grading system for acoustic neuromas | |
|---|---|
| Grade | Description |
|
I |
No tinnitus |
|
II |
Intermittent or mild tinnitus, can only be heard when the ambient noise is low |
|
III |
Persistent or moderate tinnitus, can be heard every day |
|
IV |
Persistent and severe tinnitus, interfere with work and sleep |
| Dizziness grading system for acoustic neuromas | |
|---|---|
| Grade | Description |
|
I |
No dizziness or imbalance |
|
II |
Occasional and mild dizziness or imbalance |
|
III |
Persistent or moderate vertigo or imbalance |
|
IV |
Persistent and severe dizziness or imbalance, disturbing daily life |
Tumor size and stages
Numerous stage grading system ave been reported according to tumor size, but also for the first step description of the tumor size is more important and have measured by the maximum diameter (means the one measured in cerebellopontine angle (CPA) along the long axis) of the tumor.[1][2][3]
| Main grading systems for acoustic neuromas | |||||
|---|---|---|---|---|---|
| Tumor size (CPA Maximum diameter) | Sterker | House | Koos | Samii | Tumor Description |
| 0
(intracanalicular) |
Tube type | intracanalicular | Grade I | T1 | Confining to IAC |
| ≤10 mm | Small | Grade 1
(Small) |
Grade II | T2 | Superpassing IAC |
| ≤15 mm | Grade 2
(Medium) |
T3a | Tumor occupying CPA | ||
| ≤20 mm | Mild | ||||
| ≤3o mm | Grade 3
(Moderately Large) |
Grade III | T3b | Tumor occupying CPA and contacting
the brainstem without compression | |
| ≤40 mm | Large | Grade 4
(Large) |
Grade IV | T4a | Tumor compressing the brainstem |
| >40 mm | Huge | Grade 5
(Giant) |
T4b | Sever brainstem displacement and deformation of fourth ventricle under tumor compression | |
| Main grading systems for acoustic neuromas. The classifications on the left side (blue area) are mainly based on tumor size, while those on the right side (yellow area) are based on the anatomical relationship around the tumor. Koos classification (green area) combines the tumor size and anatomical relationship for larger tumors. IAC: Intracoustic canal | |||||
References
- ↑ Sterkers JM, Morrison GA, Sterkers O, El-Dine MM., JM (1994). "Preservation of facial, cochlear, and other nerve functions in acoustic neuroma treatment". Otolaryngol Head Neck Surg.
- ↑ Hitselberger WE, House WF (1966). "classification of acoustic neuromas". Arch Otolaryngol.
- ↑ Koos WT, Day JD, Matula C, Levy DI. "Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas". J Neurisurg.
- ↑ Hao Wu, Liwei Zhang, Dongyi Han, Ying Mao, Jun Yang, Zhaoyan Wang, Wang Jia, Ping Zhong, Huan Jia (2016). "Summary and consensus in 7th International Conference on acoustic neuroma: An update for the management of sporadic acoustic neuromas". World Journal of Otorhinolaryngology-Head and Neck Surgery.