Ramin A Morshed, Tarun Arora, Philip V Theodospoulos
{"title":"Subtotal vs gross total excision of vestibular schwannomas.","authors":"Ramin A Morshed, Tarun Arora, Philip V Theodospoulos","doi":"10.1016/B978-0-12-824534-7.00024-X","DOIUrl":"https://doi.org/10.1016/B978-0-12-824534-7.00024-X","url":null,"abstract":"<p><p>Vestibular schwannomas are low-grade tumors of the eighth cranial nerve that lead to hearing loss, vestibular dysfunction, and eventual brainstem compression if significant growth occurs. Management of these tumors includes observation, radiosurgery, microsurgical resection, or a combination of these interventions. Although there has been a trend toward treatment with radiosurgery for smaller lesions, consensus reports still advocate for surgical resection in patients with large vestibular schwannomas. There has been a shift in management philosophy toward functional preservation rather than gross total resection, yet subtotal resection of vestibular schwannomas is associated with higher rates of recurrence on follow-up. In this chapter, we review common treatment modalities for VS and surgical indications. Additionally, we directly compare recurrence and complication rates after gross vs subtotal resection.</p>","PeriodicalId":12907,"journal":{"name":"Handbook of clinical neurology","volume":"212 ","pages":"333-339"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Proton therapy for vestibular schwannomas.","authors":"Gillian A Whitfield, Neil G Burnet","doi":"10.1016/B978-0-12-824534-7.00017-2","DOIUrl":"https://doi.org/10.1016/B978-0-12-824534-7.00017-2","url":null,"abstract":"<p><p>This chapter discusses the treatment of vestibular schwannoma using proton beam therapy (PBT), which has been used in stereotactic radiosurgery, hypofractionated stereotactic radiotherapy, and fully fractionated radiotherapy. Using PBT, almost no dose is delivered beyond the proton Bragg peak, so compared to photon therapy the integral dose is reduced and less dose may be delivered to specific normal tissues, which may, in turn, reduce some acute and/or late toxicities. In PBT, however, there are additional uncertainties, including range uncertainty, which requires a larger \"safety margin\" than is typically required for photon radiosurgery or hypofractionated stereotactic radiotherapy. The few published PBT series that describe patient outcomes are presented, all retrospective single center series, which do not suggest that local control or cranial nerve toxicity is more favorable than with photon therapy. Other toxicities, such as neurocognitive outcomes, risk of stroke, and radiation-induced malignancies, cannot be evaluated from the limited data. However, these series largely reflect now outdated treatment planning and delivery methods and do not include the latest Pencil Beam Scanning technology. It remains to be established whether outcomes with modern state-of-the-art PBT may be more favorable and whether particular subgroups, such as pediatric and young adult patients, may benefit.</p>","PeriodicalId":12907,"journal":{"name":"Handbook of clinical neurology","volume":"212 ","pages":"289-299"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Quality of life after treatment of vestibular schwannomas.","authors":"Morten Lund-Johansen","doi":"10.1016/B978-0-12-824534-7.00022-6","DOIUrl":"https://doi.org/10.1016/B978-0-12-824534-7.00022-6","url":null,"abstract":"<p><p>Over the last two decades, health-related quality of life (QOL) in vestibular schwannoma patients has gained increasing attention among caretakers, and patient-reported outcomes are frequently included in clinical studies, as a secondary or even primary outcome. Numerous general and disease-specific questionnaires exist, as well as questionnaires directed toward specific symptoms, such as hearing loss or vestibular complaints. When evaluating score outcomes, a small, statistically significant difference may not be clinically relevant. For several scoring systems such as the PANQOL questionnaire, the minimal clinically identifiable difference (MCID) has been identified and should be used when analyzing data. The main generator of generally reduced QOL in VS patients is vestibular complaints, in particular dizziness. When comparing groups receiving observation, or radiosurgery or surgery, differences in response tend to be minor, both between groups as well as before and after treatment. In most studies, patients operated tend to report somewhat lower than others, but the differences are quite small. In one study including non-VS responders, there were, however, highly significant differences in score outcomes between patients and controls; thus, it seems that being a VS patient is the main driver of outcome and that treatment modality has a lower impact. Future research on QOL in VS patients should direct toward a refinement of instruments, and toward prospectively designed studies with baseline and follow-up recordings.</p>","PeriodicalId":12907,"journal":{"name":"Handbook of clinical neurology","volume":"212 ","pages":"341-346"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical evaluation and investigation of vestibular schwannoma in NF2-related schwannomatosis.","authors":"Rupert Obholzer","doi":"10.1016/B978-0-12-824534-7.00029-9","DOIUrl":"https://doi.org/10.1016/B978-0-12-824534-7.00029-9","url":null,"abstract":"<p><p>The management of vestibular schwannoma (VS) in NF2-related schwannomatosis (NF2-SWN) is more complicated than that for sporadic VS because of the almost invariable presence of bilateral VS, as well as the presence of other types of schwannomas in the cerebellopontine angle, elsewhere intracranially, and within the spine. This requires a much more holistic approach to management. The key goal of treatment is to preserve function and quality of life. This can be very challenging given the bilateral nature of the disease in most patients and means that there is likely to be greater accumulated morbidity with treatment over time than for sporadic VS. It is, therefore, critical to assess all aspects related to bilateral cranial nerve function, particularly focusing on audiovestibular function. Hearing assessment using pure-tone audiometry, speech testing, and occasionally electrophysiologic assessment is critical to quantify the degree of hearing loss and to help make decisions around optimal hearing rehabilitation. Vestibular assessment is often helpful in determining the source of any balance disturbance and aids in tailoring vestibular rehabilitation where required. Prospective psychologic and quality of life assessment are very important in order to direct decision-making and ensure that the patient's quality of life is optimized. VS and other tumors are monitored using serial magnetic resonance imaging (MRI), usually on an annual basis. MRI may present particular challenges in NF2-SWN, given that a significant proportion of patients will have auditory implants, which cause significant signal distortion and have issues around magnet displacement. However, there are a number of strategies to limit the implications of scanning in the presence of auditory implants.</p>","PeriodicalId":12907,"journal":{"name":"Handbook of clinical neurology","volume":"212 ","pages":"93-96"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Decision-making in sporadic vestibular schwannoma.","authors":"Cathal John Hannan, Andrew King","doi":"10.1016/B978-0-12-824534-7.00010-X","DOIUrl":"https://doi.org/10.1016/B978-0-12-824534-7.00010-X","url":null,"abstract":"<p><p>Over the last 20 years, there has been a marked shift from active intervention to radiologic observation in the management of vestibular schwannomas, prompted by our understanding that a substantial proportion of these tumors do not demonstrate significant growth following diagnosis. In parallel with this, when active intervention does take place, our outcome measures are increasingly focused on preserving neurologic function, rather than on complete tumor removal at any cost. These principles of management are now widely accepted in most major skull-base centers throughout the world, but a number of areas of controversy in the management of these tumors remain. The chapter aims to provide an overview of such topics including intervention for hearing preservation, radiosurgery vs surgery, choice of surgical approach, and the management of residual tumor following surgical resection. Ultimately, our intention was not to add yet another voice to the debate as to which are the \"right\" approaches, but to prompt the reader to consider the evidence surrounding these areas of contention when coming to a shared decision with their patients as to which management strategies to adopt.</p>","PeriodicalId":12907,"journal":{"name":"Handbook of clinical neurology","volume":"212 ","pages":"303-313"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Emerging ethical issues in patients with disorders of consciousness: A clinical guide.","authors":"James L Bernat, Joseph J Fins","doi":"10.1016/B978-0-443-13408-1.00001-4","DOIUrl":"10.1016/B978-0-443-13408-1.00001-4","url":null,"abstract":"<p><p>Clinicians who manage patients with disorders of consciousness (DoC) commonly encounter challenging ethical issues. Consciousness disorders include the vegetative state, the minimally conscious state, and covert consciousness resulting from cognitive-motor dissociation. The practice landscape of ethical issues encompasses making the correct diagnosis; making and communicating an accurate prognosis despite irreducible uncertainty; conducting effective shared decision-making with a lawful surrogate decision-maker to deliver goal-concordant care; providing optimal medical, rehabilitative, and palliative care across the spectrum of care sites: acute inpatient, neurorehabilitative, chronic, and palliative; respecting the human rights of and advocating for DoC patient, an historically under-served population and, when appropriate, properly participating in decisions to withhold or withdraw life-sustaining therapy. Research and translational issues in DoC patients include the challenges posed by emerging diagnostics and therapeutics and their prudential integration into clinical practice in the service of patients and their families. Our conceptual analysis of these ethical issues and our practical advice to address them comprise the subject material of this chapter.</p>","PeriodicalId":12907,"journal":{"name":"Handbook of clinical neurology","volume":"207 ","pages":"217-236"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hemispheric asymmetries in the control of upper limb movements.","authors":"Luigi Trojano","doi":"10.1016/B978-0-443-15646-5.00024-5","DOIUrl":"10.1016/B978-0-443-15646-5.00024-5","url":null,"abstract":"<p><p>This chapter deals with the unique human abilities of using tools, imitating others' gestures, drawing, and building complex items. Herein, after a brief overview of clinical manifestations and assessment of disorders of tool use and imitation (upper limb apraxia) and of the impairments in drawing and assembling multipart objects (constructional apraxia), brain asymmetries are discussed mainly starting from the neuropsychologic studies on patients with focal brain lesions, although both upper limb apraxia and constructional apraxia are often observed during the course of neurodegenerative diseases. Although no room is allowed here for a full discussion of brain-behavior relationships, relevant functional neuroimaging findings in healthy individuals are considered. The data presented in this chapter clearly demonstrate that tool use, gesture imitation, and \"formative\" activities (i.e., drawing and assembling) require the interplay of several brain areas and neural networks distributed over both hemispheres. Nonetheless, gesture processing exhibits a quite strong lateralization to the left hemisphere in typical right-handers. As regards \"formative\" activities, the neural networks in both hemispheres seem to provide complementary contributions, although the left inferior parietal lobule might play a specific role. The convergence of gesture processing and \"formative activities\" in the parietal lobes might be related to their considerable expansion in our species and could suggest that some shared basic, still unknown, computational processes allowed the development of these skills in modern humans.</p>","PeriodicalId":12907,"journal":{"name":"Handbook of clinical neurology","volume":"208 ","pages":"393-405"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Seeing and visualizing across the hemispheres.","authors":"Selene Schintu, Paolo Bartolomeo","doi":"10.1016/B978-0-443-15646-5.00019-1","DOIUrl":"10.1016/B978-0-443-15646-5.00019-1","url":null,"abstract":"<p><p>Despite our subjective experience of a largely symmetric visual world, the human brain exhibits varying patterns and degrees of hemispheric asymmetry in distinct processes of visual cognition. This chapter reviews behavioral and neuroimaging evidence from neurotypical individuals and neurological patients, concerning functional asymmetries between the right hemisphere (RH) and the left hemisphere (LH) in visual object processing and mental imagery. Hierarchical perception shows RH preference for global processing and LH preference for local processing. At later stages of visual object processing, RH-based circuits exhibit a relative advantage in terms of perceptual integration, with a subsequent shift toward LH-based circuits for processing at higher conceptual and semantic levels. In voluntary visual mental imagery, circuits in the LH ventral temporal cortex play a pivotal role in transitioning from object meaning to simulated visualization. These hemispheric asymmetries in visual object processing might, in part, be influenced by the overall need to minimize wiring, coupled with the presence of distinct specialized networks within each hemisphere, such as the RH attention networks and the LH language networks. From a broader viewpoint, the evidence examined in this chapter indicates that visual object processing involves the interactions of large-scale cortical circuits within and between the hemispheres.</p>","PeriodicalId":12907,"journal":{"name":"Handbook of clinical neurology","volume":"208 ","pages":"481-497"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Emotion: An evolutionary model of lateralization in the human brain.","authors":"Guido Gainotti","doi":"10.1016/B978-0-443-15646-5.00001-4","DOIUrl":"10.1016/B978-0-443-15646-5.00001-4","url":null,"abstract":"<p><p>Since several reviews have recently discussed the lateralization of emotions, this chapter will take into account the possible evolutionary meaning of this lateralization. The organization of the chapter will be based on the following steps. I will first propose that emotions must be considered as a complex adaptive system, complementary to the more phylogenetically advanced cognitive system. Second, I will remind historical aspects and consolidated results on the lateralization of emotions. Then I will discuss the phylogenetic aspects of the problem, trying to evaluate if emotional asymmetries concern only humans and some nonhuman primates or are part of a continuum between humans and many phylogenetically distant animal species. After having reviewed various aspects of emotional lateralization across different animal species and (more specifically) in nonhuman primates, I will propose a general model of hemispheric asymmetries in the human brain, based on theoretical models and empiric data. Theoretical models stem from the influence that the presence or the absence of language can have on concomitant hemispheric functions, whereas supporting neuropsychologic data have been gathered in patients with unilateral brain damage.</p>","PeriodicalId":12907,"journal":{"name":"Handbook of clinical neurology","volume":"208 ","pages":"421-432"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Interhemispheric differences in visual attention.","authors":"Carlo Alberto Marzi","doi":"10.1016/B978-0-443-15646-5.00028-2","DOIUrl":"10.1016/B978-0-443-15646-5.00028-2","url":null,"abstract":"<p><p>The chapter explores the difference between the cerebral hemispheres in the three categories of attention described in the fundamental classification of Posner and Petersen: Alerting, Orienting, and Executive Functions. The first section is concerned with the brain localization of visuospatial attention as studied in brain-damaged patients, mainly hemineglect and callosum-sectioned patients. Other important results have been provided more recently by means of brain imaging studies of cortical and subcortical attention networks. Most of these studies have shown a clear dominance of the right hemisphere (RH) in visuospatial attention, but there are some exceptions. Accordingly, the second section concerns the role of the left hemisphere (LH) in visuospatial attention. A third section describes the contribution of attention to interhemispheric communication. A fourth section is focused on a discussion of the existence of hemispheric asymmetries not only in conscious but also in unconscious attention. Further, a fifth section concerns the effects of emotion on hemispheric differences in visuospatial attention. Finally, the last section briefly discusses the controversial evidence concerning laterality in executive functions.</p>","PeriodicalId":12907,"journal":{"name":"Handbook of clinical neurology","volume":"208 ","pages":"115-125"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
