ARTICLE REVIEW 3

Author of Article

Stephen Rosahl, Christopher Bohr, Michell Lell, Klaus Hamm, Heinrich Iro

Article Title

Diagnostics and Therapy of Vestibular Schwannomas – An Interdisciplinary Challenge

Journal Name

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery 2017

1) Bibliography

Rosahl, S., Bohr, C., Lell, M., Hamm, K., & Iro, H. (2017). Diagnostics and therapy of vestibular schwannomas – an interdisciplinary challenge. GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery, 16(ISSN 1865-1011 1/38), 1–38.

2) Purpose of the Article

This authors were discussing and presented an overview in term of diagnostic and treatment solution in treating asymptomic vestibular schwannomas aka acoustic neuroma. As for improving quality and compatibility in modern medicine, preserving the diagnosis and treatment for this disease have to be well develop regardless on the variant of the tumor itself. 

3) Brief description of Procedure and Findings/Result

At the very beginning of this paper had mentioned about the overview of the acoustic neuroma stages, the most common grading scales based on the facial nerve functions and hearing system as well. Following with the diagnostics use for clinical workup for harboring the tumor including  MRI scan as the mainstay and audiometry and vestibular diagnosis. 

Our main interest was focused on what this paper has mentioned regarding to the MRI Scan that being the main choice for detection, staging and follow up and regression of the vestibular schawannomas. The best criteria for detection and diagnose for acoustic neuroma, the MRI machine has a high-filed magnetic within 1.5 Tesla to 3.0 Tesla. A common protocol inclusively are fluid attenuated inversion recovery (FLAIR), T1-weighted spin-echo(SE) or turbo spin_echo (TSE) for pre and post contrast application, thin slice T2-weighted with 3D gradient_echo (GE) or 3D_TSE. They also had highlighted the solution to exclude or confirming the acute ischemic by optionally performing the diffusion-weighted sequence. A high resolution of contrast media may visualizing the very small tumor and postoperative evaluation, also may assist in featuring the recurrent scars or residuals tumor tissue. Meanwhile the FLAIR is used to exclude all the other pathologies that may interfere the main interest. 

In other parts of the paper, they also discussed on the management of the disease where with a good treatment and low risk of recurrence, however hearing impairment and tinnitus may persist. the classification and severity of the tumor is clearly explain based on Figure 2 below. 

At the end of the paper it showed that this contribution is unlikely the manual-published paper and nontraditional where they also had several case study presented. There almost 20 case study or more were reviewed that include all the diagnostic reports and microsurgery done in some time. for each case there are different of treatment and process which ever show there are a lot work and effort was taken to published this paper. as the result of this collaboration, they had proved a standard ways to classify for decision making regarding the treatment and treatment pathways. Same with common decision making process, reviewing the tumor size, growth rate, probability and possibility in preserving the hearing abilities and functions, not to forger the age factor, previous medical history and many more that should be take as crucial points that will be used to show the best way for treating the patient. 

4) Conclusion and Comment

As the conclusion, this paper did a very good job in explaining the vestibular schwannomas without leaving any important notes that may be used for medical doctors and specialist should refer to when dealing through these patients. Based on thoughtful diagnosis and result, the treatment will be able to reduce and preserve the disease from being spread away and affects the other system, an early detection and treatment will be the best ways once the symptoms are arise. 

5) Opinion

I like their ways expressing their interest in managing the vestibular schwannomas. Overall this appraisal is  undertandable and very thoughtful, can be used as reference and baseline for treating patients with vestibular schwannomas aka acoustic neuroma. Plus, this paper add ad the a strong evidence that MRI scan is more preferable in detection of acoustic neuroma in a long run as compare to CT scan.