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Monday, July 27, 2020

Loyola Researchers Identify Common Characteristics, Outcomes of Rare Pediatric Brain Tumors

Treatment strategies for acoustic neuromas in children should reflect a higher risk for tumor regrowth

ENT doctor checking a child's ear

MAYWOOD, IL—Vestibular schwannomas, more commonly known as acoustic neuromas, are benign brain tumors that develop on the balance (vestibular) and hearing or auditory nerves leading from the inner ear to the brain. These tumors are rare in children, and as a result, there is little consensus on common symptoms, tumor size, treatment, outcomes and recurrence rates for acoustic neuroma in pediatric patients.

In a new study, “Pediatric vestibular schwannomas: case series and a systematic review with meta-analysis,” appearing in the Journal of Neurosurgery, researchers at Loyola University Medical Center and Loyola University Chicago Stritch School of Medicine performed a retrospective review of the diagnosis, treatment and outcomes of 15 patients (21 years of age or younger) with unilateral vestibular schwannomas, without neurofibromatosis type 2 (a genetic disorder that causes noncancerous tumor growth in the nervous system), who underwent surgery at Loyola University Medical Center between 1997 and 2019. The study authors also reviewed existing literature on this type of tumor in pediatric patients.

Overall, the review found that pediatric patients had similar symptoms to those of adult patients with acoustic neuromas; however, the tumor size was typically larger in the pediatric patients at the time of diagnosis, and symptoms of mass effect (secondary effects caused by the tumor) were more common. While some children with small tumors can be successfully treated with surgery only, residual tumors in pediatric patients were found to have a higher rate of regrowth than those in adults.

“This research provides a valuable baseline from which to assess and treat future pediatric patients presenting with symptoms associated with acoustic neuromas,” said lead study author Douglas E. Anderson, MD, chair, Loyola Medicine and Loyola University Chicago Stritch School Department of Neurological Surgery. “Because of the tumor size in children at presentation, appropriate treatments should reflect the risk for tumor regrowth.”

The review also identified common symptoms in pediatric acoustic neuroma patients: hearing loss in 87% of patients; headache, 40%; vertigo, 33%; ataxia (degenerative disease of the nervous system), 33%; and tinnitus (ringing in the ear), 33%. At the time of surgery, the mean tumor size was 3.3 centimeters, with four patients presenting with 1-centimeter tumors. Four patients had residual tumor mass left following surgery, with three (75%) having significant regrowth requiring further treatment. The literature review identified another 81 patients from 26 studies, with an average age of 12.1 (range 6-21) and an average tumor size of 4.1 centimeters.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.