Cayé‐Thomasen, Per

Objective To examine the quality of information provided by artificial intelligence platforms ChatGPT-4 and Claude 2 surrounding the management of vestibular schwannomas. Study design Cross-sectional. Setting Skull base surgeons were involved from different centers and countries. Intervention Thirty-six questions regarding vestibular schwannoma management were tested. Artificial intelligence responses were subsequently evaluated by 19 lateral skull base surgeons using the Quality Assessment of Medical Artificial Intelligence (QAMAI) questionnaire, assessing “Accuracy,” “Clarity,” “Relevance,” “Completeness,” “Sources,” and “Usefulness.” Main Outcome Measure The scores of the answers from both chatbots were collected and analyzed using the Student t test. Analysis of responses grouped by stakeholders was performed with McNemar test. Stuart-Maxwell test was used to compare reading level among chatbots. Intraclass correlation coefficient was calculated. Results ChatGPT-4 demonstrated significantly improved quality over Claude 2 in 14 of 36 (38.9%) questions, whereas higher-quality scores for Claude 2 were only observed in 2 (5.6%) answers. Chatbots exhibited variation across the dimensions of “Accuracy,” “Clarity,” “Completeness,” “Relevance,” and “Usefulness,” with ChatGPT-4 demonstrating a statistically significant superior performance. However, no statistically significant difference was found in the assessment of “Sources.” Additionally, ChatGPT-4 provided information at a significant lower reading grade level. Conclusions Artificial intelligence platforms failed to consistently provide accurate information surrounding the management of vestibular schwannoma, although ChatGPT-4 achieved significantly higher scores in most analyzed parameters. These findings demonstrate the potential for significant misinformation for patients seeking information through these platforms.

Objective To evaluate cochlear implant speech perception among patients with sporadic inner ear schwannoma who underwent ipsilateral implantation. Study Design Retrospective multi-institutional cohort study. Setting Eleven tertiary academic medical centers across Germany, Denmark, and the United States. Patients One hundred six patients with sporadic inner ear schwannoma who received an ipsilateral cochlear implant from 2011 to 2022. Interventions Ipsilateral cochlear implantation with observation, stereotactic radiosurgery, or microsurgery for tumor management. Main Outcome Measures Monosyllabic speech perception testing scores and rates of open-set speech perception. Results Among 106 patients studied, 101 (95%) achieved open-set speech perception with a median of 24 months (interquartile range [IQR] 12–42 mo) of audiometric follow-up. Median ipsilateral monosyllabic speech perception testing achieved was 72% (IQR 54–85%), and median ipsilateral AzBio in quiet was 75% (IQR 46–90%). Most (91 of 106 [86%]) underwent microsurgery for tumor control, with cochlear implantation performed simultaneously in 98% (89 of 91) of these patients. The ability to achieve gross total resection significantly differed by tumor complexity, with 97% of low-complexity tumors, 100% of intermediate complexity, and 0% of high-complexity tumors undergoing gross total resection (p < 0.001). However, among patients managed with microsurgery, there was not a statistically significant difference in post-cochlear implantation monosyllabic speech perception scores across complexity groupings, with median scores of 75 and 70% for patients with tumors of low or intermediate complexity and those with tumors of high complexity, respectively (p = 0.5). Eight of 102 patients (8%) assessed experienced deterioration in cochlear implant performance over time. Among the subset of 39 patients with available MRI to review, the region of surveillance interest could be visualized postoperatively on MRI in all cases. Conclusions Open-set speech perception is achieved in most patients with inner ear schwannoma undergoing ipsilateral cochlear implantation. Although cochlear implantation in high-complexity inner ear schwannomas is only possible with incomplete tumor resection, long-term open-set speech perception outcomes are similar to lower-complexity tumors.

ABSTRACT Over the past two decades, there has been increasing interest in the diagnosis and management of schwannomas of the inner ear including hearing rehabilitation with cochlear implants. However, tumor nomenclature and classification within the literature have been variable and oftentimes cumbersome. The term “intralabyrinthine schwannoma” is in common use when describing these tumors but is a potential source of confusion given that people often use the term “labyrinth” or “labyrinthine” to refer to the vestibular component of the inner ear only (i.e., labyrinthectomy or the translabyrinthine approach). During the Ninth Quadrennial Conference on Vestibular Schwannoma and Other Cerebellopontine Angle Lesions in Bergen, Norway, in May 2023, a multidisciplinary group of conference participants met and discussed issues pertaining to current terminology and classifications to enhance clarity and to reflect recent advances in tumor management and hearing rehabilitation. Although a variety of terms have been previously used to describe inner ear schwannomas, consensus was achieved on the term “inner ear schwannoma (IES)” to describe eighth nerve schwannomas of the cochlea, vestibule, or semicircular canals. Subgroups under this term comprise intravestibular, intracochlear, or intravestibulocochlear inner ear schwannomas (low complexity tumors), inner ear schwannomas with transfundal extension into the internal auditory canal but without modiolar involvement (intermediate complexity tumors), and inner ear schwannomas with transfundal extension with modiolar involvement (high complexity tumors). The details of the recommendations for an updated and simplified tumor nomenclature centered around tumor control and hearing rehabilitation with cochlear implantation are presented.

Objective The objective of the current study was to present the results of an international working group survey identifying perceived limitations of existing facial nerve grading scales to inform the development of a novel grading scale for assessing early postoperative facial paralysis that incorporates regional scoring and is anchored in recovery prognosis and risk of associated complications. Study Design Survey. Setting A working group of 48 multidisciplinary clinicians with expertise in skull base, cerebellopontine angle, temporal bone, or parotid gland surgery. Results House-Brackmann grade is the most widely used system to assess facial nerve function among working group members (81%), although more than half (54%) agreed that the system they currently use does not adequately estimate the risk of associated complications, such as corneal injury, and confidence in interrater and intrarater reliability is generally low. Simplicity was ranked as the most important attribute of a novel postoperative facial nerve grading system to increase the likelihood of adoption, followed by reliability and accuracy. There was widespread consensus (91%) that the eye is the most critical facial region to focus on in the early postoperative setting. Conclusions Members were invited to submit proposed grading systems in alignment with the objectives of the working group for subsequent validation. From these data, we plan to develop a simple, clinically anchored, and reproducible staging system with regional scoring for assessing early postoperative facial nerve function after surgery of the skull base, cerebellopontine angle, temporal bone, or parotid gland.

ObjectiveUbiquitous throughout the literature and during patient counseling, vestibular schwannoma is often quoted to affect about 1 per 100,000 people. Yet, reports from distinct international populations suggest that the incidence is likely much higher. The objective of the current work was to systematically characterize the global incidence of sporadic vestibular schwannoma.Data SourcesScopus, Embase, and PubMed.Review MethodsPopulation‐based studies reporting incidence rates of sporadic vestibular schwannoma between January 2010 and August 2020 were searched with language restrictions requiring reports to be published in Chinese, English, German, Italian, or Spanish. The protocol was registered with PROSPERO (CRD42021228208) prior to commencement of data collection. PRISMA guidelines for transparent reporting of systematic reviews were followed.ResultsAmong 424 citations, 6 publications covering 4 distinct populations from Denmark, the Netherlands, Taiwan, and the United States met inclusion criteria. Most recent incidence rates of among all ages ranged between 3.0 and 5.2 per 100,000 person‐years. Highest incidence rates were reported among patients aged ≥70 years, peaking at 20.6 per 100,000 person‐years. One study from the United States reported the incidence of asymptomatic, incidentally diagnosed tumors at a rate of 1.3 per 100,000 person‐years from 2012 to 2016.ConclusionsRecent international incidence rates of sporadic vestibular schwannoma exceed the commonly quoted “1 per 100,000” figure by up to 5‐fold among all ages and by up to 20‐fold among age groups at highest risk. Based on modern incidence rates, the lifetime prevalence of developing sporadic vestibular schwannoma likely exceeds 1 per 500 persons.

Objective: Active treatment of small- or medium-sized vestibular schwannoma during wait-and-scan management is currently recommended at most centers globally once growth is detected. The primary aim of the current study was to characterize the natural history of growing sporadic vestibular schwannoma during observation. Study Design: Cohort study. Setting: Four tertiary referral centers across the United States and Denmark. Patients: Patients with two prior MRI scans demonstrating ≥2 mm of linear growth who continued observational management. Intervention: Observation with serial imaging. Main Outcome Measure: Subsequent linear growth-free survival (i.e., an additional ≥2 mm of growth) following initial growth of ≥2 mm from tumor size at diagnosis. Results: Among 3,402 patients undergoing observation, 592 met inclusion criteria. Median age at initial growth was 66 years (IQR 59–73) for intracanalicular tumors (N = 65) and 62 years (IQR 54–70) for tumors with cerebellopontine angle extension (N = 527). The median duration of MRI surveillance following initial detection of tumor growth was 5.2 years (IQR 2.4–6.9) for intracanalicular tumors and 1.0 year (IQR 1.0–3.3) for cerebellopontine angle tumors. For intracanalicular tumors, subsequent growth-free survival rates (95% CI; number still at risk) at 1, 2, 3, 4, and 5 years following the initial MRI that demonstrated growth were 77% (67–88; 49), 53% (42–67; 31), 46% (35–60; 23), 34% (24–49; 17), and 32% (22–47; 13), respectively. For cerebellopontine angle tumors, subsequent growth-free survival rates were 72% (68–76; 450), 47% (42–52; 258), 32% (28–38; 139), 26% (21–31; 82), and 22% (18–28; 57), respectively. For every 1 mm increase in magnitude of growth from diagnosis to tumor size at detection of initial growth, the HRs associated with subsequent growth were 1.64 (95% CI 1.25–2.15; p < 0.001) for intracanalicular tumors and 1.08 (95% CI 1.01–1.15; p = 0.02) for cerebellopontine angle tumors. Conclusions: Growth detected during observation does not necessarily portend future growth, especially for slowly growing tumors. Because early treatment does not confer improved long-term quality of life outcomes, toleration of some growth during observation is justifiable in appropriately selected cases.