Diagnosis and treatment of vestibular schwannoma: 321.16 – Otorhinolaryngology: Summary of the Doctor of Medical Sciences thesis

Abstract

Thesis structure. Thesis is presented on 91 pages of basic text and includes an introduction, 5 chapters, synthesis of the obtained results, general conclusions, practical recommendations, bibliographic index with 218 titles and 3 appendices. The illustrative material contains 10 tables and 24 figures. The obtained results are published in 17 scientific papers. Key words: vestibular schwannoma, acoustic neuroma, nuclear magnetic resonance, endothelial vascular growth factor, transforming growth factor 1b, immunoglobulin A, immunoglobulin M, carcinoembryonic antigen, translabirintic approach. The aim of the research: the clinical and paraclinical study of patients primarily diagnosed with vestibular schwannoma, in order to establish the peculiarities of tumor evolution and growth and to develop an algorithm for early diagnosis and treatment of this condition. Research objectives. 1) Clinical diagnostic study of patients with vestibular schwannoma, in order to identify the most specific clinical diagnostic signs attesting to the evolution of the pathology. 2) Analysis of the results of MRI investigations in patients with vestibular schwannoma to establish the imaging peculiarities that show tumor evolution/growth. 3) Evaluation of changes in immunological markers in patients with vestibular schwannoma, in order to identify the most informative diagnostic and prognostic markers of tumor growth. 4) Developing an algorithm for early diagnosis and treatment of vestibular schwannoma. Scientific novelty and originality of the research. The evolution of vestibular schwannoma was established based on the analysis of the results of the clinical and paraclinical examination in patients primarily diagnosed with this pathology. The immunological results of cytokines and growth factors collected from patients and the results of monitoring, by MRI examination, were analyzed. Certain clinical and immunological criteria have been established, which may be possible predictive markers of tumor growth. The obtained results that contribute to the solution of a scientific problem. The obtained results were the basis for the development of an algorithm for the diagnosis and treatment of vestibular schwannoma, which will allow an early diagnosis and a correct management of this pathology. Theoretical importance. The doctoral thesis contributes with new information on the understanding of vestibular schwannoma progression, the pace and nature of tumor changes, important in the development of new predictive models. The application of clinical and immunological criteria for estimating the risk of tumor growth can substantiate the right decisions regarding the intervention, contributing to the development of personalized pathology management strategies. Applicative value. A diagnostic and treatment algorithm has been developed for patients with vestibular schwannoma, which can be integrated into a national clinical protocol. The translabirintic approach has been introduced in vestibular schwannoma surgery. Implementation of the scientific results. The results of the research, including the diagnosis and treatment algorithm of vestibular schwannoma, were implemented in the Otorhinolaryngology Clinic of IMSP Republican Clinical Hospital "Timofei Moșneaga", and the translabyrinthine approach in vestibular schwannoma surgery was implemented in the Neurosurgery Clinic of IMSP Institute of Neurology and Neurosurgery "Diomid Gherman".