{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T21:19:29Z","timestamp":1775855969159,"version":"3.50.1"},"reference-count":16,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine if the chronic use of bevacizumab, prior to withholding for elective surgery in the preoperative period, increases the risk of hemorrhage during vestibular schwannoma (VS) resections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Retrospective reviews of estimated intraoperative blood loss volume during surgical resection of 50 bevacizumab\u2010treated and 56 bevacizumab\u2010untreated VS from patients with\n                      <jats:italic>NF2<\/jats:italic>\n                      \u2010related schwannomatosis (\n                      <jats:italic>NF2<\/jats:italic>\n                      \u2010SWN). Two index cases are included. Additionally, masked histopathologic examination of tissues from bevacizumab\u2010treated and untreated VS was evaluated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean blood loss during VS resection was statistically increased in patients with prior bevacizumab treatment (421\u2009mL) compared to untreated patients (285\u2009mL) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015). When accounting for both tumor size and the amount of tumor resected, blood loss per percent of tumor resected was also elevated in the bevacizumab treated group (15.78\u2009mL\/%resection) when compared to the untreated group (12.97\u2009mL\/%resection) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.024). Intraoperative hemostasis using standard techniques was difficult, and some cases resulted in early termination of the surgical procedure prior to total resection. Eighteen percent of bevacizumab\u2010treated patients had gross total or near total tumor resection, while untreated tumors had 52% gross total or near total resections (\n                      <jats:italic>p<\/jats:italic>\n                      \u2010value\u2009=\u20090.001). The length of time on bevacizumab preoperatively correlated with intraoperative blood loss (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.049). The median time patients were treated with bevacizumab prior to surgery was 23.5\u2009months and ranged from 3 to 121\u2009months. The median time off bevacizumab prior to surgery was 11.5\u2009months and ranged from 0.75 to 87\u2009months. Histopathologic examination revealed no readily apparent difference in blood vessel density, integrity, or growth patterns.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Bevacizumab treatment prior to excision of\n                      <jats:italic>NF2<\/jats:italic>\n                      \u2010SWN VS in this retrospective case series is associated with increased intraoperative hemorrhage. Bleeding was difficult to control using standard techniques, thus warranting preoperative surgical awareness. Underlying pathologic mechanisms are not yet understood and are under further investigation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>3.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.32342","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T08:29:43Z","timestamp":1749803383000},"page":"4355-4363","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Increased Hemorrhage During Excision of Bevacizumab\u2010Treated\n                    <scp>NF2<\/scp>\n                    \u2010Related Vestibular Schwannomas"],"prefix":"10.1002","volume":"135","author":[{"given":"Christopher G.","family":"Wood","sequence":"first","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Otolaryngology Head and Neck Surgery Massachusetts Eye and Ear Infirmary  Boston Massachusetts USA"},{"name":"Department of Otolaryngology Head and Neck Surgery Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liana","family":"Kozanno","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Neuropathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anat","family":"Stemmer\u2010Rachamimov","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Neuropathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J.","family":"Lee","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Otolaryngology Head and Neck Surgery Massachusetts Eye and Ear Infirmary  Boston Massachusetts USA"},{"name":"Department of Otolaryngology Head and Neck Surgery Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"II","given":"Fred G.","family":"Barker","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Neurosurgery Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bob S.","family":"Carter","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Neurosurgery Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott R.","family":"Plotkin","sequence":"additional","affiliation":[{"name":"Department of Neurology and Cancer Center Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin T.","family":"Jordan","sequence":"additional","affiliation":[{"name":"Department of Neurology and Cancer Center Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Long\u2010Sheng","family":"Chang","sequence":"additional","affiliation":[{"name":"Center for Childhood Cancer, Nationwide Children's Hospital and Department of Pediatrics The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9963-469X","authenticated-orcid":false,"given":"D. Bradley","family":"Welling","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Otolaryngology Head and Neck Surgery Massachusetts Eye and Ear Infirmary  Boston Massachusetts USA"},{"name":"Department of Otolaryngology Head and Neck Surgery Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gim.2022.05.007"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1086\/342716"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/jmedgenet\u20102011\u2010100562"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0902579"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/nop\/npv065"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/nop010"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010014\u20103398\u20103"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.64.3817"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.28228"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11060\u2010015\u20101828\u20108"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noad066"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100038\u20101676628"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11060\u2010016\u20102276\u20109"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.01367"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noaa284"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/jmedgenet\u20102017\u2010104519"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.32342","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.32342","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.32342","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T15:02:10Z","timestamp":1771081330000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.32342"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,13]]},"references-count":16,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1002\/lary.32342"],"URL":"https:\/\/doi.org\/10.1002\/lary.32342","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,13]]},"assertion":[{"value":"2025-03-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}