{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:34:50Z","timestamp":1753893290066,"version":"3.41.2"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T00:00:00Z","timestamp":1653436800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Rare giant vestibular schwannomas (GVSs) invade the temporal bone extensively, which carries unique risks for surgery owing to their complicated relationship with adjacent structures, difficult dissection of the temporal bone, and high risk of complications. The underlying mechanism of this invasive behavior remains unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case description<\/jats:title><jats:p>We report on a 28-year-old woman who presented with typical hearing loss and facial paralysis (House-Brackmann II). Magnetic resonance imaging exhibited a giant mass (\u223c5.0\u2005cm) in the right cerebellopontine angle (CPA), petrous apex, and middle cranial fossa. Her primary diagnosis was GVS with petrous apex invasion. With the aid of presurgical imaging reconstruction and intraoperative facial nerve monitoring, we adopted a sequential therapeutic strategy, which included microsurgery for the CPA lesion followed by gamma knife radiosurgery (GKRS) for the petrous mass. During follow-up, stable tumor control was achieved with functional preservation of the facial nerve and no other complications. The postoperative immunohistochemical examination demonstrated dramatic intratumoral inflammation, which suggested its potential role in bony erosion. We reviewed the literature of large vestibular schwannoma with a petrous invasion and further discussed its treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Microsurgery remains the top therapeutic strategy for GVS. However, gross total resection with functional preservation of cranial nerves is challenging to achieve once the temporal bone is involved. In this case, we applied a planned and sequential approach of microsurgery and GKRS with a promising outcome, which highlighted this combinational strategy in this rare situation. In addition, pathological examination suggested that intratumoral inflammation might play a role in the bony erosion of GVS. Longer observation and more cases are needed to further investigate its molecular mechanism and treatment plan.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.759163","type":"journal-article","created":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T07:03:33Z","timestamp":1653462213000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Extensive Temporal Bone Invasion in a Giant Vestibular Schwannoma"],"prefix":"10.3389","volume":"9","author":[{"given":"Fang","family":"Lyu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinlu","family":"Gan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haijun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongyang","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fangcheng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"981","DOI":"10.2147\/CLEP.S218670","article-title":"Epidemiology of vestibular schwannomas - prospective 40-year data from an unselected national cohort","volume":"11","author":"Reznitsky","year":"2019","journal-title":"Clin Epidemiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.otc.2007.10.007","article-title":"Imaging of hearing loss","volume":"41","author":"Martin","year":"2008","journal-title":"Otolaryngol Clin North Am"},{"key":"B3","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1097\/00129492-200307000-00019","article-title":"New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma","volume":"24","author":"Kanzaki","year":"2003","journal-title":"Otol Neurotol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1097\/01.mao.0000217356.73463.e7","article-title":"The natural history of vestibular schwannoma","volume":"27","author":"Stangerup","year":"2006","journal-title":"Otol Neurotol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1991","DOI":"10.1007\/s00701-015-2571-9","article-title":"Predictive value of intraoperative neurophysiologic monitoring in assessing long-term facial function in grade IV vestibular schwannoma removal","volume":"157","author":"Duarte-Costa","year":"2015","journal-title":"Acta Neurochir (Wien)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"E44","DOI":"10.1093\/neuros\/nyx513","article-title":"Congress of neurological surgeons systematic review and evidence-based guidelines on intraoperative cranial nerve monitoring in vestibular schwannoma surgery","volume":"82","author":"Vivas","year":"2018","journal-title":"Neurosurgery"},{"key":"B7","doi-asserted-by":"publisher","first-page":"624","DOI":"10.3870\/j.issn.1672-0741.2010.05.009","article-title":"Microsurgical treatment of cystic acoustic neuromas","volume":"39","author":"Zhang","year":"2010","journal-title":"J Acta Med Univ Sci Technol Huazhong"},{"key":"B8","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1055\/s-2008-1058948","article-title":"Atypical invasion of the temporal bone in vestibular schwannoma","volume":"5","author":"Feghali","year":"1995","journal-title":"Skull Base Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/02688697.2019.1588226","article-title":"Vestibular schwannoma extending into the tympanic cavity and jugular fossa by invasion of the petrous bone","volume":"2019","author":"Matsumura","year":"2019","journal-title":"Br J Neurosurg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"292","DOI":"10.3340\/jkns.2015.57.4.292","article-title":"Vestibular schwannoma atypically invading temporal bone","volume":"57","author":"Park","year":"2015","journal-title":"J Korean Neurosurg Soc"},{"key":"B11","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.wneu.2017.10.176","article-title":"Retrosigmoid intradural suprameatal-inframeatal approach for complete surgical removal of a giant recurrent vestibular schwannoma with severe petrous bone involvement: technical case report","volume":"110","author":"Sato","year":"2018","journal-title":"World Neurosurg"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.687201","article-title":"Current understanding of hearing loss in sporadic vestibular schwannomas: a systematic review","volume":"11","author":"Gan","year":"2021","journal-title":"Front Oncol"},{"key":"B13","first-page":"739","article-title":"[Morphological and clinical study of acoustic tumor with respect to enlargement of internal auditory canal: mechanism of bone destruction]","volume":"24","author":"Takada","year":"1996","journal-title":"No Shinkei Geka"},{"key":"B14","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1146\/annurev.immunol.24.021605.090646","article-title":"Osteoimmunology: interplay between the immune system and bone metabolism","volume":"24","author":"Walsh","year":"2006","journal-title":"Annu Rev Immunol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"4838","DOI":"10.4049\/jimmunol.173.8.4838","article-title":"Marrow stromal cells and osteoclast precursors differentially contribute to TNF-alpha-induced osteoclastogenesis in vivo","volume":"173","author":"Kitaura","year":"2004","journal-title":"J Immunol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1504","DOI":"10.1126\/science.289.5484.1504","article-title":"Bone resorption by osteoclasts","volume":"289","author":"Teitelbaum","year":"2000","journal-title":"Science"},{"key":"B17","doi-asserted-by":"publisher","first-page":"27307","DOI":"10.1074\/jbc.M003886200","article-title":"Tumor necrosis factor receptors types 1 and 2 differentially regulate osteoclastogenesis","volume":"275","author":"Abu-Amer","year":"2000","journal-title":"J Biol Chem"},{"key":"B18","doi-asserted-by":"publisher","first-page":"5757","DOI":"10.1158\/1078-0432.Ccr-18-0472","article-title":"Functions and mechanisms of tumor necrosis factor-\u03b1 and noncoding RNAs in bone-invasive pituitary adenomas","volume":"24","author":"Zhu","year":"2018","journal-title":"Clin Cancer Res"},{"key":"B19","doi-asserted-by":"publisher","first-page":"737","DOI":"10.3892\/mmr.2015.3415","article-title":"Immunohistochemical profile of cytokines and growth factors expressed in vestibular schwannoma and in normal vestibular nerve tissue","volume":"12","author":"Taurone","year":"2015","journal-title":"Mol Med Rep"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e895","DOI":"10.1016\/j.wneu.2018.07.093","article-title":"Adjunctive gamma knife surgery or wait and scan policy after optimal resection of large vestibular schwannomas: clinical and radiologic outcomes","volume":"118","author":"Troude","year":"2018","journal-title":"World Neurosurg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e0253338","DOI":"10.1371\/journal.pone.0253338","article-title":"Impact of extent of internal acoustic meatus tumor removal using translabyrinthine approach for acoustic neuroma surgery","volume":"16","author":"Chiang","year":"2021","journal-title":"PLoS One"},{"key":"B22","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/S0030-6665(20)30990-7","article-title":"Transotic approach to the cerebellopontine angle","volume":"25","author":"Browne","year":"1992","journal-title":"Otolaryngol Clin North Am"},{"key":"B23","doi-asserted-by":"publisher","first-page":"3041","DOI":"10.1007\/s00405-017-4627-3","article-title":"The transotic approach for vestibular schwannoma: indications and results","volume":"274","author":"Xia","year":"2017","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1227\/01.neu.0000429862.50018.b9","article-title":"Conservative management or gamma knife radiosurgery for vestibular schwannoma: tumor growth, symptoms, and quality of life","volume":"73","author":"Breivik","year":"2013","journal-title":"Neurosurgery"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1016\/j.otc.2018.07.015","article-title":"Management of vestibular schwannoma (Including NF2): facial nerve considerations","volume":"51","author":"Kaul","year":"2018","journal-title":"Otolaryngol Clin North Am"},{"key":"B26","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1227\/01.Neu.0000340684.60443.55","article-title":"Vestibular schwannoma: surgery or gamma knife radiosurgery? a prospective, nonrandomized study","volume":"64","author":"Myrseth","year":"2009","journal-title":"Neurosurgery"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1007\/s00701-017-3164-6","article-title":"Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review","volume":"159","author":"Persson","year":"2017","journal-title":"Acta Neurochir (Wien)"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e001345","DOI":"10.1136\/bmjopen-2012-001345","article-title":"What intervention is best practice for vestibular schwannomas? a systematic review of controlled studies","volume":"3","author":"Wolbers","year":"2013","journal-title":"BMJ Open"},{"key":"B29","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1016\/j.wneu.2016.07.117","article-title":"Gamma knife radiosurgery as primary treatment for large vestibular schwannomas: clinical results at long-term follow-up in a series of 59 patients","volume":"95","author":"Bailo","year":"2016","journal-title":"World Neurosurg"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.3171\/2016.12.Jns161530","article-title":"Gamma knife radiosurgery for large vestibular schwannomas greater than 3\u2005cm in diameter","volume":"128","author":"Huang","year":"2018","journal-title":"J Neurosurg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1700\/1636.17912","article-title":"Radiosurgical options in neuro-oncology: a review on current tenets and future opportunities. Part I: therapeutic strategies","volume":"100","author":"Ganau","year":"2014","journal-title":"Tumori"},{"key":"B32","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1227\/neu.0000000000001227","article-title":"Emerging indications for fractionated gamma knife radiosurgery","volume":"80","author":"McTyre","year":"2017","journal-title":"Neurosurgery"},{"key":"B33","doi-asserted-by":"publisher","first-page":"57","DOI":"10.5301\/tj.5000215","article-title":"Radiosurgical options in neuro-oncology: a review on current tenets and future opportunities. Part II: adjuvant radiobiological tools","volume":"101","author":"Ganau","year":"2015","journal-title":"Tumori Journal"},{"key":"B34","doi-asserted-by":"publisher","first-page":"14676","DOI":"10.1073\/pnas.1512570112","article-title":"Anti-VEGF treatment improves neurological function and augments radiation response in NF2 schwannoma model","volume":"112","author":"Gao","year":"2015","journal-title":"Proc Natl Acad Sci U S A"},{"key":"B35","doi-asserted-by":"publisher","first-page":"E2077","DOI":"10.1073\/pnas.1719966115","article-title":"Targeting the cMET pathway augments radiation response without adverse effect on hearing in NF2 schwannoma models","volume":"115","author":"Zhao","year":"2018","journal-title":"Proc Natl Acad Sci U S A"},{"key":"B36","doi-asserted-by":"publisher","first-page":"875","DOI":"10.3171\/2011.6.JNS101958","article-title":"Management of large vestibular schwannoma. Part I. Planned subtotal resection followed by Gamma Knife surgery: radiological and clinical aspects","volume":"115","author":"van de Langenberg","year":"2011","journal-title":"J Neurosurg"},{"key":"B37","doi-asserted-by":"publisher","first-page":"69","DOI":"10.3171\/2012.6.GKS12697","article-title":"Intracapsular decompression or radical resection followed by Gamma Knife surgery for patients harboring a large vestibular schwannoma","volume":"117","author":"Pan","year":"2012","journal-title":"J Neurosurg"},{"key":"B38","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1002\/hed.20338","article-title":"Stereotactic radiosurgery plus intracavitary irradiation in the salvage of nasopharyngeal carcinoma","volume":"28","author":"Low","year":"2006","journal-title":"Head Neck"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.759163\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T07:03:38Z","timestamp":1653462218000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.759163\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,25]]},"references-count":38,"alternative-id":["10.3389\/fsurg.2022.759163"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.759163","relation":{},"ISSN":["2296-875X"],"issn-type":[{"type":"electronic","value":"2296-875X"}],"subject":[],"published":{"date-parts":[[2022,5,25]]},"article-number":"759163"}}