Vestibular schwannoma: role of conservative management

Department of Otolaryngology, Manchester Royal Infirmary and Hope Hospital, Salford, UK.
The Journal of Laryngology & Otology (Impact Factor: 0.7). 12/2009; 124(3):251-7. DOI: 10.1017/S0022215109992362
Source: PubMed

ABSTRACT To assess the outcome of conservative management of vestibular schwannoma.
Observational study.
Tertiary referral centre.
Four hundred and thirty-six patients with vestibular schwannoma (490 tumours), including 327 sporadic tumours and 163 tumours in 109 patients with neurofibromatosis type two.
The relationship of tumour growth to tumour size at presentation, and to certain demographic features.
The initial tumour size was significantly larger in the neurofibromatosis type two group (11 mm) than in the sporadic vestibular schwannoma group (5.1 mm). In both groups, 68 per cent of tumours did not grow during follow up (mean 3.6 years; range one to 14 years). The mean growth rate was 1.1 mm/year (range 0-15 mm/year) for sporadic tumours and 1.7 mm/year (range 0-18 mm/year) for neurofibromatosis type two tumours. The tumour growth rate correlated positively with tumour size in the sporadic tumour group, and correlated negatively with age in the neurofibromatosis type two group.
Two-thirds of vestibular schwannomas did not grow. Radiological surveillance is an acceptable approach in carefully selected patients. Once a sporadic vestibular schwannoma reaches 2 cm in intracranial diameter, it is likely to continue growing. We do not recommend conservative management for sporadic tumours with an intracranial diameter of 1.5 cm or more. Vestibular schwannoma management is more complex in patients with neurofibromatosis type two.

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    ABSTRACT: Objective To evaluate the effectiveness and long-term outcome of Gamma Knife radiosurgery (GKRS) for tiny vestibular schwannomas (VSs) detected by three-dimensional fast imaging employing steady-state acquisition magnetic resonance (3D-FIESTA MR). Materials and methods Between January and December 2004, 3D-FIESTA MR of the brain was performed in patients who had physical health examinations at the Buddhist Tzu Chi General Hospital (Hualien, Taiwan). Tiny intracanalicular VSs (defined as a tumor volume < 0.5 cm2) was detected in 13 patients (8 women and 5 men). The mean age of the patients was 60 years (range, 45–84 years). Hearing function was graded using the Gardner–Robertson (GR) classification. Dose planning was performed on intraoperative stereotactic contrast-enhanced images using multiple 4-mm isocenters. The mean tumor volume was 0.098 cm2 (range, 0.013–0.4 cm2). The mean margin dose was 12.4 Gy (range, 11–14 Gy), and the isodose line was set at a mean of 53.8% (range, 50–70%). Results Twelve patients had GR Grade I or II hearing before GKRS, and GR I or II hearing was maintained in 11 patients. Facial and trigeminal nerve functions were preserved in all patients. The tumor control rate was 100% at a mean follow-up period of 9.8 ± 1.1 years (range, 76–126 months). One patient developed acute vertigo 1 day after GKRS, which subsided after short-term use of steroids and did not recur. Conclusion With the application of 3D-FIESTA, tiny VSs can be detected early. Because low-dose (12–14 Gy) GKRS is safe and effective for long-term control of the growth of tumors with acceptable preservation rate of hearing function, it may be worthwhile to use 3D-FIESTA to detect tiny VSs and treat the patients using GKRS.
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    ABSTRACT: Objective: To study the natural course of vestibular schwannomas 15 to 31 mm in diameter. Methods: A retrospective study of 45 patients conservatively managed with interval scanning was performed. Outcome measures were: changes in tumour size, clinical features and hearing. A tumour was considered to be growing if it increased in size by more than 2 mm. Results: Initial tumour sizes ranged from 15 to 31 mm, with a mean (± standard deviation) diameter of 20.1 ± 4.3 mm. The duration of follow up ranged from 6 months to 14 years (median, 3 years). Tumours grew in 11 cases (24.4 per cent), remained stable in 30 cases (66.7 per cent) and regressed in 4 cases (8.9 per cent). The overall mean tumour growth rate was 0.9 ± 2.2 mm per year; in growing tumours, it was 3.6 ± 2.9 mm per year. Conclusion: Outcomes were similar to those reported for smaller tumours. These findings suggest that patients with medium or moderately large tumours can be safely offered an initial period of conservative management before intervention is considered.
    The Journal of Laryngology & Otology 08/2014; 128(9):1-7. DOI:10.1017/S0022215114001315 · 0.70 Impact Factor
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    ABSTRACT: To evaluate the results of local control and complications in the treatment of vestibular schwannoma treated with radiation.
    Acta Otorrinolaringológica Española 12/2014; DOI:10.1016/j.otorri.2014.08.003