Vestibular schwannoma: role of conservative management
ABSTRACT To assess the outcome of conservative management of vestibular schwannoma.
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: To examine long-term hearing outcomes after microsurgical excision of vestibular schwannoma (VS). Retrospective case review. Tertiary referral center. Forty-nine subjects at a single institution who had undergone microsurgical excision of a VS via middle cranial fossa (MCF) approach between 1994 and 2007 with immediate postoperative (PO) hearing preservation and for whom long-term audiograms were available. Diagnostic. Word Recognition Score (WRS) is defined by speech discrimination scores (SDS) greater than 70% (grade I), 50% to 70% (grade II), less than 50% (grade III), and 0% (grade IV). For subjects with more than 2 years of follow-up, WRS I hearing was present PO in 42 of 49 patients and was preserved at the latest follow-up in 38 (90%) of 42 patients. No subjects fell beyond WRS II. WRS I hearing was maintained in 23 (88%) of 26 patients with more than 5 years of follow-up. Postoperative WRS I to II hearing was maintained in 28 (96%) of 29 patients with more than 5 years of follow-up. The patient who lost significant hearing in the ear operated on had sensorineural hearing loss that paralleled deterioration in her ear that was not operated on. Most subjects maintain their initial PO SDS after microsurgical VS removal, and therefore, the initial PO WRS is predictive of long-term hearing. Postsurgical changes do not alter the natural rate or pattern of progressive bilateral sensorineural hearing loss in individual subjects.Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 09/2010; 31(7):1144-52. DOI:10.1097/MAO.0b013e3181edb8b2 · 1.60 Impact Factor
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ABSTRACT: Magnetic resonance imaging (MRI) is the diagnostic gold standard in vestibular schwannoma. Sensitivity and specificity are both close to 100%. MRI detects the tumour and describes its extension, thereby giving the potential surgeon prognostic clues. Prediction of tumour growth, however, is not possible. Careful analysis of imaging findings almost always enables differentiation from various other disease entities. Follow-up of surgical as well as non-surgical patients is another important role of MRI. Computed tomography (CT) is restricted to pre-surgical workup and to the immediate postoperative period.HNO 01/2011; 59(1):9-15. · 0.54 Impact Factor
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ABSTRACT: Zusammenfassung In der Diagnosestellung von Vestibularisschwannomen ist die Bildgebung mittels Magnetresonanztomographie (MRT) der Goldstandard. Senitivität und Spezifität liegen bei fast 100%. Mit der MRT lässt sich der Tumor entdecken und seine Ausdehnung beschreiben, was dem potenziellen Operateur auch prognostische Hinweise liefert. Eine Vorhersage für das Wachstumsverhalten der Tumoren ist damit aber nicht möglich. Eine subtile Analyse der Bildbefunde erlaubt fast immer die differenzialiagnostische Abgrenzung gegenüber anderen Entitäten. Sowohl bei operierten als auch bei nicht operierten Patienten sind Verlaufskontrollen eine weitere wichtige Aufgabe der MRT. Die Computertomographie (CT) ist nur noch zur Operationsvorbereitung und in der unmittelbar postoperativen Phase nötig.HNO 01/2011; 59(1):9-15. DOI:10.1007/s00106-010-2188-5 · 0.54 Impact Factor