ABSTRACT
We conducted a retrospective observational study to assess the consequences of conservative management of vestibular schwannoma (VS). Data were collected from tertiary neuro-otological referral units in United Kingdom. The study included 59 patients who were managed conservatively with radiological diagnosis of VS. The main outcome measures were growth rate and rate of failure of conservative management. Multivariate analysis sought correlation between tumor growth and (i) demographic features, (ii) tumor characteristics. The mean tumor growth was 0.66 mm/y. 11 patients (19%) required intervention. Mean time to intervention was 37 months with two notable late “failures” occurring at 75 and 84 months. Tumors extending into the cerebellopontine angle (CPA) grew significantly faster than intracanalicular tumors (p = 0.0045). No association was found between growth rate and age, sex, tumor laterality, facial nerve function, and grade of hearing loss. Conservative management is acceptable for a subset of patients. Tumors extending into the CPA at diagnosis grow significantly faster than intracanalicular tumors. No growth within 5 years of surveillance does not guarantee a continued indolent growth pattern; surveillance must therefore continue.
KEYWORDS
Vestibular schwannoma - conservative - surveillance
REFERENCES
-
1
Stangerup S E, Tos M, Caye-Thomasen P, Tos T, Klokker M, Thomsen J.
Increasing annual incidence of vestibular schwannoma and age at diagnosis.
J Laryngol Otol.
2004;
118
(8)
622-627
-
2
Hardell L, Hansson Mild K, Sandström M, Carlberg M, Hallquist A, Påhlson A.
Vestibular schwannoma, tinnitus and cellular telephones.
Neuroepidemiology.
2003;
22
(2)
124-129
-
3
Howitz M F, Johansen C, Tos M, Charabi S, Olsen J H.
Incidence of vestibular schwannoma in Denmark, 1977-1995.
Am J Otol.
2000;
21
(5)
690-694
-
4
Tos M, Charabi S, Thomsen J.
Incidence of vestibular schwannomas.
Laryngoscope.
1999;
109
(5)
736-740
-
5
Stangerup S-E, Tos M, Caye-Thomasen P, Tos T, Klokker M, Thomsen J.
Increasing annual incidence of vestibular schwannoma and age at diagnosis.
J Laryngol Otol.
2004;
118
(8)
622-627
-
6
Tos M, Charabi S, Thomsen J.
Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results.
Eur Arch Otorhinolaryngol.
1998;
255
(1)
1-6
-
7
Nikolopoulos T P, Johnson I, O'Donoghue G M.
Quality of life after acoustic neuroma surgery.
Laryngoscope.
1998;
108
(9)
1382-1385
-
8
Bennett M, Haynes D S.
Surgical approaches and complications in the removal of vestibular schwannomas. 2007.
Neurosurg Clin N Am.
2008;
19
(2)
331-343
vii
-
9
Roland P S, Eston D.
Stereotactic radiosurgery of acoustic tumors.
Otolaryngol Clin North Am.
2002;
35
(2)
343-355
-
10
Pollock B E, Link M J, Foote R L.
Failure rate of contemporary low-dose radiosurgical technique for vestibular schwannoma.
J Neurosurg.
2009;
111
(4)
840-844
-
11
Battaglia A, Mastrodimos B, Cueva R.
Comparison of growth patterns of acoustic neuromas with and without radiosurgery.
Otol Neurotol.
2006;
27
(5)
705-712
-
12
Roche P H, Régis J, Devèze A, Delsanti C, Thomassin J M, Pellet W.
[Surgical removal of unilateral vestibular schwannomas after failed Gamma Knife radiosurgery].
Neurochirurgie.
2004;
50
(2-3 Pt 2)
383-393
-
13
Committee on Hearing and Equilibrium. Guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC.
Otolaryngol Head Neck Surg.
1995;
113
(3)
179-180
-
14
Kanzaki J, Tos M, Sanna M, Moffat D A, Monsell E M, Berliner K I.
New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma.
Otol Neurotol.
2003;
24
(4)
642-648
discussion 648-649
-
15
Fortnum H, O'Neill C, Taylor R et al..
The role of magnetic resonance imaging in the identification of suspected acoustic neuroma: a systematic review of clinical and cost effectiveness and natural history.
Health Technol Assess.
2009;
13
(18)
iii-iv
ix-xi
1-154
-
16
Yamakami I, Uchino Y, Kobayashi E, Yamaura A.
Conservative management, gamma-knife radiosurgery, and microsurgery for acoustic neurinomas: a systematic review of outcome and risk of three therapeutic options.
Neurol Res.
2003;
25
(7)
682-690
-
17
Yoshimoto Y.
Systematic review of the natural history of vestibular schwannoma.
J Neurosurg.
2005;
103
(1)
59-63
-
18
Smouha E E, Yoo M, Mohr K, Davis R P.
Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm.
Laryngoscope.
2005;
115
(3)
450-454
-
19
Selesnick S H, Johnson G.
Radiologic surveillance of acoustic neuromas.
Am J Otol.
1998;
19
(6)
846-849
-
20
Flint D, Fagan P, Panarese A.
Conservative management of sporadic unilateral acoustic neuromas.
J Laryngol Otol.
2005;
119
(6)
424-428
-
21 Moller P, Myrseth E, Pedersen P-H, Lund-Johannessen M, Krakenes J, Moen G. Small vestibular schwannoma: results with observation, surgery and gamma-knife. Proceedings of the Fourth International Conference on Vestibular Schwannoma and Other CPA Lesions. Cambridge, UK, July 13–17, 2003.
-
22
O'Reilly B, Murray C D, Hadley D M.
The conservative management of acoustic neuroma: a review of forty-four patients with magnetic resonance imaging.
Clin Otolaryngol Allied Sci.
2000;
25
(2)
93-97
-
23
Bederson J B, von Ammon K, Wichmann W W, Yasargil M G.
Conservative treatment of patients with acoustic tumors.
Neurosurgery.
1991;
28
(5)
646-650
discussion 650-651
-
24
Glasscock III M E, Pappas Jr D G, Manolidis S, Von Doersten P G, Jackson C G, Storper I S.
Management of acoustic neuroma in the elderly population.
Am J Otol.
1997;
18
(2)
236-241
discussion 241-242
-
25
Stangerup S-E, Caye-Thomasen P, Tos M, Thomsen J.
The natural history of vestibular schwannoma.
Otol Neurotol.
2006;
27
(4)
547-552
-
26 Quaranta N, Baguley D M, Axon P R, Moffat D A. Conservative management of vestibular schwannomas. Proceedings of the Fourth International Conference on Vestibular Schwannoma and Other CPA Lesions. Cambridge, UK, July 13–17, 2003. 256-257
-
27
Hajioff D, Raut V V, Walsh R M et al..
Conservative management of vestibular schwannomas: third review of a 10-year prospective study.
Clin Otolaryngol.
2008;
33
(3)
255-259
-
28
Solares C A, Panizza B.
Vestibular schwannoma: an understanding of growth should influence management decisions.
Otol Neurotol.
2008;
29
(6)
829-834
-
29
Bederson J B, von Ammon K, Wichmann W W, Yasargil M G.
Conservative treatment of patients with acoustic tumors.
Neurosurgery.
1991;
28
(5)
646-650
discussion 650-651
-
30
Flint D, Fagan P, Panarese A.
Conservative management of sporadic unilateral acoustic neuromas.
J Laryngol Otol.
2005;
119
(6)
424-428
-
31
Rosenberg S I.
Natural history of acoustic neuromas.
Laryngoscope.
2000;
110
(4)
497-508
-
32
Walsh R M, Bath A P, Bance M L, Keller A, Rutka J A.
Consequences to hearing during the conservative management of vestibular schwannomas.
Laryngoscope.
2000;
110
(2 Pt 1)
250-255
-
33
Vokurka E A, Herwadkar A, Thacker N A, Ramsden R T, Jackson A.
Using Bayesian tissue classification to improve the accuracy of vestibular schwannoma volume and growth measurement.
AJNR Am J Neuroradiol.
2002;
23
(3)
459-467
-
34
van de Langenberg R, de Bondt B J, Nelemans P J, Baumert B G, Stokroos R J.
Follow-up assessment of vestibular schwannomas: volume quantification versus two-dimensional measurements.
Neuroradiology.
2009;
51
(8)
517-524
-
35
Marshall A H, Owen VMF, Nikolopoulos T P, O'Donoghue G M.
Acoustic schwannomas: awareness of radiologic error will reduce unnecessary treatment.
Otol Neurotol.
2005;
26
(3)
512-515
Mark HughesM.Sc. B.Sc. M.R.C.S.
Department of Neurosurgery, Royal Free Hospital
Pond Street, London NW3 2QG
eMail: hughes81@gmail.com
