Vestibular schwannoma conservative treatment

see Vestibular schwannoma natural history.

There is a continuing trend toward nonsurgical management, with approximately half of the patients opting for nonsurgical management. In a cohort, the patients commonly presented with otologic symptoms and otolaryngologists made the most diagnoses. Neurotologists and neurosurgeons were the most influential in treatment discussion 1).

The reported rate of spontaneous shrinkage of vestibular schwannoma in a review of Huang et al. in 2013 was 5-10% of patients managed conservatively. Extreme shrinkage of the tumor may occur spontaneously 2).

Vestibular schwannoma growth is usually manifest in the first 3 years after presentation.

Martin et al. recommended in 2009 an initial magnetic resonance imaging scan at 6 months, with scans to take place at annual intervals for 2 years. A further scan 2 years later will identify any patient with indolent tumors. Thereafter, follow-up should be lifelong every 5 years. Cystic tumors represent a particular threat to patients and should only be treated conservatively with caution 3).

Most reports on wait-and-scan in the literature describe results of VS over different time periods and do not analyze a specific subset of tumors that have been followed-up for 5 yr or longer. This is exclusive to the study of Prasad et al. from the Department of Neurotology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy and Department of Otolaryngology-Head and Neck Surgery, Military Hospital, Hisar, India, and gives valuable information. They discuss there own selection criteria for wait-and-scan modality, present long-term outcomes, compare there results with the literature, and try to find an answer to the all-important question “is there a price to pay?” in wait-and-scan.

EM: Extrameatal

IM: Intrameatal

PTA: Pure tone audiometry

SDS: Speech discrimination score

Grading: see Koos grading scale 4).

Goshtasbi K, Abouzari M, Moshtaghi O, Sahyouni R, Sajjadi A, Lin HW, Djalilian HR. The changing landscape of vestibular schwannoma diagnosis and management: A cross-sectional study. Laryngoscope. 2019 Apr 5. doi: 10.1002/lary.27950. [Epub ahead of print] PubMed PMID: 30953401.
Huang X, Caye-Thomasen P, Stangerup SE. Distinct spontaneous shrinkage of a sporadic vestibular schwannoma. Auris Nasus Larynx. 2013 Apr;40(2):243-6. doi: 10.1016/j.anl.2012.01.011. Epub 2012 Aug 1. Review. PubMed PMID: 22858145.
Martin TP, Senthil L, Chavda SV, Walsh R, Irving RM. A protocol for the conservative management of vestibular schwannomas. Otol Neurotol. 2009 Apr;30(3):381-385. PubMed PMID: 19326500.
Prasad SC, Patnaik U, Grinblat G, Giannuzzi A, Piccirillo E, Taibah A, Sanna M. Decision Making in the Wait-and-Scan Approach for Vestibular Schwannomas: Is There a Price to Pay in Terms of Hearing, Facial Nerve, and Overall Outcomes? Neurosurgery. 2018 Nov 1;83(5):858-870. doi: 10.1093/neuros/nyx568. PubMed PMID: 29281097.
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