Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-26T04:13:08.608Z Has data issue: false hasContentIssue false
  • English
  • Français

Vestibular schwannoma: role of conservative management

Published online by Cambridge University Press:  11 December 2009

R Suryanarayanan ,
R T Ramsden ,
S R Saeed ,
R Aggarwal ,
A T King ,
S A Rutherford ,
D G Evans  and
J E Gillespie
R Suryanarayanan*
Affiliation:
Department of Otolaryngology, Manchester Royal Infirmary and Hope Hospital, Salford, UK
R T Ramsden
Affiliation:
Department of Otolaryngology, Manchester Royal Infirmary and Hope Hospital, Salford, UK
S R Saeed
Affiliation:
Department of Otology – Neuro-otology, University College London Ear Institute, Royal National Throat, Nose and Ear Hospital, London, UK
R Aggarwal
Affiliation:
Department of Otolaryngology, Manchester Royal Infirmary and Hope Hospital, Salford, UK
A T King
Affiliation:
Department of Neurosurgery, Manchester Royal Infirmary and Hope Hospital, Salford, UK
S A Rutherford
Affiliation:
Department of Neurosurgery, Manchester Royal Infirmary and Hope Hospital, Salford, UK
D G Evans
Affiliation:
Department of Medical Genetics, Manchester Royal Infirmary and Hope Hospital, Salford, UK
J E Gillespie
Affiliation:
Department of Neuroradiology, Manchester Royal Infirmary and Hope Hospital, Salford, UK
*
Address for correspondence: Mr R Suryanarayanan, 56 California Close, Warrington WA5 8WU, UK. Fax: 01925 415280 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To assess the outcome of conservative management of vestibular schwannoma.

Study design:

Observational study.

Setting:

Tertiary referral centre.

Patients:

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.

Main outcome measures:

The relationship of tumour growth to tumour size at presentation, and to certain demographic features.

Results:

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.

Conclusion:

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.

Keywords

Neuroma, AcousticMagnetic Resonance ImagingNeurofibromatosis 2Follow-up Studies
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 3 , March 2010 , pp. 251 - 257
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Kanzaki, J, Tos, M, Sanna, M. New and modified reporting systems from the consensus meeting on systems for reporting results in Vestibular Schwannoma. Otol Neurotol 2003;24:642–9CrossRefGoogle ScholarPubMed
2Nikolopoulos, TP, O'Donoghue, GM. Acoustic neuroma management: an evidence-based medicine approach. Otol Neurotol 2002;23:534–41CrossRefGoogle ScholarPubMed
3Yoshimoto, Y. Systematic review of the natural history of vestibular schwannoma. J Neurosurg 2005;103:59–63Google Scholar
4Suryanarayanan, R, Lesser, THJ. Growth rate of vestibular schwannoma – what the literature tells us. The Otorhinolaryngologist 2007;1:66–71Google Scholar
5Selesnick, HS, Johnson, G. Radiologic surveillance of acoustic neuromas. Am J Otol 1998;19:846–9Google ScholarPubMed
6Smouha, EE, Yoo, M, Mohr, K, Davis, RP. Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm. Laryngoscope 2005;115:450–4Google Scholar
7Yamakami, 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;25:682–90CrossRefGoogle ScholarPubMed
8Baser, ME, Mautner, VF, Parry, DM, Evans, DGR. Methodological issues in longitudinal studies: vestibular schwannoma growth rates in neurofibromatosis 2. J Med Genet 2005;42:903–6Google Scholar
9Ogawa, K, Kanzaki, J, Ogawa, S, Yamamoto, M, Ikeda, S, Shiobara, R. The growth rate of acoustic neuromas. Acta Otolaryngol Suppl 1991;487:157–63CrossRefGoogle ScholarPubMed
10Charabi, S, Thomsen, J, Tos, M, Charabi, B, Mantoni, M, Borgesen, SE. Acoustic neuroma/vestibular schwannoma growth: past, present and future. Acta Otolaryngol 1998;118:327–32Google ScholarPubMed
11Niemczyk, K, Vaneecloo, FM, Lemaitre, L, Lejeune, JP, Skarzynski, H, Dubrulle, F. The growth of acoustic neuromas in volumetric radiologic assessment. Am J Otol 1999;20:244–8Google ScholarPubMed
12Laasonen, E, Troupp, H. Volume growth rate of acoustic neurinomas. Neuroradiology 1986;28:203–7CrossRefGoogle ScholarPubMed
13Valvassori, GE, Guzman, M. Growth rate of acoustic neuromas. Am J Otol 1989;10:174–6Google ScholarPubMed
14Mirz, F, Jorgensen, B, Fiirgaard, B, Lundorf, E, Pedersen, CB. Investigations into the natural history of vestibular schwannomas. Clin Otol 1999;24:13–18CrossRefGoogle ScholarPubMed
15Fucci, MJ, Buchman, CA, Brackmann, DE, Berliner, KI. Acoustic tumour growth: implications for treatment choices. Am J Otol 1999;20:495–9Google ScholarPubMed
16Martin, TPC, Tzifa, K, Kowalski, C, Holder, RL, Walsh, R, Irving, RM. Conservative versus primary surgical treatment of acoustic neuromas: a comparison of rates of facial nerve and hearing preservation. Clin Otolaryngol 2008;33:228–35Google Scholar
17Walsh, RM, Bath, AP, Bance, ML, Keller, A, Tator, CH, Rutka, JA. The role of conservative management of vestibular schwannomas. Clin Otolaryngol 2000;25:28–39Google Scholar
18Charabi, S, Thomsen, J, Mantoni, M, Charabi, B, Jorgensen, B, Borgesen, SE. Acoustic neuroma: growth and surgical and nonsurgical consequences of the wait and see policy. Otolaryngol Head Neck Surg 1995;113:5–14Google ScholarPubMed
19Tschudi, DC, Linder, TE, Fisch, U. Conservative management of unilateral acoustic neuromas. Am J Otol 2000;21:722–8Google ScholarPubMed
20Deen, HG, Ebersold, MJ, Harner, SG, Beatty, CW, Marion, MS, Wharen, RE. Conservative management of acoustic neuroma: an outcome study. Neurosurgery 1996;39:260–4Google Scholar
21O'Reilly, B, Murray, CD, Hadley, DM. The conservative management of acoustic neuroma: a review of forty-four patients with magnetic resonance imaging. Clin Otolaryngol 2000;25:93–7CrossRefGoogle ScholarPubMed
22Herwadker, A, Vokurka, EA, Evans, DGR, Ramsden, RT, Jackson, A. Size and growth rate of sporadic vestibular schwannoma: predictive value of information available at presentation. Otol Neurotol 2005;26:86–92CrossRefGoogle ScholarPubMed
23Mohyuddin, A, Vokurka, EA, Evans, DG, Ramsden, RT, Jackson, A. Is clinical growth index a reliable predictor of tumor growth in vestibular schwannomas? Clin Otolaryngol 2003;28:85–90CrossRefGoogle ScholarPubMed
24Rosenberg, SI. Natural history of acoustic neuromas. Laryngoscope 2000;110:497–508CrossRefGoogle ScholarPubMed
25Evans, DG, Trueman, L, Wallace, A, Collins, S, Strachan, T. Genotype/phenotype correlations in type 2 neurofibromatosis (NF2): evidence for more severe disease associated with truncating mutations. J Med Genet 1998;35:450–5CrossRefGoogle ScholarPubMed
26Baser, ME, Kuramoto, L, Joe, H, Friedman, JM, Wallace, AJ, Gillespie, JE et al. Genotype-phenotype correlations for nervous system tumors in neurofibromatosis 2: a population-based study. Am J Hum Genet 2004;75:231–9Google Scholar