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Conservative management of vestibular schwannomas of 15 to 31 mm intracranial diameter

  • C E E Reddy (a1), H G Lewis-Jones (a2), M Javadpour (a3), I Ryland (a4) and T H J Lesser (a1)...

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.

Copyright

Corresponding author

Address for correspondence: Mr C Ekambar E Reddy, Department of Otolaryngology, University Hospital Aintree, Liverpool L9 7AL, UK E-mail: ekambarreddy@yahoo.com

Footnotes

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Presented at the 6th International Congress of the World Federation of Skull Base Societies and the 10th European Skull Base Society Congress, 16–19 May 2012, Brighton, UK, and at the 14th British Academic Conference in Otolaryngology, 4–6 July 2012, Glasgow, Scotland, UK.

Footnotes

References

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1Lanser, MJ, Sussman, SA, Frazer, K. Epidemiology, pathogenesis, and genetics of acoustic tumors. Otolaryngol Clin North Am 1992;25:499520
2Moffat, DA, Hardy, DG, Irving, RM, Viani, L, Beynon, GJ, Baguley, DM. Referral patterns in vestibular schwannomas. Clin Otolaryngol Allied Sci 1995;20:80–3
3Lin, D, Hegarty, JL, Fischbein, NJ, Jackler, RK. The prevalence of ‘incidental’ acoustic neuroma. Arch Otolaryngol Head Neck Surg 2005;131:241–4
4van Leeuwen, JP, Braspenning, JC, Meijer, H, Cremers, CW. Quality of life after acoustic neuroma surgery. Ann Otol Rhinol Laryngol 1996;105:423–30
5Wiegand, DA, Fickel, V. Acoustic neuroma—the patient's perspective: subjective assessment of symptoms, diagnosis, therapy, and outcome in 541 patients. Laryngoscope 1989;99:179–87
6Tan, M, Myrie, OA, Lin, FR, Niparko, JK, Minor, LB, Tamargo, RJ et al. Trends in the management of vestibular schwannomas at Johns Hopkins 1997–2007. Laryngoscope 2010;120:144–9
7Stangerup, SE, Caye-Thomasen, P, Tos, M, Thomsen, J. The natural history of vestibular schwannoma. Otol Neurotol 2006;27:547–52
8Al Sanosi, A, Fagan, PA, Biggs, ND. Conservative management of acoustic neuroma. Skull Base 2006;16:95100
9Hajioff, D, Raut, VV, Walsh, RM, Bath, AP, Bance, ML, Guha, A et al. Conservative management of vestibular schwannomas: third review of a 10-year prospective study. Clin Otolaryngol 2008;33:255–9
10Martin, TP. Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm. Laryngoscope 2005;115:1704; author reply 1704
11Ferri, GG, Modugno, GC, Pirodda, A, Fioravanti, A, Calbucci, F, Ceroni, AR. Conservative management of vestibular schwannomas: an effective strategy. Laryngoscope 2008;118:951–7
12Suryanarayanan, R, Ramsden, RT, Saeed, SR, Aggarwal, R, King, AT, Rutherford, SA et al. Vestibular schwannoma: role of conservative management. J Laryngol Otol 2010;124:251–7
13Kanzaki, J, Tos, M, Sanna, M, Moffat, DA, Monsell, EM, Berliner, KI. New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma. Otol Neurotol 2003;24:642–8
14Clark, JG. Uses and abuses of hearing loss classification. ASHA 1981;23:493500
15Fucci, MJ, Buchman, CA, Brackmann, DE, Berliner, KI. Acoustic tumor growth: implications for treatment choices. Am J Otol 1999;20:495–9
16Yamakami, 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;25:682–90
17Yoshimoto, Y. Systematic review of the natural history of vestibular schwannoma. J Neurosurg 2005;103:5963
18O'Reilly, B, Murray, CD, Hadley, DM. The conservative management of acoustic neuroma: a review of forty-four patients with magnetic resonance imaging. Clin Otolaryngol Allied Sci 2000;25:93–7
19Aslan, A, De Donato, G, Balyan, FR, Falcioni, M, Russo, A, Taibah, A et al. Clinical observations on coexistence of sudden hearing loss and vestibular schwannoma. Otolaryngol Head Neck Surg 1997;117:580–2
20Chaimoff, M, Nageris, BI, Sulkes, J, Spitzer, T, Kalmanowitz, M. Sudden hearing loss as a presenting symptom of acoustic neuroma. Am J Otolaryngol 1999;20:157–60
21Roehm, PC, Gantz, BJ. Management of acoustic neuromas in patients 65 years or older. Otol Neurotol 2007;28:708–14
22Smouha, EE, Yoo, M, Mohr, K, Davis, RP. Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm. Laryngoscope 2005;115:450–4
23Nikolopoulos, TP, Fortnum, H, O'Donoghue, G, Baguley, D. Acoustic neuroma growth: a systematic review of the evidence. Otol Neurotol 2010;31:478–85
24Sughrue, ME, Yang, I, Aranda, D, Lobo, K, Pitts, LH, Cheung, SW et al. The natural history of untreated sporadic vestibular schwannomas: a comprehensive review of hearing outcomes. J Neurosurg 2010;112:163–7
25Martinez Del Pero, M, Lloyd, SK, Moffat, DA. Hearing improvement in a growing vestibular schwannoma. Skull Base 2009;19:159–62
26Sakamoto, T, Fukuda, S, Inuyama, Y. Hearing loss and growth rate of acoustic neuromas in follow-up observation policy. Auris Nasus Larynx 2001;28:S23–7
27Mehrotra, N, Behari, S, Pal, L, Banerji, D, Sahu, RN, Jain, VK. Giant vestibular schwannomas: focusing on the differences between the solid and the cystic variants. Br J Neurosurg 2008;22:550–6
28Park, CK, Jung, HW, Kim, JE, Son, YJ, Paek, SH, Kim, DG. Therapeutic strategy for large vestibular schwannomas. J Neurooncol 2006;77:167–71
29Piccirillo, E, Wiet, MR, Flanagan, S, Dispenza, F, Giannuzzi, A, Mancini, F et al. Cystic vestibular schwannoma: classification, management, and facial nerve outcomes. Otol Neurotol 2009;30:826–34
30Charabi, S, Thomsen, J, Mantoni, M, Charabi, B, Jørgensen, B, Børgesen, SE et al. Acoustic neuroma (vestibular schwannoma): growth and surgical and nonsurgical consequences of the wait-and-see policy. Otolaryngol Head Neck Surg 1995;113:514
31Charabi, S, Tos, M, Børgesen, SE, Thomsen, J. Cystic acoustic neuromas. Results of translabyrinthine surgery. Arch Otolaryngol Head Neck Surg 1994;120:1333–8
32Samii, M, Matthies, C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 1997;40:1121; discussion 21–3
33Bassim, MK, Berliner, KI, Fisher, LM, Brackmann, DE, Friedman, RA. Radiation therapy for the treatment of vestibular schwannoma: a critical evaluation of the state of the literature. Otol Neurotol 2010;31:567–73
34Beenstock, M. Predicting the stability and growth of acoustic neuromas. Otol Neurotol 2002;23:542–9
35Mick, P, Westerberg, BD, Ngo, R, Akagami, R. Growing vestibular schwannomas: what happens next? Otol Neurotol 2009;30:101–4
36Clinical Practice Advisory Group of the British Association of Otorhinolaryngologists – Head and Neck Surgeons (BAO-HNS). Clinical Effective Guidelines: Acoustic Neuroma (Vestibular Schwannoma), BAO-HNS Document 5. London: British Association of Otorhinolaryngologists – Head and Neck Surgeons, 2002
37Sandooram, D, Grunfeld, EA, McKinney, C, Gleeson, MJ. Quality of life following microsurgery, radiosurgery and conservative management for unilateral vestibular schwannoma. Clin Otolaryngol Allied Sci 2004;29:621–7
38Raut, VV, Walsh, RM, Bath, AP, Bance, ML, Guha, A, Tator, CH et al. Conservative management of vestibular schwannomas - second review of a prospective longitudinal study. Clin Otolaryngol Allied Sci 2004;29:505–14
39Verma, S, Anthony, R, Tsai, V, Taplin, M, Rutka, J. Evaluation of cost effectiveness for conservative and active management strategies for acoustic neuroma. Clin Otolaryngol 2009;34:438–46
40Godefroy, WP, van der Mey, AG, de Bruine, FT, Hoekstra, ER, Malessy, MJ. Surgery for large vestibular schwannoma: residual tumor and outcome. Otol Neurotol 2009;30:629–34
41Mandl, ES, Meijer, OW, Slotman, BJ, Vandertop, WP, Peerdeman, SM. Stereotactic radiation therapy for large vestibular schwannomas. Radiother Oncol 2010;95:94–8
42Møller, P, Myrseth, E, Pedersen, PH, Larsen, JL, Krakenes, J, Moen, G. Acoustic neuroma – treatment modalities. Surgery, gamma-knife or observation? Acta Otolaryngol Suppl 2000;543:34–7

Keywords

Conservative management of vestibular schwannomas of 15 to 31 mm intracranial diameter

  • C E E Reddy (a1), H G Lewis-Jones (a2), M Javadpour (a3), I Ryland (a4) and T H J Lesser (a1)...

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