Vestibular schwannoma: Role of conservative management

R. Suryanarayanan, R. T. Ramsden, S. R. Saeed, R. Aggarwal, Andrew King, S. A. Rutherford, D. G. Evans, J. E. Gillespie

Research output: Contribution to journalArticlepeer-review

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 (11mm) than in the sporadic vestibular schwannoma group (5.1mm). 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 1.1mm/year (range 0-15mm/year) for sporadic tumours and 1.7mm/year (range 0-18mm/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 2cm in intracranial diameter, it is likely to continue growing. We do not recommend conservative management for sporadic tumours with an intracranial diameter of 1.5cm or more. Vestibular schwannoma management is more complex in patients with neurofibromatosis type two. Copyright © JLO (1984) Limited 2009.
Original languageEnglish
Pages (from-to)251-257
Number of pages6
JournalThe Journal of laryngology and otology
Volume124
Issue number3
DOIs
Publication statusPublished - Mar 2010

Keywords

  • Follow-up studies
  • Magnetic resonance imaging
  • Neurofibromatosis 2
  • Neuroma, acoustic

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