Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-28T15:46:26.261Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  14 August 2014

C E E Reddy ,
H G Lewis-Jones ,
M Javadpour ,
I Ryland  and
T H J Lesser
C E E Reddy*
Affiliation:
Department of Otolaryngology, University Hospital Aintree NHS Foundation Trust, Liverpool, UK
H G Lewis-Jones
Affiliation:
Department of Radiology, University Hospital Aintree NHS Foundation Trust, Liverpool, UK
M Javadpour
Affiliation:
Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, UK
I Ryland
Affiliation:
Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
T H J Lesser
Affiliation:
Department of Otolaryngology, University Hospital Aintree NHS Foundation Trust, Liverpool, UK
*
Address for correspondence: Mr C Ekambar E Reddy, Department of Otolaryngology, University Hospital Aintree, Liverpool L9 7AL, UK E-mail: ekambarreddy@yahoo.com
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Patient MonitoringPrognosisAcoustic NeuromaSchwannoma, VestibularMagnetic Resonance Imaging
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 9 , September 2014 , pp. 752 - 758
Copyright
Copyright © JLO (1984) Limited 2014 

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.)

Footnotes

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.

References

1Lanser, MJ, Sussman, SA, Frazer, K. Epidemiology, pathogenesis, and genetics of acoustic tumors. Otolaryngol Clin North Am 1992;25:499–520Google Scholar
2Moffat, DA, Hardy, DG, Irving, RM, Viani, L, Beynon, GJ, Baguley, DM. Referral patterns in vestibular schwannomas. Clin Otolaryngol Allied Sci 1995;20:80–3Google Scholar
3Lin, D, Hegarty, JL, Fischbein, NJ, Jackler, RK. The prevalence of ‘incidental’ acoustic neuroma. Arch Otolaryngol Head Neck Surg 2005;131:241–4Google Scholar
4van Leeuwen, JP, Braspenning, JC, Meijer, H, Cremers, CW. Quality of life after acoustic neuroma surgery. Ann Otol Rhinol Laryngol 1996;105:423–30CrossRefGoogle ScholarPubMed
5Wiegand, DA, Fickel, V. Acoustic neuroma—the patient's perspective: subjective assessment of symptoms, diagnosis, therapy, and outcome in 541 patients. Laryngoscope 1989;99:179–87Google Scholar
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;120:144–9CrossRefGoogle Scholar
7Stangerup, SE, Caye-Thomasen, P, Tos, M, Thomsen, J. The natural history of vestibular schwannoma. Otol Neurotol 2006;27:547–52CrossRefGoogle ScholarPubMed
8Al Sanosi, A, Fagan, PA, Biggs, ND. Conservative management of acoustic neuroma. Skull Base 2006;16:95–100Google Scholar
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;33:255–9Google Scholar
10Martin, TP. Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm. Laryngoscope 2005;115:1704; author reply 1704Google Scholar
11Ferri, GG, Modugno, GC, Pirodda, A, Fioravanti, A, Calbucci, F, Ceroni, AR. Conservative management of vestibular schwannomas: an effective strategy. Laryngoscope 2008;118:951–7CrossRefGoogle ScholarPubMed
12Suryanarayanan, R, Ramsden, RT, Saeed, SR, Aggarwal, R, King, AT, Rutherford, SA et al. Vestibular schwannoma: role of conservative management. J Laryngol Otol 2010;124:251–7CrossRefGoogle ScholarPubMed
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;24:642–8Google Scholar
14Clark, JG. Uses and abuses of hearing loss classification. ASHA 1981;23:493–500Google ScholarPubMed
15Fucci, MJ, Buchman, CA, Brackmann, DE, Berliner, KI. Acoustic tumor growth: implications for treatment choices. Am J Otol 1999;20:495–9Google Scholar
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;25:682–90CrossRefGoogle ScholarPubMed
17Yoshimoto, Y. Systematic review of the natural history of vestibular schwannoma. J Neurosurg 2005;103:59–63Google Scholar
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;25:93–7Google Scholar
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;117:580–2Google Scholar
20Chaimoff, M, Nageris, BI, Sulkes, J, Spitzer, T, Kalmanowitz, M. Sudden hearing loss as a presenting symptom of acoustic neuroma. Am J Otolaryngol 1999;20:157–60Google Scholar
21Roehm, PC, Gantz, BJ. Management of acoustic neuromas in patients 65 years or older. Otol Neurotol 2007;28:708–14CrossRefGoogle ScholarPubMed
22Smouha, EE, Yoo, M, Mohr, K, Davis, RP. Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm. Laryngoscope 2005;115:450–4CrossRefGoogle ScholarPubMed
23Nikolopoulos, TP, Fortnum, H, O'Donoghue, G, Baguley, D. Acoustic neuroma growth: a systematic review of the evidence. Otol Neurotol 2010;31:478–85Google Scholar
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;112:163–7Google Scholar
25Martinez Del Pero, M, Lloyd, SK, Moffat, DA. Hearing improvement in a growing vestibular schwannoma. Skull Base 2009;19:159–62Google Scholar
26Sakamoto, T, Fukuda, S, Inuyama, Y. Hearing loss and growth rate of acoustic neuromas in follow-up observation policy. Auris Nasus Larynx 2001;28:S23–7Google Scholar
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;22:550–6Google Scholar
28Park, CK, Jung, HW, Kim, JE, Son, YJ, Paek, SH, Kim, DG. Therapeutic strategy for large vestibular schwannomas. J Neurooncol 2006;77:167–71Google Scholar
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;30:826–34CrossRefGoogle ScholarPubMed
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;113:5–14Google Scholar
31Charabi, S, Tos, M, Børgesen, SE, Thomsen, J. Cystic acoustic neuromas. Results of translabyrinthine surgery. Arch Otolaryngol Head Neck Surg 1994;120:1333–8Google Scholar
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;40:11–21; discussion 21–3Google Scholar
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;31:567–73Google Scholar
34Beenstock, M. Predicting the stability and growth of acoustic neuromas. Otol Neurotol 2002;23:542–9Google Scholar
35Mick, P, Westerberg, BD, Ngo, R, Akagami, R. Growing vestibular schwannomas: what happens next? Otol Neurotol 2009;30:101–4Google Scholar
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, 2002Google Scholar
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;29:621–7Google Scholar
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;29:505–14Google Scholar
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;34:438–46Google Scholar
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;30:629–34Google Scholar
41Mandl, ES, Meijer, OW, Slotman, BJ, Vandertop, WP, Peerdeman, SM. Stereotactic radiation therapy for large vestibular schwannomas. Radiother Oncol 2010;95:94–8CrossRefGoogle ScholarPubMed
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;543:34–7Google Scholar