Abstract
Objectives:
In our skull base unit, large vestibular schwannomas (VS) over 30 mm at presentation are usually offered surgery but the remainder have their growth monitored by interval imaging with treatment (surgery or stereotactic radiotherapy) being offered to patients whose tumors are growing significantly.
Methods:
A prospective database of consecutive patients diagnosed with sporadic VS and referred to the Skull Base unit in South Glasgow, United Kingdom, over the last 20 years was retrospectively reviewed. Patients with neurofibromatosis type II were excluded. Patients who consented to being managed conservatively by initial interval imaging using 6-monthly axial T1-weighted post-gadolinium magnetic resonance imaging (MRI) had the growth of their VS assessed. Growth (defined as >2mm) was the primary outcome measure. Intracanalicular tumors were compared to cerebellopontine angle (CPA) ones.
Results:
There were 62 intracanalicular (IC) tumors, mean size of 8mm, and 102 CPA VS, mean size of 11mm. One third of patients managed conservatively showed evidence of growth and 50% showed no change (IC > CPA). Twenty percent reduced in size (CPA > IC). Two-thirds of the VS showing growth stabilized or regressed over time. Audiometry was not found to be a useful tool to predict growth but interval MRI scans were. The quality of life of the VS group managed conservatively was found to be comparable across all domains of the short-form 36 (SF-36) with an age and sex match control group.
Conclusions:
All asymptomatic patients and symptomatic ones with a VS size of <30 mm should initially be offered conservative management with interval imaging.
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