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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: drsury@gmail.com
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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

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