A comparison of growth rates of acoustic neuromas: Nonsurgical patients vs. subtotal resection

Abstract

A conservative approach to the management of acoustic neuromas in elderly patients has been used since 1971. Elderly patients without symptoms of brain stem compression are initially treated by observation and yearly radiographic imaging. A translabyrinthine radical-subtotal resection is performed if brain stem compression is present or if tumor is growing rapidly. Twenty-three patients, ages 65 to 86 years, had initial nonsurgical management of their tumors. Growth rates could be determined for 16 patients. Thirteen patients not requiring surgery had an average tumor growth rate of 0.6 mm/yr. Three patients with an average growth rate of 6.8 mm/yr eventually required surgery. No patient whose tumor was < 15 mm at initial evaluation has experienced brain stem symptoms or demonstrated rapid tumor growth. Twenty-four patients ages 65 to 86 years underwent planned subtotal tumor excision. Eighteen patients followed postoperatively for more than 1 year demonstrated an average rate of regrowth of tumor of 0.7 mm/yr.

Surgical management of vestibular schwannoma in elderly patients

“…Partial removal did not show significant increase in the rate of tumor growth postoperatively, as stated by Rosenberg et al [11] and shown by our published results [9]. Facial nerve preservation in most elderly patients is a challenging task due to their tendency of having atherosclerotic process in feeding vessels leading to low blood perfusion to the affected area, and decreasing tissue regeneration ability.…”

“…On the other hand, the risks of operating on elderly patients with short life expectancy should be taken in account, and also the effect of complications on the life quality of these patients with low functional capacity should be borne in mind. Balancing the above two opinions may lead to a higher tendency for watchful observation as these tumors have slow growth rate (\0.2 cm/year) in more than 80% of cases [2,11], making this choice safe and cost effective for asymptomatic patients. One of the drawbacks of this conservative management is the psychological impact on observed patients, as leaving a growing tumor inside skull without intervention will put some patients in continuous stress, affecting their quality of life; on the other extreme, other patients may have a false impression that no intervention means unimportant disease, thus leading to loss of follow-up as documented in some studies [12,13].…”

“…Subtotal removal was planned to decrease the duration of the surgical procedure with preservation of the maximum possible facial nerve function and reduce the Table 4 Comparison between frequency of complication after surgical intervention for acoustic neuroma in our series of elderly patients and patients younger than 65 years with other articles of elderly patients' results [ 2,[10][11][12][13][14][15][16][17][18][19][20] Complication…”

Incidental vestibular schwannomas: a review of prevalence, growth rate, and management challenges

“…5,24 The same was true when initial tumor size was used to predict growth, that is, with contradictory evidence suggested across studies. 7,18,22,23,25 However, Nikolopoulos and colleagues did assert that cystic tumors tend to have a higher growth rate (approximately 3.7 mm/year) as compared with solid tumors. Regardless, no other consistent indicators of growth were revealed across the multiple studies: not age, initial lesion size, duration of symptoms, tumor laterality, or patient sex.…”

Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results

“…Serial neuroradiological imaging has been the subject of several publications concerning VS growth in patients who were not operated on at the time of diagnosis [1,5,14,17,19,20,24,28,29,31]. The number of tumors investigated in these studies have varied from 4 [28] to 98 [19].…”