An Update on Epidemiology and Management Trends of Vestibular Schwannomas

Abstract

Objective: To determine the current epidemiology and management trends for patients with vestibular schwannomas (VS). Study Design: Retrospective cohort study. Setting: The Surveillance, Epidemiology, and End Results (SEER) tumor registry. Patients: The SEER database was queried to identify patients diagnosed with VS from 1973 to 2015. Demographics, patient and tumor characteristics, and treatment methods were analyzed. Results: A total of 14,507 patients with VS were identified. The mean age at diagnosis was 55 ± 14.9 years. Age-adjusted incidence from 2006 to 2015 was 1.4 per 100,000 per year and remained relatively stable. Incidence across age varied with sex, as younger women and older men had increased incidences comparatively. A higher percentage of patients underwent surgery alone (43%), followed by observation (32%), radiation alone (23%), and combined radiation and surgery (2%). Age 65 and older was associated with observation (odds ratio [OR] 1.417; p = 0.029) whereas age 20 to 39 and 40 to 49 were associated with surgery (OR 2.013 and 1.935; p < 0.001). Older age was associated with radiation. Larger tumor size was associated with surgery and combined treatment. African American patients and American Indian or Alaskan Native patients were more likely to undergo observation than surgery. Conclusions: The overall incidence of VS is 1.4 per 100,000 per year and has remained relatively stable. There is a trend toward more conservative management with observation, which may be secondary to earlier diagnosis given widespread use of magnetic resonance imaging. Further studies are necessary to investigate differences in disease patterns and disparities in management.

Potential Molecular Biomarkers of Vestibular Schwannoma Growth: Progress and Prospects

“…The goal of VS treatment has shifted from saving lives towards functional preservation, with multifaceted decision including watch-wait-rescan protocol, surgical resection and radiation ( 4 , 5 ). However, surgery can be traumatic ( 6 ), while radiotherapy has a low hearing retention rate and can affect neurological function even after many years ( 7 ).…”

“…A study showed that conservative management in small‐ to medium‐sized VS (less than 2cm) can improve rates of facial nerve preservation and hearing protection in comparison to patients who undergo primary surgical treatment ( 10 ). Therefore, for stable or involuting tumors with no mass effect, or elderly patients who will suffer higher risk of comorbidities, the continuing trend toward observation with regular follow-up imaging is reasonable ( 5 , 11 ).…”

Single Fraction Stereotactic Radiosurgery (SRS) versus Fractionated Stereotactic Radiotherapy (FSRT) for Vestibular Schwannoma (VS)

“…Vestibular schwannoma (VS), formerly referred to as acoustic neuroma, is one of the common benign intracranial tumors with rising incidence due to improved and more frequent neuroimaging [1][2][3]. These common tumors of the cerebellopontine angle arise from the Schwann cells of vestibulocochlear nerve, and management with main therapeutic modalities of surgery and radiation therapy (RT) may be considered while observation is also an option for selected patients [4][5][6][7][8]. Several studies have also addressed multimodality management of VS to improve the toxicity profi le of treatment [9][10][11].…”

Radiosurgery in Comparison with Surgery for Treatment of Neurofibromatosis Type 2 (NF-2) Associated Acoustic Neuroma (AN)

“…Acoustic neuroma (AN), also known as acoustic neurinoma or vestibular schwannoma is a primary intracranial tumor derived from Schwann cells of the myelin sheath surrounding the 8th cranial nerve which may be observed or treated by surgery, radiosurgery, or with a combined modality approach depending on individual patient and tumor characteristics [1][2][3][4][5]. The incidence of these benign and typically slow growing tumors is in an increasing trend given the substantial improvements in neuroimaging techniques and aging of the population [6][7][8].…”

“…The incidence of these benign and typically slow growing tumors is in an increasing trend given the substantial improvements in neuroimaging techniques and aging of the population [6][7][8]. Despite the indolent disease course in an overwhelming majority of patients, symptomatology may include hearing impairment, tinnitus, vertigo, dizziness, headache, incoordination or instability, gait ataxia, cranial nerve symptoms due to involvement of facial and trigeminal nerves, facial dysesthesia or spasms, dysphagia, dysarthria, cerebellar seizures, symptoms of increased intracranial pressure and respiratory distress in some of the affected patients [1][2][3][4][5]. AN is typically located in the internal auricular canal or at the cerebellopontine angle in the vicinity of critical neurovascular structures, and compression Copyright@ Omer Sager | Biomed J Sci & Tech Res | BJSTR.…”