An update on unilateral sporadic small vestibular schwannoma

Abstract

<jats:p>Advances in neuroimaging have increased the detection rate of small vestibular schwannomas (VSs, maximum diameter &lt; 25 mm). Current management modalities include observation with serial imaging, stereotactic radiosurgery, and microsurgical resection. Selecting one approach over another invites speculation, and no standard management consensus has been established. Moreover, there is a distinct clinical heterogeneity among patients harboring small VSs, making standardization of management difficult. The aim of this article is to guide treating physicians toward the most plausible therapeutic option based on etiopathogenesis and the highest level of existing evidence specific to the different cohorts of hypothetical case scenarios.</jats:p> <jats:p>Hypothetical cases were created to represent 5 commonly encountered scenarios involving patients with sporadic unilateral small VSs, and the literature was reviewed with a focus on small VS. The authors extrapolated from the data to the hypothetical case scenarios, and based on the level of evidence, they discuss the most suitable patient-specific treatment strategies. They conclude that observation and imaging, stereotactic radiosurgery, and microsurgery are all important components of the management strategy. Each has unique advantages and disadvantages best suited to certain clinical scenarios. The treatment of small VS should always be tailored to the clinical, personal, and social requirements of an individual patient, and a rigid treatment protocol is not practical.</jats:p>

Expanded transcanal transpromontorial approach to the internal auditory canal and cerebellopontine angle: a cadaveric study

“…Since management of intracanalicular vestibular schwannomas (VSs) is complex and strongly debated 12 , this kind of therapeutic option in appropriate and selected cases could modify classic concepts of the management of this pathology, even expanding the indications of EndoTTA, which at present are limited to small vestibular schwannomas of the IAC.…”

Nonsteroidal anti-inflammatory medications are cytostatic against human vestibular schwannomas

“…Stereotactic radiotherapy entails delivering a radiation dose to the tumor and can be associated with severe side effects such as further exacerbation of the sensorineural hearing loss, vestibular dysfunction and potential malignant transformation of the tumor (5, 6). Patients with non-growing or asymptomatic VSs can undergo conservative management and follow tumor progression through serial magnetic resonance imaging (MRI), but due to the lack of biomarkers for VS growth and associated symptoms, conservative monitoring can be a risky approach (7). Effective drug therapies that can limit VS growth would greatly advance health care for VS patients.…”

Medial acoustic neuromas: clinical and surgical implications

“…7,23 Cystic acoustic neuromas are reported to have faster growth rates, lower total resection rates, and poorer surgical out come, 29,40 most notably, with respect to facial nerve function. 7,27,33,36 This may be due to vulnerability of the splayed facial nerve separated from dissection by the thin peripherally located cyst capsule. 23 Cystic tumors have been speculated to arise from focal degeneration of tumor cells, recurrent intratumoral microhemorrhages, or coalescence of microcysts.…”