Conservative versus Primary Surgical Treatment of Acoustic Neuromas: A Comparison of Rates of Facial Nerve and Hearing Preservation

Martín, Timothy; Tzifa, Konstance; Kowalski, Caroline; Holder, Roger; Walsh, Richard; Irving, Richard

doi:10.1055/s-2008-1093123

Cited by 13 publications

(16 citation statements)

References 14 publications

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“…Such screening options included hearing tests, which were reported to be equivocal between lesions that grew and those that did not. 9,17,31 Interestingly, in line with the findings of Nikolopoulos et al, 22 Martin and colleagues 16 also suggested that cystic tumors should be followed more closely, as they represented a disproportionate percentage of the tumors that grew, especially in cases in which a solid tumor converted into a cystic one.…”

supporting

confidence: 64%

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

Schmidt¹,

Boghani²,

Choudhry³

et al. 2012

FOC

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With the relatively recent increase in the use of MRI techniques, there has been a concurrent rise in the number of vestibular schwannomas (VSs) detected as incidental findings. These incidental VSs may be prevalent in up to 0.02%–0.07% of individuals undergoing MRI and represent a significant portion of all diagnosed VSs. The management of these lesions poses a significant challenge for practitioners. Most incidental VSs tend to be small and associated with minimal symptoms, permitting them to be managed conservatively at the time of diagnosis. However, relatively few indicators consistently predict tumor growth and patient outcomes. Furthermore, growth rates have been shown to vary significantly over time with a large variety of long-term growth patterns. Thus, early MRI screening for continued tumor growth followed by repeated MRI studies and clinical assessments throughout the patient's life is an essential component in a conservative management strategy. Note that tumor growth is typically associated with a worsening of symptoms in patients who undergo conservative management, and many of these symptoms have been shown to significantly impact the patient's quality of life. Specific indications for the termination of conservative management vary across studies, but secondary intervention has been shown to be a relatively safe option in most patients with progressive disease. Patients with incidental VSs will probably qualify for a course of conservative management at diagnosis, and regular imaging combined with the expectation that the tumor and symptoms may change at any interval is crucial to ensuring positive long-term outcomes in these patients. In this report, the authors discuss the current literature pertaining to the prevalence of incidental VSs and various considerations in the management of these lesions. It is hoped that by incorporating an understanding of tumor growth, patient outcomes, and management strategies, practitioners will be able to effectively address this challenging disease entity.

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supporting

confidence: 64%

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

Schmidt¹,

Boghani²,

Choudhry³

et al. 2012

FOC

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“…15 Further, Martin and colleagues' 'intention to treat' analysis showed that conservative management of vestibular schwannomas with an intracranial size of up to 20 mm was safe and yielded significantly better preservation of facial nerve function and hearing, compared with surgical management. 16 Intracanalicular tumours do not exhibit significant growth, compared with tumours with extension into the cerebellopontine angle. 17 We found a significantly higher probability of growth in vestibular schwannomas with an intracranial size of more than 15 mm, in both the sporadic and NF2 groups.…”

Section: Discussionmentioning

confidence: 99%

Vestibular schwannoma: role of conservative management

et al. 2009

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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.

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“…At the Queen Elizabeth Hospital (QEH) in Birmingham, UK, 90% of diagnosed small‐to‐medium‐sized vestibular schwannomas are initially managed conservatively; in other jurisdictions (in particular the United States of America), the practice is less widespread, with only 25% of tumours treated in this manner . Employing an intention‐to‐treat analysis, conservative management has been demonstrated to offer a safe management option for tumours <2 cm in diameter with lower rates of morbidity (facial nerve injury, hearing loss) than when surgery is offered as a primary treatment option . In this article, we develop an economic decision‐analytic model to determine whether initial conservative management of tumours of this size also represents the most cost‐effective strategy when compared to primary surgery or radiosurgery.…”

mentioning

confidence: 99%

“…6 Employing an intention-to-treat analysis, conservative management has been demonstrated to offer a safe management option for tumours <2 cm in diameter with lower rates of morbidity (facial nerve injury, hearing loss) than when surgery is offered as a primary treatment option. 7 In this article, we develop an economic decision-analytic model to determine whether initial conservative management of tumours of this size also represents the most cost-effective strategy when compared to primary surgery or radiosurgery.…”

mentioning

confidence: 99%

Conservative management, surgery and radiosurgery for treatment of vestibular schwannomas: a model‐based approach to cost‐effectiveness

Gait

Frew

Martín

et al. 2014

Clinical Otolaryngology

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Conservative versus Primary Surgical Treatment of Acoustic Neuromas: A Comparison of Rates of Facial Nerve and Hearing Preservation

Cited by 13 publications

References 14 publications

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

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

Vestibular schwannoma: role of conservative management

Conservative management, surgery and radiosurgery for treatment of vestibular schwannomas: a model‐based approach to cost‐effectiveness

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