Determinants of Vestibular Schwannoma Growth

Abstract

Objective: Management of vestibular schwannomas (VS) involves surgery, radiotherapy, or surveillance, based on patient and tumor factors. We recently described conditional probability as a more accurate method for stratifying VS growth risk. Building on this, we now describe determinants of VS growth, allowing clinicians to move toward a more personalized approach to growth-risk profiling. Methods: Retrospective analysis of a prospectively collected database in a tertiary referral skull base unit between 2005 and 2014. Inclusion of patients with unilateral VS managed on surveillance protocol for a minimum of 5 years. Analysis of patient age, sex, tumor location, tumor size, and symptomology using conditional probability. Results: A total of 340 patients met inclusion criteria. The conditional probability of growth of extracanalicular VS was significantly higher versus intracanalicular (IC) VS (30% versus 13%, p < 0.001) as was small-sized VS versus IC VS (28 versus 13%, p ¼ 0.002), but only in the first year after diagnosis. Sex, age, and presenting symptoms did not significantly affect VS growth. Conclusion: In our series, extracanalicular VS were more likely to grow than IC VS and small-sized VS more likely to grow than IC VS, but only in the first year after diagnosis. Conversely, sex, age, and presenting symptoms did not affect the conditional probability of VS growth.

Evidence-based surveillance protocol for vestibular schwannomas: a long-term analysis of tumor growth using conditional probability

“…We found no significant difference in growth risk between IC and EC VSs from 6 to 10 years. This finding is in keeping with previous data showing that the EC VS is more likely to grow only in the first year of surveillance, but that after this, the growth risk becomes comparable to that of IC VS. 15 There is no consensus on the most appropriate timeline and duration of surveillance imaging for VS patients managed under a surveillance protocol. This uncertainty results from a lack of available evidence specifically addressing this matter.…”

Single-cell sequencing reveals the cell map and transcriptional network of sporadic vestibular schwannoma

“…VS is a histologically benign tumor, it is characterized by slow growth with a low probability of metastasis or malignant transformation, but its growth pattern can vary greatly depending on characteristics such as tumor size ( Samii et al, 2017 ; Sethi et al, 2021 ). It can lead to brain stem compression and even death if the tumor continues to grow.…”