Diagnostik und Therapie des Vestibularisschwannoms – eine interdisziplinäre Herausforderung

Abstract

Vestibular schwannomas expand slowly in the internal auditory canal, in the cerebellopontine angle, inside the cochlear and the labyrinth. Larger tumors can displace and compress the brainstem. With an annual incidence of 1:100 000 vestibular schwannoma represent 6-7% of all intracranial tumors. In the cerebellopontine angle they are by far the most neoplasm with 90% of all lesions located in this region. Magnetic resonance imaging (MRI), audiometry, and vestibular diagnostics are the mainstays of the clinical workup for patients harboring tumors. The first part of this paper delivers an overview of tumor stages, the most common grading scales for facial nerve function and hearing as well as a short introduction to the examination of vestibular function.Upholding or improving quality of life is the central concern in counseling and treating a patient with vestibular schwannoma. Preservation of neuronal function is essential and the management options - watchful waiting, microsurgery and stereotactic radiation - should be custom-tailored to the individual situation of the patient. Continuing interdisciplinary exchange is important to monitor treatment quality and to improve treatment results. Recently, several manuscripts and reviews have been published on the topic of vestibular schwanomma. On the occasion of the 88 annual meeting of the German Society of Oto-rhino-laryngology, Head and Neck surgery a special volume of the journal "HNO" will be printed. Hence this presentation has been designed to deviate from the traditional standard which commonly consists of a pure literature review. The current paper was conceptually woven around a series of interdisciplinary cases which outlines examples for every stage of the disease that show characteristic results for management options to date. Systematic clinical decision pathways have been deduced from our experience and from results reported in the literature. These pathways are graphically outlined after the case presentations. Important criteria for decision making are size and growth rate of the tumor, hearing of the patient and the probability of total tumor resection with preservation of hearing and facial nerve function, age and co-morbidity of the patient, best possible control of vertigo and tinnitus and last but not least the patient's preference and choice. In addition to this, the experience and the results of a given center with each treatment modality will figure in the decision making process.We will discuss findings that are reported in the literature regarding facial nerve function, hearing, vertigo, tinnitus, and headache and reflect on recent studies on their influence on the patient's quality of life. Vertigo plays an essential role in this framework since it is an independent predictor of quality of life and a patient's dependence on social welfare.Pathognomonic bilateral vestibular schwannoma that occur in patients suffering from neurofibromatosis typ-2 (NF2) differ from spontaneous unilateral tumors in their biologic behavior. Treatment of neurof...

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“…VS, also known as acoustic schwannoma, originates from the myelin-forming Schwann cells that surround the vestibular branches of the eighth (auditory) cranial nerve ( 70 ). VS accounts for 6-7% of all intracranial tumors, 90% of which are located in the cerebellopontine angle ( 71 ). Yang et al ( 46 ) demonstrated the anticancer effect of AIL in human VS cells.…”

The Patient-Centered Approach: A Review of the Literature and Its Application for Acoustic Neuromas

“…ANs, also known as vestibular schwannomas, are most typically benign, slow-growing tumors, accounting for approximately 6 to 7% of all intracranial tumors and as the most frequent lesions to occur in the cerebellopontine angle. 19 Although these tumors can be found in all patients regardless of age and gender, they are most commonly diagnosed between the third and fifth decades of life, and the annual incidence rate affects approximately 1 in every 100,000 persons. 20 Despite their benign histology and growth rate, these tumors may cause considerable symptoms for patients, given their critical location along the skull base and abutting the brain stem.…”

“…Although there are no established guidelines to dictate surgery versus radiation, microsurgery is usually considered in symptomatic patients, favored in those who are relatively younger (<70 years of age) and/or with larger tumors (>2.5 cm). 19 Likewise, patient medical comorbidities play an important role in deciding treatment. Despite general guidelines for observation versus treatment in ANs, 21 practice patterns continue to vary widely throughout the country and the optimal management of these tumors continues to be an ongoing focus of debate, 19,21 outside the scope of this article.…”

“…19 Likewise, patient medical comorbidities play an important role in deciding treatment. Despite general guidelines for observation versus treatment in ANs, 21 practice patterns continue to vary widely throughout the country and the optimal management of these tumors continues to be an ongoing focus of debate, 19,21 outside the scope of this article. This again underscores that while recommendations for certain patients and their tumors may clearly favor surgery or radiation, many others fall in between where either modality can be used safely and effectively (►Fig.…”

Management des Vestibularisschwannoms

“…Eine Fazialisparese ist trotz der engen Beziehung der beiden Nerven zueinander eher selten [11]. Zephalgien sind eher untergeordnet (11 %).…”