Non-surgical management of acoustic neuromas

Anand, Vanika; Kerr, A. G.; Byrnes, D. P.; Smyth, G. D. L.

doi:10.1111/j.1365-2273.1992.tb01683.x

Cited by 24 publications

(15 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…natural history) of vestibular schwannomas (Table 1). 12–14,19,23,28–38,40,42,44–51 The results of these studies share many similarities with this report. The mean age of patients in these studies was 63.4 years and there was a female : male preponderance of 1.5 : 1 (Table 1).…”

Section: Discussionsupporting

confidence: 83%

The role of conservative management of vestibular schwannomas

Walsh¹,

Bath²,

Bance³

et al. 2000

Clin Otolaryngol

View full text Add to dashboard Cite

Although microsurgery is generally regarded as the conventional treatment of choice for most vestibular schwannomas, there remains a group of patients in whom a conservative management approach may be a desirable alternative. The aim of this study was to determine the natural history and outcome following the conservative management of 72 patients with unilateral vestibular schwannomas. The reasons for conservative management included poor general health, age, patient preference, small tumour size, minimal or no symptoms, and tumour in the only/better hearing ear. The mean duration of follow-up was 39.8 months (range 12-194 months). All patients underwent serial magnetic resonance imaging (MRI) for assessment of tumour growth. Patients were deemed to have failed conservative management if there was evidence of continuous or rapid radiological tumour growth and/or increasing symptoms or signs. The mean tumour growth rate, according to the 1995 guidelines of the American Academy of Otolaryngology/Head and Neck Surgery, was 1.16 mm/year (range: 0.75 9.65 mm/year). Approximately 83% of tumours grew at < 2 mm/year. Significant tumour growth was seen in 36.4%, no or insignificant growth in 50%, and negative growth in 13.6% of tumours. The growth rate of CPA tumours (1.4 mm/year) was significantly greater than that of IAC tumours (0.2 mm/year) (P = 0.001). Failure of conservative management, in which active treatment was required, occurred in 15.3%. The outcome of these patients appeared to be as favourable to a comparable group who underwent primary treatment, without a period of conservative management. The mean growth rate of tumours in patients who failed conservative management (4.2 mm/year) was significantly greater than that in patients who did not fail (0.5 mm/year) (P < 0.01). No factors predictive of tumour growth or failure of conservative management were identified. Deterioration of mean pure tone average (0.5, 1, 2, 3 kHz) and speech discrimination scores occurred regardless of whether radiological tumour growth was demonstrated or not. This study suggests that in a select number of cases of vestibular schwannoma, a conservative management approach may be appropriate. Regular follow-up with serial MRI is mandatory. Deterioration of auditory function occurs even in the absence of tumour growth.

show abstract

Section: Discussionsupporting

confidence: 83%

The role of conservative management of vestibular schwannomas

Walsh¹,

Bath²,

Bance³

et al. 2000

Clin Otolaryngol

View full text Add to dashboard Cite

show abstract

“…The average length of follow‐up for all the studies was 3.2 years, ranging from 2.2 to 5 years. Despite the fact that several authors had published multiple updated studies on conservative management, only one study was identified with greater than 5 years of average follow‐up, 1 and only four studies had greater than 4 years of average follow‐up 1,3,13,16 . The actual length of follow‐up for individual patients ranged from 0.1 to 18.0 years.…”

Section: Resultsmentioning

confidence: 99%

“…Despite the fact that several authors had published multiple updated studies on conservative management, only one study was identified with greater than 5 years of average follow-up, 1 and only four studies had greater than 4 years of average follow-up. 1,3,13,16 The actual length of follow-up for individual patients ranged from 0.1 to 18.0 years. The average age of the patients in these studies was 62, revealing a tendency to recommend conservative management to older patients.…”

Section: Resultsmentioning

confidence: 99%

Conservative Management of Acoustic Neuroma: A Meta-Analysis and Proposed Treatment Algorithm

et al. 2005

View full text Add to dashboard Cite

Our meta-analysis supports the role of conservative management of acoustic neuromas in properly selected patients on the basis of a slow overall rate of growth and a substantial incidence of no growth. However, the lack of predictive factors, the relatively short duration of follow-up, and the variability of inclusion criteria underscore the need for continued collection of long-term data. An algorithm for acoustic neuroma management is proposed based on initial tumor size, patient age, and hearing status.

show abstract

“…Tumor growth was evaluated on serial MR imaging in 12 studies, 8,15,17,20,23,24,26,32,35,37,38,40 on CT or MR imaging in the other 14. 1,2,4,5,7,9,14,16,18,19,22,25,30,33 The mean age of patients was 62 years (range 52-75 years). Information regarding initial tumor size was available in 22 studies (1163 patients).…”

Section: Characteristics Of Studies Patients and Tumorsmentioning

confidence: 99%