Vestibular Schwannoma Growth: The Continuing Controversy

Charabi, Samih; Tos, Mirko; Thomsen, Jens; Charabi, Birgitte; Mantoni, Margit

doi:10.1097/00005537-200010000-00030

Cited by 50 publications

(42 citation statements)

References 26 publications

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“…15,35 When it comes to volumetric versus diametric measurements of tumor, while some authors have stressed that volumetric determination is a reliable measure of tumor size and minimizes the risk of error due to partial volume effects, 19,35 other investigators have found no differences in growth results between measurements of tumor volume and tumor diameter. 11 Volumetric determination also requires expertise and an imaging technique that may not be available at all centers.…”

Section: Terminology Of Incomplete Resections and Algorithmmentioning

confidence: 99%

The behavior of residual tumors and facial nerve outcomes after incomplete excision of vestibular schwannomas

Chen

Prasad²,

Lella³

et al. 2014

JNS

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Object The authors evaluated the behavior of residual tumors and facial nerve outcomes after incomplete excision of vestibular schwannomas (VSs). Methods The case records of all patients who underwent surgical treatment of VSs were analyzed. All patients in whom an incomplete excision had been performed were analyzed. Incomplete excision was defined as near-total resection (NTR), subtotal resection (STR), and partial resection (PR). Tumors in the NTR and STR categories were followed up with a wait-and-rescan approach, whereas the tumors in the PR category were subjected to a second-stage surgery and were excluded from this series. All patients included in the study underwent baseline MRI at the 3rd and 12th postoperative months, and repeat imaging was subsequently performed every year for 7–10 years postoperatively or as indicated clinically. Preoperative and postoperative facial function was noted. Results Of the 2368 patients who underwent surgery for VS, 111 patients who had incomplete excisions of VSs were included in the study. Of these patients, 73 (65.77%) had undergone NTR and 38 (34.23%) had undergone STR. Of the VSs, 62 (55.86%) were cystic and 44 (70.97%) of these cystic VSs underwent NTR. The residual tumor was left behind on the facial nerve alone in 62 patients (55.86%), on the facial nerve and vessels in 2 patients (1.80%), on the facial nerve and brainstem in 15 patients (13.51%), and on the brainstem alone in 25 patients (22.52%). In the 105 patients with normal preoperative facial nerve function, postoperative facial nerve function was House-Brackmann (HB) Grades I and II in 51 patients (48.57%), HB Grade III in 34 patients (32.38%), and HB Grades IV–VI in 20 patients (19.05%). Seven patients (6.3%) showed evidence of tumor regrowth on follow-up MRI. All 7 patients (100%) who showed evidence of tumor regrowth had undergone STR. No patient in the NTR group exhibited regrowth. The Kaplan-Meier plot demonstrated a 5-year tumor regrowth-free survival of 92%, with a mean disease-free interval of 140 months (95% CI 127–151 months). The follow-up period ranged from 12 to 156 months (mean 45.4 months). Conclusions The authors' report and review of the literature show that there is undoubtedly merit for NTR and STR for preservation of the facial nerve. On the basis of this they propose an algorithm for the management of incomplete VS excisions. Patients who undergo incomplete excisions must be subjected to follow-up MRI for a period of at least 7–10 years. When compared with STR, NTR via an enlarged translabyrinthine approach has shown to have a lower rate of regrowth of residual tumor, while having almost the same result in terms of facial nerve function.

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Section: Terminology Of Incomplete Resections and Algorithmmentioning

confidence: 99%

The behavior of residual tumors and facial nerve outcomes after incomplete excision of vestibular schwannomas

Chen

Prasad²,

Lella³

et al. 2014

JNS

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“…They commonly occur on the vestibular branch of the eighth cranial nerve but can arise anywhere in the periphery. Vestibular schwannomas (VS) account for up to 8% of all intracranial tumors [1] . About 95% of VS occur sporadically and unilaterally, while about 5% occur as part of the inherited disorder neurofibromatosis type 2 (NF2), an autosomal-dominant disorder with an incidence of approximately 1 in 33,000-40,000 individuals [2] .…”

Section: Introductionmentioning

confidence: 99%

Lack of Neurofibromatosis Type 2 Gene Promoter Methylation in Sporadic Vestibular Schwannomas

Koutsimpelas¹,

Ruerup²,

Mann³

et al. 2012

ORL

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Background: Vestibular schwannomas (VS) are benign tumors of the nervous system that are usually sporadic but also occur in the inherited disorder neurofibromatosis type 2 (NF2). In VS, losses of chromosomal material and mutations of the NF2 gene have been established to be causative. For a subset of VS without detectable gene alterations, promoter inactivation by hypermethylation has been suggested. However, published data are very limited and contradictory. Methods: We analyzed NF2 gene promoter methylation in 35 sporadic VS by methylation-specific PCR. Results: Twenty-three of the tumors were informative, showing no promoter methylation. In the remaining 12 tumors, promoter methylation could neither be verified nor excluded. Conclusions: Our study suggests that NF2 gene inactivation by promoter hypermethylation is a rare or very uncommon mechanism of NF2 gene inactivation in sporadic VS. Other mechanisms destabilizing the NF2 gene product, yet to be identified, might play a role in the genesis of VS apart from the loss or mutation of the NF2 gene.

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“…In case of a solid VS a wait-and-scan-policy is often appropriate because these tumors in general show no growth or have a slow growth pattern, varying between 0.9 and 1.9 mm in maximal diameter per year [1][2][3][4]. Moreover, several studies on the growth rate of VSs, have shown besides stability even regression during conservative management [1,[5][6][7][8][9][10]. In contrast, part of the solid VSs is able to present with relatively rapid growth, which eventually might result in serious morbidity and even mortality if left untreated.…”

Section: Introductionmentioning

confidence: 99%

Predictors of future growth of sporadic vestibular schwannomas obtained by history and radiologic assessment of the tumor

Artz

Timmer

Mulder

et al. 2008

Eur Arch Otorhinolaryngol

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Management of a sporadic vestibular schwannoma (VS) is still a subject of controversy, mainly due to distinct and unpredictable growth patterns. To embark on an appropriate therapy it is necessary to dispose of a reliable prediction about tumor progression. This study aims to design a risk proWle with predictors for VS growth. A total of 234 VS patients who were managed conservatively were included. Data concerning (duration of) symptoms and localization of VS were analyzed with Cox proportional hazards regression models. Predictors for growth are unsteadiness/vertigo, no sudden onset of hearing loss and short duration of hearing loss. High-risk patients have (1) VS with an extrameatal localization, short duration of hearing loss and at least one of the two other predictors (unsteadiness/vertigo or no sudden sensorineural hearing loss) or (2) VS with an intrameatal localization and all three other predictors. Low-risk patients have (1) VS with an extrameatal component and no other predictor or (2) VS with an intrameatal localization and at most one other predictor. High-risk patients have a risk of growth of 36.9% in the Wrst year and 64.6% in the second year. For patients with a low risk this is 2.5 and 12.7%, respectively. Simple data gathered at the moment of diagnosis may provide useful information since they may lead to a risk proWle for growth.

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Vestibular Schwannoma Growth: The Continuing Controversy

Abstract: Combined with other factors, the achieved results should be considered when timing of surgery is to be decided.

Cited by 50 publications

References 26 publications

The behavior of residual tumors and facial nerve outcomes after incomplete excision of vestibular schwannomas

The behavior of residual tumors and facial nerve outcomes after incomplete excision of vestibular schwannomas

Lack of Neurofibromatosis Type 2 Gene Promoter Methylation in Sporadic Vestibular Schwannomas

Predictors of future growth of sporadic vestibular schwannomas obtained by history and radiologic assessment of the tumor

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