Vestibular schwannoma: role of conservative management

Suryanarayanan, R.; Ramsden, R. T.; Saeed, Shakeel R; Aggarwal, Rohini; King, Andrew T.; Rutherford, Scott A.; Evans, D. Gareth; Gillespie, James

doi:10.1017/s0022215109992362

Cited by 51 publications

(38 citation statements)

References 22 publications

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“…Data from the United Kingdom also support the increase in the use of conservative management, with a paper from Manchester showing that two thirds of patients with acoustic neuromas who were managed conservatively did not undergo any further growth. 7 This and similar papers also provide new information on factors that can be used to stratify patients at increased risk of further growth, such as extracanalicular more than intracanalicular, intracranial (extracanalicular) component with diameter > 20 mm, and young age. 7,8 The introduction of GK/stereotactic radiosurgery has been met with varying degrees of enthusiasm since its introduction.…”

Section: Discussionmentioning

confidence: 89%

“…7 This and similar papers also provide new information on factors that can be used to stratify patients at increased risk of further growth, such as extracanalicular more than intracanalicular, intracranial (extracanalicular) component with diameter > 20 mm, and young age. 7,8 The introduction of GK/stereotactic radiosurgery has been met with varying degrees of enthusiasm since its introduction. Criticisms of this treatment modality identify the failure to remove disease (as its aim is to arrest growth).…”

Section: Discussionmentioning

confidence: 89%

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Trends In Acoustic Neuroma Management: A 20-Year Review of the Oxford Skull Base Clinic

2013

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Objective?To describe the change in the management of acoustic neuromas at one United Kingdom center over a 20-year period and to compare this with what is known regarding trends in practice on a national and international scale. Design, Setting, and Participants?Data was collected prospectively on all patients attending the Oxford Skull Base Clinic between 1990 and 2009. Main Outcome Measures?The proportion of patients managed initially by observation versus radiotherapy versus surgery was recorded for each year. Results?Significantly more patients received radiation treatment (instead of surgery) between 2000 and 2009 when compared with 1990 to 1999. Compared with national audit data, the Oxford Skull Base Clinic treats a higher proportion of patients with radiotherapy and significantly lower proportion with surgery, though the trend nationally is toward more observation and radiotherapy and less surgery. Conclusion?Surgery will remain crucial in the management of some patients with acoustic neuromas (usually those with the larger tumors where radiosurgery is recognized to be less appropriate), but using current trends to predict future practice would suggest that alternative nonmicrosurgical treatment may play an increasingly important role in the future.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 89%

Trends In Acoustic Neuroma Management: A 20-Year Review of the Oxford Skull Base Clinic

2013

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“…There are many studies that have followed the natural history of small VSs, but typically their patient populations have advanced age (>60 yr) compared with surgical arms, which may bias the results (7,10,37,38). These studies, however, report similar rates of hearing deterioration, which seem unrelated to age at presentation, growth pattern, or initial size of tumor.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Hearing Preservation After Microsurgical Excision of Vestibular Schwannoma

Woodson

Dempewolf²,

Gubbels³

et al. 2010

Otology &Amp; Neurotology

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Objective To examine long-term hearing outcomes after microsurgical excision of vestibular schwannoma (VS). Study Design Retrospective case review. Setting Tertiary referral center. Patients Forty-nine subjects at a single institution who had undergone microsurgical excision of a VS via middle cranial fossa (MCF) approach between 1994 and 2007 with immediate postoperative (PO) hearing preservation and for whom long-term audiograms were available. Intervention Diagnostic. Main Outcome Measures Word Recognition Score (WRS) is defined by speech discrimination scores (SDS) greater than 70% (grade I), 50% to 70% (grade II), less than 50% (grade III), and 0% (grade IV). Results For subjects with more than 2 years of follow-up, WRS I hearing was present PO in 42 of 49 patients and was preserved at the latest follow-up in 38 (90%) of 42 patients. No subjects fell beyond WRS II. WRS I hearing was maintained in 23 (88%) of 26 patients with more than 5 years of follow-up. Postoperative WRS I to II hearing was maintained in 28 (96%) of 29 patients with more than 5 years of follow-up. The patient who lost significant hearing in the ear operated on had sensorineural hearing loss that paralleled deterioration in her ear that was not operated on. Conclusion Most subjects maintain their initial PO SDS after microsurgical VS removal, and therefore, the initial PO WRS is predictive of long-term hearing. Postsurgical changes do not alter the natural rate or pattern of progressive bilateral sensorineural hearing loss in individual subjects.

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“…Actually, CI may provide new options for hearing restoration with limited morbidity in this circumstance [4,17]. For patients with VS in the only hearing ear, significant hearing deterioration on the tumor side with no evidence of tumor growth is an indication that ipsilateral CI is likely to be successful, given that nearly two-thirds of tumors, especially stable ones, do not grow [18,19]. In our series, patient 1 underwent CI on the ipsilateral side, without tumor resection.…”

Section: Discussionmentioning

confidence: 99%

Hearing Restoration for Adults with Vestibular Schwannoma in the Only Hearing Ear: Ipsilateral or Contralateral Cochlear Implantation?

Huo

Zhang²,

Huang³

et al. 2016

ORL

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Objective: To explore auditory outcomes following cochlear implantation (CI) in patients with vestibular schwannoma (VS) in the only hearing ear. Methods: Three patients, all with a long history of hearing loss on one side and with newly diagnosed VS on the other side, underwent ipsilateral or contralateral CI. Their clinical data were collected retrospectively. Postoperative hearing outcomes were measured during follow-up and compared with the preoperative test results. A thorough search of the English-language literature was performed. Results: Patients 1 and 2 underwent CI in the ipsilateral and contralateral ear, respectively, without tumor removal; patient 3 underwent CI after tumor resection. At the last follow-up, the result of pure-tone audiometry was 25, 45, and 25 dB, respectively. An open-set speech discrimination score was achieved in all 3 patients, with monosyllabic word recognition of 60, 30, and 75%, respectively. Besides the patients included in our study, 28 CI cases with VS in the only hearing ear have been reported up to now. Conclusions: In patients with VS in the only hearing ear, significant hearing deterioration with no obvious tumor growth is a good indication for ipsilateral CI. Long-term deafness in the tumor-free ear is not an absolute contraindication for CI.

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Vestibular schwannoma: role of conservative management

Cited by 51 publications

References 22 publications

Trends In Acoustic Neuroma Management: A 20-Year Review of the Oxford Skull Base Clinic

Trends In Acoustic Neuroma Management: A 20-Year Review of the Oxford Skull Base Clinic

Long-Term Hearing Preservation After Microsurgical Excision of Vestibular Schwannoma

Hearing Restoration for Adults with Vestibular Schwannoma in the Only Hearing Ear: Ipsilateral or Contralateral Cochlear Implantation?

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