Wait and Scan Management of Intra-canalicular Vestibular Schwannomas: Analysis of Growth and Hearing Outcome

Abstract

ObjectiveTo report on the results of intracanalicular vestibular schwannomas (ICVS) that were managed by wait and scan and to analyze the possible predictors of tumor growth and hearing deterioration throughout the observation period.Study DesignA retrospective case series.SettingQuaternary referral center for skull base pathologies.PatientsPatients with sporadic ICVS managed by wait and scan.InterventionSerial resonance imaging (MRI) with size measurement and serial audiological evaluation.Main Outcome MeasureTumor growth defined as 2 mm increase of maximal tumor diameter, further treatment, and hearing preservation either maintain initial modified Sanna hearing class, or maintain initial serviceable hearing (class A/B).Results339 patients were enrolled. The mean follow-up was 36.5±31.7 months with a median of 24 months. Tumor growth occurred in 141 patients (40.6%) either as slow growth (SG) in 26.3% of cases or fast growth (FG) in 15.3% of cases. Intervention was performed in only 64 cases (18.8%). Out of 271 patients who underwent hearing analysis, 86 patients (33.5%) showed hearing deterioration to a lower hearing class of the modified Sanna classification. Tumor growth and older age were predictors of hearing deterioration. Of the 125 cases with initial serviceable hearing (Class A/B), 91 cases (72.8%) maintained serviceable hearing at last follow-up. Tumor growth and a worse initial pure tone average (PTA) were predictors of hearing deterioration.ConclusionsWait and scan management of ICVS is a viable option and only 18.8% of patients needed further treatment. Hearing tends to deteriorate over time.

Patient Characteristics Impacting Adherence to Serial Observation for Vestibular Schwannomas

“…While many factors impact VS management selection, recent trends highlight the increasing prevalence of serial observation as a viable treatment modality 14 . Specifically, patients with smaller tumors and minimal symptoms may prefer this treatment modality, though hearing will tend to decline overtime 15 . Adherence to serial observation is crucial to monitor potential growth and need for change in treatment strategy.…”

“…14 Specifically, patients with smaller tumors and minimal symptoms may prefer this treatment modality, though hearing will tend to decline overtime. 15 Adherence to serial observation is crucial to monitor potential growth and need for change in treatment strategy. Identifying factors that may impact serial observation adherence in patients is thus essential.…”

Development and Validation of a Deep Learning Predictive Model Combining Clinical and Radiomic Features for Short-Term Postoperative Facial Nerve Function in Acoustic Neuroma Patients

“…Alternatively, the variability observed may be due to the subjective assessment of many features, such as the degree of adhesion determined by the neurosurgeon during operation [14] . Meanwhile, objective characteristics are limited to gauging tumor diameter with preoperative MRI [16][17] . In short, previous approaches neglect some important data, such as the intratumor features and three-dimensional information which are hard to perceive.…”

Functional Outcome After Simultaneous Vestibular Schwannoma Resection and Cochlear Implantation With Intraoperative Cochlear Nerve Monitoring

“…Nevertheless, this observational approach bears the risk of progressive loss of serviceable hearing and continuous tumor growth requiring ensuing treatment. [1][2][3] When managing VS, hearing preservation and restoration play an essential role in alleviating the main symptom experienced by patients. Hearing loss in VS, however, is not only caused by mechanical compression of the cochlear nerve (CN) but can also be induced by ototoxic secretions of VS in the form of extracellular vesicles.…”

“…VS can be treated with surgical resection or stereotactic radiation therapy; if however, the tumor is asymptomatic, small, and does not exhibit significant growth tendencies, a wait‐and‐scan approach with periodic magnetic resonance imaging (MRI) can also be considered. Nevertheless, this observational approach bears the risk of progressive loss of serviceable hearing and continuous tumor growth requiring ensuing treatment 1‐3 …”