Conservative Treatment of Vestibular Schwannomas: A Follow-Up Study on Clinical Outcomes

Objective: The aim of this study was to determine the natural history and clinical outcome following conservative management of patients with unilateral vestibular schwannomas.

Study Design: A retrospective study conducted in a university-based tertiary referral center.

Patients: Between 1992 and 2011, 762 patients with vestibular schwannomas were recruited from the Neurotology and Skull Base Multidisciplinary Clinic at Beaumont Hospital; 44% (n = 422) of these were included in our serial scanning protocol using magnetic resonance imaging (MRI). Patients were deemed to have failed conservative management if there was evidence of radiological tumor growth on serial scans (> 2mm/year or > 2 mm between the first and last scans).

Results: Conservative management failed in 20% (n = 84); 80% (n = 67) of these were referred for stereotactic radiosurgery (SRS), and 20% (n = 17) underwent microsurgery. Patients with cerebellopontine angle vestibular schwannomas were more likely to fail conservative management than patients with intracanalicular tumors.

Conclusion: Conservative management of small to medium sized vestibular schwannomas may be regarded as a reasonable management option as most of these do not demonstrate significant radiological growth. However, regular follow-up with serial MRI is essential.