RSS-Feed abonnieren
DOI: 10.1055/s-0040-1701222
Initial Observation among Patients with Vestibular Schwannoma
![](https://www.thieme-connect.de/media/jnlsb/2021S03/lookinside/thumbnails/10-1055-s-0040-1701222_190155-1.jpg)
Abstract
Introduction Vestibular schwannomas (VS) are slow growing tumors. Although there are a wide variety of available treatment options, these tumors are often initially observed. We aimed to establish the presenting symptoms and outcomes of patients treated with initial observation at our institution.
Methods The medical records of patients with radiographically diagnosed VS were reviewed from 1989 to 2018. Actuarial estimates of radiographic tumor control and freedom of local therapy were calculated and compared using Cox regression analyses.
Results A total of 360 patients were diagnosed with VS at our institution from 1989 through 2018 with a median age of 59.9 years. After radiographic diagnosis, 243 patients (67.5%) opted for initial observation. Local control at 1, 5, and 10 years was 91, 67, and 58%, respectively. On multivariable analysis, factors associated with shorter time to radiographic tumor progression included younger patient age (p = 0.016) and tumors with an extracanalicular component (p = 0.032). Regarding time until definitive treatment only larger baseline American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) tumor size predicted for earlier initiation of therapy (p < 0.001), although this was restricted to tumors with an extracanalicular component (p = 0.004), as opposed to purely internal auditory canal tumors (p = 0.839).
Conclusion Many patients who were initially observed continued to have satisfactory local control rates at 10 years. In patients with extracanalicular tumors, larger AAO-HNS tumor measurements were associated with earlier radiographic tumor progression and shorter time to local therapy, with 7 mm serving as a potential threshold value for extracanalicular tumors. Younger patients and tumors with primarily an extracanalicular portion may warrant closer observation.
Publikationsverlauf
Eingereicht: 02. Mai 2019
Angenommen: 02. Dezember 2019
Artikel online veröffentlicht:
24. Januar 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Rosahl S. Acoustic neuroma: treatment or observation?. Dtsch Arztebl Int 2009; 106 (30) 505-506
- 2 Rosenberg SI. Natural history of acoustic neuromas. Laryngoscope 2000; 110 (04) 497-508
- 3 Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg 1995; 113 (03) 179-180
- 4 Stangerup SE, Caye-Thomasen P, Tos M, Thomsen J. The natural history of vestibular schwannoma. Otol Neurotol 2006; 27 (04) 547-552
- 5 Fayad JN, Semaan MT, Lin J, Berliner KI, Brackmann DE. Conservative management of vestibular schwannoma: expectations based on the length of the observation period. Otol Neurotol 2014; 35 (07) 1258-1265
- 6 Chou KN, Tsai BH, Huang WY, Hueng DY. Morbidity in vestibular schwannoma surgery. J Neurosurg 2014; 120 (03) 785-786
- 7 Persson O, Bartek Jr J, Shalom NB, Wangerid T, Jakola AS, Förander P. Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review. Acta Neurochir (Wien) 2017; 159 (06) 1013-1021
- 8 Sughrue ME, Kane AJ, Kaur R. et al. A prospective study of hearing preservation in untreated vestibular schwannomas. J Neurosurg 2011; 114 (02) 381-385
- 9 Régis J, Carron R, Park MC. et al. Wait-and-see strategy compared with proactive Gamma Knife surgery in patients with intracanalicular vestibular schwannomas. J Neurosurg 2010; 113 (Suppl): 105-111
- 10 González-Orús Álvarez-Morujo RJ, Alvarez-Palacios I, Martin-Oviedo C, Scola-Yurrita B, Arístegui-Ruiz MA. Conservative management of vestibular schwannoma. Acta Otorrinolaringol Esp 2014; 65 (05) 275-282
- 11 Valvassori GE, Shannon M. Natural history of acoustic neuromas. Skull Base Surg 1991; 1 (03) 165-167
- 12 Al Sanosi A, Fagan PA, Biggs ND. Conservative management of acoustic neuroma. Skull Base 2006; 16 (02) 95-100
- 13 Selesnick SH, Johnson G. Radiologic surveillance of acoustic neuromas. Am J Otol 1998; 19 (06) 846-849
- 14 Deberge S, Meyer A, Le Pabic E, Peigne L, Morandi X, Godey B. Quality of life in the management of small vestibular schwannomas: observation, radiotherapy and microsurgery. Clin Otolaryngol 2018; 43 (06) 1478-1486
- 15 Hirvonen T, Pyykkö I, Juhola M, Aalto H. High frequency deficit of the vestibular system after acoustic neurinoma surgery. Acta Otolaryngol Suppl 1995; 520 (Pt 1): 16-18
- 16 Hunter JB, Dowling EM, Lohse CM. et al. Hearing outcomes in conservatively managed vestibular schwannoma patients with serviceable hearing. Otol Neurotol 2018; 39 (08) e704-e711
- 17 Prasad SC, Patnaik U, Grinblat G. et al. Decision making in the wait-and-scan approach for vestibular schwannomas: is there a price to pay in terms of hearing, facial nerve, and overall outcomes?. Neurosurgery 2018; 83 (05) 858-870
- 18 Lees KA, Tombers NM, Link MJ. et al. Natural history of sporadic vestibular schwannoma: a volumetric study of tumor growth. Otolaryngol Head Neck Surg 2018; 159 (03) 535-542