Conservative management of vestibular schwannomas: an effective strategy.
OBJECTIVE
Stimulated by the availability of a larger sample of patients and a longer follow-up period, we update our experience with conservative management of vestibular schwannomas.


METHODS
Patients with intracanalicular and small/medium-sized tumors have been followed prospectively at a tertiary referral center.


METHODS
One hundred twenty-three patients affected by sporadic vestibular schwannoma were primarily observed by means of magnetic resonance imaging scans. In case of significant tumor growth (> or =2 mm), patients were either surgically treated or submitted to radiotherapy, but, not rarely, they continued to follow the "wait-and-scan" policy. Tumor-size changes over time were also evaluated with hearing function. Statistical analysis with predictive growth factors was performed.


RESULTS
Almost two thirds (64.5%) of the cases did not show tumor growth during the entire period of observation (mean follow-up period, 4.8 yrs). Among growing tumors, 16 patients were surgically treated with no complications or facial nerve palsy. Less than half (45.5%) of the patients presented useful hearing (classes A and B of the American Academy of Otolaryngology-Head and Neck Surgery classification) at diagnosis, and 41 (73.2%) patients had preserved hearing during follow-up independently from the tumor growth rate.


CONCLUSIONS
Conservative management of vestibular schwannoma appears to be a safe procedure because most tumors do not grow and surgical outcomes are not affected by possible delays. In the great majority of cases, useful hearing is maintained over time. Because of the irregular behavior of the tumor, periodic neuroradiologic scans are mandatory to limit late surgical risks.
Ferri
Gian Gaetano
GG
Department of Surgical and Anaesthesiological Sciences, ENT Section, S. Orsola-Malpighi University Hospital, Bologna, Italy. giangaetano.ferri@unibo.it
Modugno
Giovanni Carlo
GC
Pirodda
Antonio
A
Fioravanti
Antonio
A
Calbucci
Fabio
F
Ceroni
Alberto Rinaldi
AR
D001299:Audiometry; D004428:Ear Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009442:Neurilemmoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D014722:Vestibule, Labyrinth