Conservative management of vestibular schwannomas: third review of a 10-year prospective study.
Seventy-two patients with a unilateral vestibular schwannoma have been treated conservatively for a median of 121 months. They have been followed prospectively by serial clinical examination, MRI scans and audiometry. Twenty-five patients (35%, 95% CI: 24-47) failed conservative management and required active intervention during the study. No factors predictive of tumour growth or failure of conservative management could be identified. Seventy-five per cent of failures occurred in the first half of the 10-year study. The median growth rate for all tumours at 10 years was 1 mm/year (range -0.53-7.84). Cerebellopontine angle tumours grew faster (1.4 mm/year) than intracanalicular tumours (0 mm/year, P < 0.01); 92% had growth rates under 2 mm/year. Hearing deteriorated substantially even in tumours that did not grow, but did so faster in tumours that grew significantly (mean deterioration in pure tone average at 0.5, 1, 2 and 3 kHz was 36 dB; speech discrimination scores deteriorated by 40%). Patients who failed conservative management had clinical outcomes that were not different from those who underwent primary treatment without a period of conservative management.
Hajioff
D
D
Raut
V V
VV
Walsh
R M
RM
Bath
A P
AP
Bance
M L
ML
Guha
A
A
Tator
C H
CH
Rutka
J A
JA
D000328:Adult; D000368:Aged; D001299:Audiometry; D005260:Female; D006309:Hearing; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D017211:Treatment Failure