title: The wait and see strategy for intracanalicular vestibular schwannomas.
abstract: To refine our therapeutic policy for intracanalicular tumors, we reviewed our series of patients who where initially treated conservatively. Forty-seven patients (22 men and 25 women) harboring an intracanalicular vestibular schwannoma were followed prospectively. Mean age at the time of inclusion was 54.4 (20-71) years. The mean follow-up period was 43.8 months (+/-40 months) ranging from 9 to 222 months. Failure was defined as significant tumor growth and/or hearing deterioration that required a microsurgical or radiosurgical treatment. Failure was observed in 35 cases while a conservative treatment is still ongoing in 12 patients. Ten patients kept an unchanged tumor size (21.3%), while 36 patients experienced a tumor growth (76.6%), and 1 patient experienced a mild decreased tumor size (2.1%). Among the 40 patients who where available for hearing level study, 24 patients (60%) did not change their Gardner and Robertson hearing class. Fifteen patients (37.5%) experienced a >10-dB hearing loss and 2 of them became deaf. One patient (2.5%) improved her hearing level from 56.3 to 43.8 dB over a 39.5-month follow-up period. These data suggest that the wait and see policy exposes the patient to degradation of hearing and tumor growth. Both events may occur in an independent way in the middle-term period. This information has to be given to the patient, and a careful sequential follow-up may be adopted when the wait and see strategy is chosen.
authors.affiliation: Service de Neurochirurgie, Hôpital Sainte-Marguerite, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Pierre-Hugues
authors.initials: PH
authors.lastname: Roche
authors.forename: Outouma
authors.initials: O
authors.lastname: Soumare
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Thomassin
authors.forename: Jean
authors.initials: J
authors.lastname: Régis
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004428:Ear Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D007758:Ear, Inner; D005260:Female; D034381:Hearing Loss / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D016634:Radiosurgery; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure; D055815:Young Adult