title: A protocol for the conservative management of vestibular schwannomas.
abstract: OBJECTIVE
  To devise a protocol for the safe surveillance of vestibular schwannomas.
  
  
  METHODS
  Retrospective review of case records.
  
  
  METHODS
  Tertiary referral neurotology clinic.
  
  
  METHODS
  Three hundred twenty patients have been managed conservatively with a mean follow-up of 43 months since 1997. Two hundred seventy-six patients with at least 1 follow-up scan have been included in the study.
  
  
  METHODS
  Review of case records and radiologic data to devise management protocol.
  
  
  METHODS
  Tumor growth rates, timing of detection of growth in growing tumors, and timing of detection of growth in tumors growing at different rates.
  
  
  RESULTS
  Of 276 patients, 62 (22%) demonstrated growth. The mean growth rate for growing tumors was 4 mm annually (range, 0.5-17 mm/yr). Of the growing tumors, 65% grew slowly (0.5-5 mm/yr) and 35% grew more rapidly (>5-17 mm/yr). Four tumors displayed genuine nonlinear growth. Of the rapidly growing tumors, 16 of 19 were detected at the first follow-up magnetic resonance imaging (6 mo). Of all growing tumors, 90% were detected within 3 years. The remaining 10% were detected within a further 3 years.
  
  
  CONCLUSIONS
  Growth is usually manifest in the first 3 years after presentation. We recommend an initial magnetic resonance imaging scan at 6 months, with scans to take place at annual intervals for 2 years. A further scan 2 years later will identify any patient with indolent tumors. Thereafter, follow-up should be lifelong every 5 years. Cystic tumors represent a particular threat to patients and should only be treated conservatively with caution.
authors.affiliation: Departments of Otolaryngology, Queen Elizabeth Medical Centre, Birmingham, West Midlands, UK. tpcmartin@blueyonder.co.uk
authors.forename: Thomas P C
authors.initials: TP
authors.lastname: Martin
authors.forename: Latha
authors.initials: L
authors.lastname: Senthil
authors.forename: Swarapsinh V
authors.initials: SV
authors.lastname: Chavda
authors.forename: Richard
authors.initials: R
authors.lastname: Walsh
authors.forename: Richard M
authors.initials: RM
authors.lastname: Irving