Clinical, radiographic, and audiometric predictors in conservative management of vestibular schwannoma.
OBJECTIVE
Vestibular schwannomas (VS) can be managed by observation. The goals were to examine clinical, radiographic, and audiometric variables at presentation and during observation that may predict which patients fail conservative management.


METHODS
A retrospective chart review was performed of 202 patients who elected observation primarily. Data collection included presenting symptoms, symptom progression, tumor size, audiologic measures, and global clinical outcomes. Univariate and multivariate analyses were performed.


RESULTS
Follow-up ranged from 1 month to 16 years (mean, 2.48 yr). Nineteen patients (9.4%) in the study group failed. Disequilibrium as a presenting symptom appeared more often in patients who failed observation (58% versus 32%; p = 0.039), as did new-onset disequilibrium. Presenting tumor size differed for patients who failed conservative management, with a mean of 14.0 versus 8.4 mm (p = 0.0006). Neurotologic complications compared favorably to those treated with primary surgery or radiotherapy.


CONCLUSIONS
Patients with subjective disequilibrium at presentation and subjective disequilibrium developed during observation may be more likely to fail conservative management. Increased tumor size at presentation also may indicate the same, although no threshold could be achieved.
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. Prashant.Malhotra@jefferson.edu
Prashant S
PS
Malhotra
Pranav
P
Sharma
Michael A
MA
Fishman
F Lawson
FL
Grumbine
Renee
R
Tholey
Vincent Q
VQ
Dam
Abhijit
A
Dasgupta
Edward
E
Pequignot
Thomas O
TO
Willcox
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003389:Cranial Nerve Diseases / Q000209:etiology; D004244:Dizziness / Q000209:etiology; D005260:Female; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D014012:Tinnitus / Q000209:etiology; D016896:Treatment Outcome