Vestibular schwannoma: role of conservative management.
OBJECTIVE
To assess the outcome of conservative management of vestibular schwannoma.


METHODS
Observational study.


METHODS
Tertiary referral centre.


METHODS
Four hundred and thirty-six patients with vestibular schwannoma (490 tumours), including 327 sporadic tumours and 163 tumours in 109 patients with neurofibromatosis type two.


METHODS
The relationship of tumour growth to tumour size at presentation, and to certain demographic features.


RESULTS
The initial tumour size was significantly larger in the neurofibromatosis type two group (11 mm) than in the sporadic vestibular schwannoma group (5.1 mm). In both groups, 68 per cent of tumours did not grow during follow up (mean 3.6 years; range one to 14 years). The mean growth rate was 1.1 mm/year (range 0-15 mm/year) for sporadic tumours and 1.7 mm/year (range 0-18 mm/year) for neurofibromatosis type two tumours. The tumour growth rate correlated positively with tumour size in the sporadic tumour group, and correlated negatively with age in the neurofibromatosis type two group.


CONCLUSIONS
Two-thirds of vestibular schwannomas did not grow. Radiological surveillance is an acceptable approach in carefully selected patients. Once a sporadic vestibular schwannoma reaches 2 cm in intracranial diameter, it is likely to continue growing. We do not recommend conservative management for sporadic tumours with an intracranial diameter of 1.5 cm or more. Vestibular schwannoma management is more complex in patients with neurofibromatosis type two.
Suryanarayanan
R
R
Department of Otolaryngology, Manchester Royal Infirmary and Hope Hospital, Salford, UK. drsury@gmail.com
Ramsden
R T
RT
Saeed
S R
SR
Aggarwal
R
R
King
A T
AT
Rutherford
S A
SA
Evans
D G
DG
Gillespie
J E
JE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016518:Neurofibromatosis 2 / Q000473:pathology / Q000628:therapy*; D009464:Neuroma, Acoustic / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult