title: A large vestibular schwannoma that did not grow for 18 years.
abstract: BACKGROUND
  Treatment strategies for vestibular schwannoma include microsurgery, stereotactic radiotherapy and conservative management (wait and scan). To avoid neurological complications or even death, surgery is the preferred treatment for large tumours with an extrameatal diameter > 3.0 cm.
  
  
  OBJECTIVE
  We present the case history of a man with a large vestibular schwannoma who had refused treatment and was seen again eighteen years later.
  
  
  RESULTS
  This patient had not developed symptoms other than the initial hearing loss. Repeated imaging showed that the tumour had not grown and the brainstem compression had not progressed.
  
  
  CONCLUSIONS
  This case history illustrates the unpredictable growth pattern of vestibular schwannomas. Apparently, even large tumours in close proximity to the brainstem may remain stable for many years. However, there still are no valid arguments to refrain from therapy in patients with a large vestibular schwannoma, since reliable growth predictors are not available.
authors.affiliation: Donders Institute for Brain, Cognition and Behaviour, Department of Otorhinolaryngology, Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. f.timmer@kno.umcn.nl
authors.forename: F C A
authors.initials: FC
authors.lastname: Timmer
authors.forename: K
authors.initials: K
authors.lastname: Graamans
mesh_terms: D000368:Aged; D001301:Audiometry, Pure-Tone; D001302:Audiometry, Speech; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009464:Neuroma, Acoustic / Q000473:pathology* / Q000628:therapy; D013997:Time Factors; D057832:Watchful Waiting