title: Current practices in vestibular schwannoma management: a survey of American and Canadian neurosurgeons.
abstract: OBJECTIVE
  Comprehensive therapy for vestibular schwannomas has changed dramatically over the past fifty years. Previously, neurosurgeons were most likely to treat these tumors via an independent surgical approach. Currently, many neurosurgeons treat vestibular schwannomas employing an interdisciplinary team approach with neuro-otologists and radiation oncologists. This survey aims to determine the current treatment paradigm for vestibular schwannomas among American and Canadian neurosurgeons, with particular attention to the utilization of a team approach to the surgical resection of these lesions.
  
  
  METHODS
  A seventeen part survey questionnaire was sent by electronic mail to residency trained members of the American Association of Neurological Surgeons currently practicing in Canada or the United States. Questions were divided into groups regarding physician background, overall practice history, recent practice history, opinions on treatment paradigms, and experience with an interdisciplinary team approach.
  
  
  RESULTS
  Seven hundred and six responses were received. The vast majority of neurosurgeons surgically resect vestibular schwannomas as part of an interdisciplinary team (85.7%). Regional variations were observed in the use of an interdisciplinary team: 52.3% of responding neurosurgeons who surgically treat vestibular schwannomas without neuro-otologists currently practice in the South (no other region represented more than 15.4% of this group, p=0.02). Surgeons who have treated >50 vestibular schwannomas show a trend towards more frequent utilization of an interdisciplinary approach than less experienced surgeons, but this did not reach statistical significance.
  
  
  CONCLUSIONS
  The majority of neurosurgeons in the United States and Canada surgically resect vestibular schwannomas via an interdisciplinary approach with the participation of a neuro-otologist. Neurosurgeons in the South appear more likely to surgically treat these tumors alone than neurosurgeons in other regions of the U.S. and Canada.
authors.affiliation: UAB Department of Surgery, Division of Neurosurgery, 1720 2(nd) Avenue S, FOT 1062, Birmingham, AL 25294-3410, USA; UAB Department of Surgery, Division of Otolaryngology, 1530 3rd Ave S, Birmingham, AL 25294-3410, USA. Electronic address: mfusco@bidmc.harvard.edu.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Fusco
authors.affiliation: UAB Department of Surgery, Division of Neurosurgery, 1720 2(nd) Avenue S, FOT 1062, Birmingham, AL 25294-3410, USA; UAB Department of Surgery, Division of Otolaryngology, 1530 3rd Ave S, Birmingham, AL 25294-3410, USA.
authors.forename: Winfield S
authors.initials: WS
authors.lastname: Fisher
authors.affiliation: UAB Department of Surgery, Division of Neurosurgery, 1720 2(nd) Avenue S, FOT 1062, Birmingham, AL 25294-3410, USA; UAB Department of Surgery, Division of Otolaryngology, 1530 3rd Ave S, Birmingham, AL 25294-3410, USA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: McGrew
authors.affiliation: UAB Department of Surgery, Division of Neurosurgery, 1720 2(nd) Avenue S, FOT 1062, Birmingham, AL 25294-3410, USA; UAB Department of Surgery, Division of Otolaryngology, 1530 3rd Ave S, Birmingham, AL 25294-3410, USA.
authors.forename: Beverly C
authors.initials: BC
authors.lastname: Walters
mesh_terms: D002170:Canada; D019538:Health Care Surveys; D006801:Humans; D009464:Neuroma, Acoustic / Q000601:surgery*; D009493:Neurosurgery / Q000592:standards*; D019635:Neurosurgical Procedures / Q000379:methods*; D010348:Patient Care Team; D016634:Radiosurgery; D019291:Skull Base / Q000601:surgery; D011795:Surveys and Questionnaires; D014481:United States
keywords: Acoustic neuroma; Interdisciplinary team; Skull base surgery; Stereotactic radiosurgery