Vestibular schwannoma growth: the continuing controversy

Area of Science:

• Neurosurgery
• Oncology
• Audiology

Background:

• Vestibular schwannoma (VS), a benign tumor of the vestibulocochlear nerve, is often managed with a
• wait and scan
• policy due to its slow growth rate.
• Long-term data on VS growth patterns and outcomes are crucial for refining management strategies.

Purpose of the Study:

• To investigate the growth patterns and long-term outcomes of vestibular schwannoma (VS) in patients managed conservatively.
• To evaluate the effectiveness of the
• wait and scan
• approach in a large cohort.

Main Methods:

• Retrospective review of prospectively collected data from 123 patients with 127 VS tumors.
• Analysis of clinical, audiometric, and neuroradiological data from 1973 to 1999, with data updated multiple times.
• Inclusion of national register data to determine patient survival status.

Main Results:

• Over extended observation periods (up to 4.2 years), 74-85% of tumors exhibited measurable growth.
• A significant proportion of patients (42%) remained alive without intervention, while 28% were treated and alive.
• Tumor growth did not necessitate intervention in many cases, and non-tumor-related deaths occurred in 19% of patients.

Conclusions:

• The
• wait and scan
• policy for vestibular schwannoma allows for observation of tumor behavior over extended periods.
• A substantial number of VS tumors do not require intervention, highlighting the importance of individualized management.
• These findings provide valuable insights for clinical decision-making regarding the optimal timing for surgical intervention in VS patients.