Documented Initial Growth Does Not Necessarily Indicate Treatment for Sporadic Vestibular Schwannomas

Jean-Michel Bourque , Benedict J Panizza

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology +

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August 14, 2024

View abstract on PubMed

Summary

Vestibular schwannoma (VS) growth is common, with over 44% of observed patients experiencing significant growth. Extracanalicular location and initial growth rate predict further tumor expansion, guiding observation strategies.

Area Of Science

Neurosurgery
Neurology
Otolaryngology

Background

Vestibular schwannoma (VS) management often involves observation due to slow growth.
Understanding VS natural history and growth predictors is crucial for optimizing surveillance.

Purpose Of The Study

To detail the natural history of vestibular schwannoma (VS) in patients electing observation.
To identify prognostic factors for VS growth and subsequent growth patterns.
To review current literature on VS management.

Main Methods

Prospective cohort study and literature review at a tertiary referral center.
Adult patients diagnosed with VS between 1998 and 2023.
Magnetic resonance imaging (MRI) surveillance with significant growth defined as ≥2 mm size change.

Main Results

44.9% of 430 observed VS patients showed significant growth within 1.6 years.
Of those with initial growth, 60.6% experienced a second growth episode.
Subsequent 10-year growth-free survival was 36.11%. Extracanalicular (EC) location and initial growth rate predicted further growth.

Conclusions

Observation is suitable for selected VS cases, as only ~56% continue to grow.
EC tumor location and initial growth rate are key prognostic factors for surveillance candidacy.
These factors aid in selecting patients for continued close monitoring after initial growth detection.