Document Detail

Conservative management of vestibular schwannomas - second review of a prospective longitudinal study.
MedLine Citation:
PMID:  15373864     Owner:  NLM     Status:  MEDLINE    
Vestibular schwannomas have been traditionally managed with microsurgical removal and in recent years, stereotactic radiotherapy. However, there is a group of patients in whom a conservative management approach might represent a desirable alternative. The aim of this study was to determine the natural history and outcome following the conservative management of 72 patients with unilateral vestibular schwannomas. This is a prospective cohort review of a previously published group of patients [Clin. Otolaryngol. (2000) 25, 28-39] with unilateral vestibular schwannoma that were initially analysed at our institution in 1998 [Walsh R.M., Bath A.P., Bance M.L. et al., Clin. Otolaryngol. (2000) 25, 28]. The mean duration of follow-up was 80 months (range 52-242 months). All the patients in the study underwent serial magnetic resonance imaging (MRI) for assessment of tumour growth. Patients were deemed to have failed conservative management if there was evidence of rapid radiological tumour growth and/or increasing signs and symptoms, which necessitated active intervention. The mean tumour growth rate for the entire group at the second review was 1 mm/year (range -0.84-9.65 mm/year). The mean growth rate for cerebellopontine angle tumours (1.3 mm/year) was significantly greater than that of internal auditory canal (IAC) tumours (0 mm/year) (P = 0.005). The majority of tumours (87.14%) grew <2 mm/year. There was significant tumour growth seen in 38.9%, no or insignificant growth in 41.7%, and negative growth in 19.4%. Twenty-three patients (32%) failed conservative management at the second review. There was no difference in the outcome of these failed patients in comparison with patients who underwent primary treatment without a period of conservative management. The mean growth rate of tumours in patients that failed conservative management (3.1 mm/year) was significantly greater than that in patients who did not fail (0.2 mm/year) (P < 0.001). No factors predictive of tumour growth or failure of conservative management were identified. Hearing deterioration with pure tone averages (0.5, 1, 2, 3 kHz) and speech discrimination scores occurred irrespective of tumour growth. This prospective study further emphasizes the role of conservative management in selected cases of vestibular schwannomas. Tumours in this study confined to the IAC typically demonstrated minimal or no growth on serial MRI scanning. Regular follow-up with interval scanning is mandatory in all patients.
V V Raut; R M Walsh; A P Bath; M L Bance; A Guha; C H Tator; J A Rutka
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical otolaryngology and allied sciences     Volume:  29     ISSN:  0307-7772     ISO Abbreviation:  Clin Otolaryngol Allied Sci     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-09-17     Completed Date:  2005-01-11     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7701793     Medline TA:  Clin Otolaryngol Allied Sci     Country:  England    
Other Details:
Languages:  eng     Pagination:  505-14     Citation Subset:  IM    
Department of Otolaryngology, New Cross Hospital, Wolverhampton, UK.
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MeSH Terms
Audiometry, Pure-Tone
Cerebellopontine Angle / pathology,  surgery
Cohort Studies
Combined Modality Therapy
Ear Neoplasms / pathology,  therapy*
Follow-Up Studies
Magnetic Resonance Imaging
Middle Aged
Neoplasm Recurrence, Local
Neuroma, Acoustic / pathology,  therapy*
Otologic Surgical Procedures / methods
Prospective Studies
Radiotherapy / methods
Speech Perception
Treatment Failure

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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