Document Detail

The role of conservative management of vestibular schwannomas.
MedLine Citation:
PMID:  10764234     Owner:  NLM     Status:  MEDLINE    
Although microsurgery is generally regarded as the conventional treatment of choice for most vestibular schwannomas, there remains a group of patients in whom a conservative management approach may be 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. The reasons for conservative management included poor general health, age, patient preference, small tumour size, minimal or no symptoms, and tumour in the only/better hearing ear. The mean duration of follow-up was 39.8 months (range 12-194 months). All patients underwent serial magnetic resonance imaging (MRI) for assessment of tumour growth. Patients were deemed to have failed conservative management if there was evidence of continuous or rapid radiological tumour growth and/or increasing symptoms or signs. The mean tumour growth rate, according to the 1995 guidelines of the American Academy of Otolaryngology/Head and Neck Surgery, was 1.16 mm/year (range: 0.75 9.65 mm/year). Approximately 83% of tumours grew at < 2 mm/year. Significant tumour growth was seen in 36.4%, no or insignificant growth in 50%, and negative growth in 13.6% of tumours. The growth rate of CPA tumours (1.4 mm/year) was significantly greater than that of IAC tumours (0.2 mm/year) (P = 0.001). Failure of conservative management, in which active treatment was required, occurred in 15.3%. The outcome of these patients appeared to be as favourable to a comparable group who underwent primary treatment, without a period of conservative management. The mean growth rate of tumours in patients who failed conservative management (4.2 mm/year) was significantly greater than that in patients who did not fail (0.5 mm/year) (P < 0.01). No factors predictive of tumour growth or failure of conservative management were identified. Deterioration of mean pure tone average (0.5, 1, 2, 3 kHz) and speech discrimination scores occurred regardless of whether radiological tumour growth was demonstrated or not. This study suggests that in a select number of cases of vestibular schwannoma, a conservative management approach may be appropriate. Regular follow-up with serial MRI is mandatory. Deterioration of auditory function occurs even in the absence of tumour growth.
R M Walsh; A P Bath; M L Bance; A Keller; 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:  25     ISSN:  0307-7772     ISO Abbreviation:  Clin Otolaryngol Allied Sci     Publication Date:  2000 Feb 
Date Detail:
Created Date:  2000-05-05     Completed Date:  2000-05-05     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:  28-39     Citation Subset:  IM    
Department of Otolaryngology, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada.
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MeSH Terms
Case-Control Studies
Deafness / epidemiology
Disease Progression
Follow-Up Studies
Magnetic Resonance Imaging
Middle Aged
Neuroma, Acoustic / physiopathology,  therapy*
Retrospective Studies
Risk Factors
Time Factors
Treatment Failure

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

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