Abstract
The goal of modern management of vestibular schwannoma is to improve the quality of life and to preserve the neurological functions while maintaining mortality and morbidity rates as low as possible. Tumor size and growth pattern as well as patient’s age, symptoms, and comorbidities determine the treatment of choice among three main options: conservative therapy with watchful waiting, radiation therapy, and surgery. Watchful waiting mainly applies to incidentally diagnose vestibular schwannomas with small size (≤2 cm) and low growth rate (≤2 mm/year) at diagnosis in patients with nonfunctional hearing (AAO-HNS class C/D). Radiation therapy is indicated in case of small tumor size (≤2 cm), high tumor growth rate (≥3 mm/year), nonfunctional hearing (AAO-HNS class C/D), and poor clinical conditions contraindicating surgical intervention (ASA ≥ 4). Surgical resection is the sole treatment modality that—if total—guarantees tumor eradication and is indicated in case of large tumor size (>2 cm), high tumor growth rate (>2 mm/year), and/or presence of socially useful hearing (AAO-HNS class A/B) and/or cystic degeneration of tumor on MRI.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
As the thickness of the slices in MRI scans is 1 mm, anything smaller is attributable to interobserver variation; this is the reason why the cutoffs to discriminate between slow and fast growth are integers.
References
Di Ieva A, Lee JM, Cusimano MD. Handbook of skull base surgery. New York: Thieme; 2016. xxvii, 978 p.
Park JK, Vernick DM, Ramakrishna N. Vestibular schwannoma (acoustic neuroma). In: Post TW, editor. UpToDate. Waltham: UpToDate. Accessed 14 Jan 2018.
Quiñones-Hinojosa A, Rincon-Torroella J. Video atlas of neurosurgery: contemporary tumor and skull base surgery. 1st ed. Edinburgh; New York: Elsevier; 2017. p. 285.
Patnaik U, Prasad SC, Tutar H, Giannuzzi AL, Russo A, Sanna M. The long-term outcomes of wait-and-scan and the role of radiotherapy in the management of vestibular schwannomas. Otol Neurotol. 2015;36(4):638–46.
Prasad SC, Patnaik U, Grinblat G, Giannuzzi A, Piccirillo E, Taibah A, et al. Decision making in the wait-and-scan approach for vestibular schwannomas: is there a price to pay in terms of hearing, facial nerve, and overall outcomes? Neurosurgery. 2018;83(5):858–70.
Hoa M, Drazin D, Hanna G, Schwartz MS, Lekovic GP. The approach to the patient with incidentally diagnosed vestibular schwannoma. Neurosurg Focus. 2012;33(3):E2.
Nuseir A, Sequino G, De Donato G, Taibah A, Sanna M. Surgical management of vestibular schwannoma in elderly patients. Eur Arch Otorhinolaryngol. 2012;269(1):17–23.
Hadjipanayis CG, Carlson ML, Link MJ, Rayan TA, Parish J, Atkins T, et al. Congress of Neurological Surgeons systematic review and evidence-based guidelines on surgical resection for the treatment of patients with vestibular schwannomas. Neurosurgery. 2018;82(2):E40–3.
Wu H, Zhang L, Han D, Mao Y, Yang J, Wang Z, et al. Summary and consensus in 7th International Conference on acoustic neuroma: an update for the management of sporadic acoustic neuromas. World J Otorhinolaryngol Head Neck Surg. 2016;2(4):234–9.
Winn HR. Youmans and Winn neurological surgery. 7th ed. Philadelphia: Elsevier; 2017.
Germano IM, Sheehan J, Parish J, Atkins T, Asher A, Hadjipanayis CG, et al. Congress of Neurological Surgeons systematic review and evidence-based guidelines on the role of radiosurgery and radiation therapy in the management of patients with vestibular schwannomas. Neurosurgery. 2018;82(2):E49–51.
Kondziolka D, Mousavi SH, Kano H, Flickinger JC, Lunsford LD. The newly diagnosed vestibular schwannoma: radiosurgery, resection, or observation? Neurosurg Focus. 2012;33(3):E8.
Zumofen DW, Guffi T, Epple C, Westermann B, Krähenbühl AK, Zabka S, et al. Intended near-total removal of Koos grade IV vestibular schwannomas: reconsidering the treatment paradigm. Neurosurgery. 2018;82(2):202–10.
Samii M, Metwali H, Gerganov V. Microsurgical management of vestibular schwannoma after failed previous surgery. J Neurosurg. 2016;125(5):1198–203.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Mastronardi, L., Campione, A., Roperto, R., Sufianov, A., Fukushima, T. (2019). Treatment Options and Surgical Indications. In: Mastronardi, L., Fukushima, T., Campione, A. (eds) Advances in Vestibular Schwannoma Microneurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-03167-1_2
Download citation
DOI: https://doi.org/10.1007/978-3-030-03167-1_2
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-03166-4
Online ISBN: 978-3-030-03167-1
eBook Packages: MedicineMedicine (R0)