Acoustic Neuroma Management 2014
Fayad et al (2014) reported on 114 vestibular schwannoma (VS, aka acoustic neuroma) patients observed via serial gadolinium enhanced MRI, with regard to tumor size measurement. They report that 38 percent of tumors grew (on average) 3.1 mm annually and importantly, only approximately 31 percent of all patients had treatment beyond “watch and wait.” Of note, for patients followed 5 to 10 years, approximately one-fifth had additional treatment (radio-therapy or surgical management). The authors report that of the 12 patients followed 10 years or more, only one had additional treatment. There was no correlation between tumor size and hearing threshold change.
Fayad et al report that treatment of VS depends on multiple factors including patient age, hearing status, tumor size, patient preference, and more. For people presenting with small tumors, observation (“watch and wait”) is recommended, as many of these tumors will not grow. MRI monitoring is typically recommended six months after the first MRI, then at 12 and 24 months, then 5 years. Of note, if there has been no tumor growth by five years, tumor growth is very rare (only obvious in 4 percent of all cases with no growth prior to five years).
For More Information, References, and Recommendations
Fayad JN, Semaan MT, Lin J, Berliner KI, Brackmann DE. (2014) Conservative Management of Vestibular Schwannoma--Expectations Based on the Length of the Observation Period. Otology & Neurotology 35:1285-1265.