Hearing preservation and growth of small vestibular schwannomas: preliminary outcomes from patients under observation

Abstract

Objective: Conservative management in sporadic vestibular schwannomas (VS) represents a valid treatment option, however, tumour growth and hearing decay during observation are still a matter of controversy and shift to alternative therapies. The present study aims at evaluating patients diagnosed with VS submitted to a wait and scan protocol of treatment.

Study design: Case series review from a tertiary referral centre. Data collected from an in-house prospectively-maintained database of 108 patients with sporadic small VS, managed with primary observation, were evaluated. Inclusion criteria were tumour diameter less than 10 mm in the cerebello-pontine angle. At serial follow-up evaluations, objective measures of hearing status and tumour growth through magnetic resonance imaging were conducted. Hearing status was stratified according to the Tokyo Consensus Meeting Guidelines. Tumour growth and hearing function represented the main endpoints and were analysed according to tumour site at diagnosis.

Results: Eighty-one patients were included in the study. During observation with a mean follow-up time of 27 months, 29.6% of the patients demonstrated tumour growth, with extrameatal lesions growing faster than intrameatal tumours (p = .049). Decay of good hearing was observed in 32.5% of patients, with a higher frequency of hearing instability revealed in the intrameatal group of VS (p = .004). Conservative treatment was maintained in 75.3% of cases. In 18% of cases, patients underwent surgical VS removal, while only 6.2% of patients favoured radiotherapy.

Conclusions: Conservative treatment led to low rates of tumour growth after a mean 27 months observation. The cases with good hearing at diagnosis evidenced hearing deterioration in 33.3% of patients. Wait and scan outcomes need to be evaluated in comparison with other active treatments in terms of hearing and growth and further studies are required in this sense.

Keywords:

• Vestibular schwannoma
• acoustic neuroma
• wait and scan
• hearing preservation
• treatment

Disclosure statement

The authors declare no conflict of interest.