Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Nov;21(6):379-84.
doi: 10.1055/s-0031-1287680.

Management of large and giant vestibular schwannomas

Irumee Pai, James Bowman, Nick Thomas, Neil Kitchen, Anthony Strong, Rupert Obholzer, Michael Gleeson

Management of large and giant vestibular schwannomas

Irumee Pai et al. Skull Base. 2011 Nov.

Abstract

The study was conducted to analyze outcomes following surgical management of large and giant vestibular schwannomas and management options for residual disease. This retrospective case note study includes patients who had undergone microsurgical resection of sporadic, large, or giant vestibular schwannomas from 1986 to 2008. Tumors are classified as large if the largest extracanalicular diameter was 3.5 cm or greater and giant if 4.5 cm or greater. The study included 45 patients (33 large, 12 giant tumors), mean tumor size 4.1 cm. Total excision was achieved in 14 cases (31.1%), near-total in 26 (57.8%), and subtotal in 5 (11.1%). Facial nerve outcome was House-Brackmann Grade I/II in 25 cases (55.6%), III/IV in 16 (35.6%), and V/VI in 4 (8.9%). No recurrence has been detected in those undergoing a complete resection. No residual tumor growth been observed in 15 of 26 who underwent near-total resection (57.7%). Of 11 patients, 10 received further treatment as their residual tumors showed growth. In the subtotal excision group, one patient died, three have demonstrated no growth, and one residual tumor has grown slightly but not required intervention. Optimal management for patients with large or giant vestibular schwannomas has yet to be determined. Management decisions must balance long term function with tumor control.

Keywords: Large vestibular schwannomas; management; residual disease; stereotactic radiotherapy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A, B) Pre- and postoperative magnetic resonance scans illustrating a totally resected tumor in a young woman.
Figure 2
Figure 2
(A, B) Pre- and postoperative magnetic resonance scans of a near-total resection undertaken in a 77-year-old man who had become confined to a wheel chair. He made a complete recovery and regained mobility.
Figure 3
Figure 3
(A, B) Pre- and postoperative magnetic resonance scans of a subtotal resection undertaken in a 74-year-old woman. At operation, it became apparent that a complete resection would inflict a permanent complete facial palsy.
See this image and copyright information in PMC

References

    1. Nikolopoulos T P, Fortnum H, O'Donoghue G, Baguley D. Acoustic neuroma growth: a systematic review of the evidence. Otol Neurotol. 2010;31(3):478–485. - PubMed
    1. Verma S, Anthony R, Tsai V, Taplin M, Rutka J. Evaluation of cost effectiveness for conservative and active management strategies for acoustic neuroma. Clin Otolaryngol. 2009;34(5):438–446. - PubMed
    1. Solares C A, Panizza B. Vestibular schwannoma: an understanding of growth should influence management decisions. Otol Neurotol. 2008;29(6):829–834. - PubMed
    1. Mandl E S, Meijer O W, Slotman B J, Vandertop W P, Peerdeman S M. Stereotactic radiation therapy for large vestibular schwannomas. Radiother Oncol. 2010;95(1):94–98. - PubMed
    1. Chung W Y, Pan D H, Lee C C, et al. Large vestibular schwannomas treated by Gamma Knife surgery: long-term outcomes. J Neurosurg. 2010;113(Suppl):112–121. - PubMed