EANO guideline on the diagnosis and treatment of vestibular schwannoma

Abstract

The level of evidence to provide treatment recommendations for vestibular schwannoma is low compared with other intracranial neoplasms. Therefore, the vestibular schwannoma task force of the European Association of Neuro-Oncology assessed the data available in the literature and composed a set of recommendations for health care professionals. The radiological diagnosis of vestibular schwannoma is made by magnetic resonance imaging. Histological verification of the diagnosis is not always required. Current treatment options include observation, surgical resection, fractionated radiotherapy, and radiosurgery. The choice of treatment depends on clinical presentation, tumor size, and expertise of the treating center. In small tumors, observation has to be weighed against radiosurgery, in large tumors surgical decompression is mandatory, potentially followed by fractionated radiotherapy or radiosurgery. Except for bevacizumab in neurofibromatosis type 2, there is no role for pharmacotherapy.

Keywords: diagnosis; radiotherapy; surgery; treatment; vestibular schwannoma.

Fig. 1

Intracanalicular and cisternal VS (Koos grade III). Axial 3D heavily T2-weighted sequence (DRIVE) (A) shows a VS expanding from the internal porus acusticus into the cerebellopontine-angle cistern. Coronal T2-weighted image (B) depicts slight mass effect on middle cerebellar peduncle. Cystic degenerative changes seen on T2 are well evident on axial (C) and coronal (D) T1-weighted images after gadolinium (arrows).