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
. 2023 Nov;280(11):4885-4894.
doi: 10.1007/s00405-023-08009-6. Epub 2023 May 17.

Evolution in the management of vestibular schwannoma: a single-center 15-year experience

Youssef El Sayed Ahmad  1 , Yohan Gallois  2 , Jean Christophe Sol  3 , Sergio Boetto  3 , Justine Attal  4 , Jean Sabatier  5 , Rachel Debs  6 , Olivier Deguine #  2 , Mathieu Marx #  2
Affiliations

Evolution in the management of vestibular schwannoma: a single-center 15-year experience

Youssef El Sayed Ahmad et al. Eur Arch Otorhinolaryngol. 2023 Nov.

Abstract

Purpose: To highlight the changes in the management of vestibular schwannoma (VS) since 2004 with a focus on small- to middle-size VS.

Methods: Retrospective analysis of the decisions made in skull base tumor board between 2004 and 2021.

Results: 1819 decisions were analyzed (average age 59.25, 54% females). Overall, 850 (47%) cases were allocated to a Wait and Scan (WS) approach, 416 (23%) received radiotherapy and 553 (30%) were treated surgically (MS). All stages considered WS increased from 39% before 2010 to 50% after 2010. Similarly, Stereotactic Radio Therapy (SRT) increased from 5 to 18%. MS decreased from 46 to 25%. It was more commonly proposed to younger patients and larger tumors, p < 0.001. For Koos stages 1, 2, and 3 there was a statistically significant increase in SRT, and a decrease in MS, p < 0.001. WS also increased for stages 1 and 2. However, such a trend was not observed for stage 3. MS remained the primary treatment modality for stage 4 tumors throughout the study period, p = 0.057. The significance of advanced age as a factor favoring SRT decreased over time. The opposite is true for serviceable hearing. There was also a decrease in the percentage of the justification "young age" in the MS category.

Conclusion: The is a continuing trend towards non-surgical treatment. Small- to medium-sized VS witnessed an increase in both WS and SRT. There is only an increase in SRT for moderately large VS. Physicians are less and less considering young age as a factor favoring MS over SRT. There is a tendency towards favoring SRT when hearing is serviceable.

Keywords: Acoustic neuroma; Microsurgery; Stereotactic radiosurgery; Treatment trend; Vestibular schwannoma; Wait and scan.

PubMed Disclaimer

References

    1. Ramsden RT (1995) The bloody angle: 100 years of acoustic neuroma surgery. J R Soc Med 88: 464P-468P. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1295305/
    1. Tos M, Charabi S, Thomsen J (1999) Incidence of vestibular schwannomas. Laryngoscope 109:736–740. https://doi.org/10.1097/00005537-199905000-00011 - DOI - PubMed
    1. Selesnick SH, Deora M, Drotman MB, Heier LA (2016) Incidental discovery of acoustic neuromas. Otolaryngol Neck Surg. https://doi.org/10.1016/S0194-5998(99)70319-0 - DOI
    1. Reznitsky M, Petersen MMBS, West N, Stangerup S-E, Cayé-Thomasen P (2019) Epidemiology of vestibular schwannomas—prospective 40-year data from an unselected national cohort. Clin Epidemiol 11:981–986. https://doi.org/10.2147/CLEP.S218670 - DOI - PubMed - PMC
    1. Singh K, Singh MP, Thukral CL, Rao K, Singh K, Singh A (2015) Role of magnetic resonance imaging in evaluation of cerebellopontine angle schwannomas. Indian J Otolaryngol Head Neck Surg 67:21–27. https://doi.org/10.1007/s12070-014-0736-0 - DOI - PubMed

LinkOut - more resources