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Management and Outcomes of Sporadic Vestibular Schwannoma: A Longitudinal Study Over 12 Years
Author(s) -
Jia Huan,
Sterkers Olivier,
PavillonMaisonnier Clémence,
Smail Mustapha,
Nguyen Yann,
Wu Hao,
Kalamarides Michel,
Lahlou Ghizlène
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28888
Subject(s) - medicine , schwannoma , radiosurgery , surgery , retrospective cohort study , vestibular system , audiology , radiation therapy
Objectives To evaluate the management of sporadic vestibular schwannomas (VS) with a 12‐year follow‐up. Study Design Retrospective study of all VS patients initially treated in 2005 in a tertiary referent center. Methods Initial decision making for microsurgical resection (MSR) or wait‐and‐scan (WaS) was according to VS size and hearing; subsequently, MSR or stereotactic radiosurgery (SRS) was proposed dependent on VS growth and size, hearing, and patient's age or willingness. Results Two hundred and one sporadic VS were included. The first management apportionment was 120 WaS (61.5%), 72 MSR (37%), three SRS (1.5%), and six others refused MSR and were lost to follow‐up (LFU). Within 1 year, 95 (47%) VS were surgically removed; 17 (8.5%) were treated by SRS; and 35 (17.5%) were LFU. The proportions for SRS and LFU were virtually unchanged for the following years, and the proportion under MSR increased slightly within 3 years and then remained stable. Finally, at 12 years, 104 (51.5%) cases had been operated on, 21 (10.5%) treated by SRS, 23 (11.5%) still under WaS, and 53 (26.5%) LFU, which were mainly intracanalicular. The initially and subsequently operated cases presented similar hearing preservation rates and good facial nerve function outcomes. Conclusion This longitudinal study of a large number of VS, which were diagnosed over a short period of time and followed for 12 years, provides new information on both the natural history of these benign tumors and individual patient concerns. This study recommends use of the WaS policy for small and mid‐sized VS before active therapeutic decision making. Level of Evidence 3 Laryngoscope , 131:E970–E976, 2021