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Conservative management of vestibular schwannomas: third review of a 10‐year prospective study
Author(s) -
Hajioff D.,
Raut V.V.,
Walsh R.M.,
Bath A.P.,
Bance M.L.,
Guha A.,
Tator C.H.,
Rutka J.A.
Publication year - 2008
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/j.1749-4486.2008.01705.x
Subject(s) - medicine , conservative management , cerebellopontine angle , schwannoma , vestibular system , pure tone audiometry , surgery , conservative treatment , prospective cohort study , audiometry , hearing loss , radiology , audiology , magnetic resonance imaging
Keypoints• Seventy‐two patients with a unilateral vestibular schwannoma have been treated conservatively for a median of 121 months. They have been followed prospectively by serial clinical examination, MRI scans and audiometry. • Twenty‐five patients (35%, 95% CI: 24–47) failed conservative management and required active intervention during the study. No factors predictive of tumour growth or failure of conservative management could be identified. Seventy‐five per cent of failures occurred in the first half of the 10‐year study. • The median growth rate for all tumours at 10 years was 1 mm/year (range −0.53–7.84). Cerebellopontine angle tumours grew faster (1.4 mm/year) than intracanalicular tumours (0 mm/year, P < 0.01); 92% had growth rates under 2 mm/year. • Hearing deteriorated substantially even in tumours that did not grow, but did so faster in tumours that grew significantly (mean deterioration in pure tone average at 0.5, 1, 2 and 3 kHz was 36 dB; speech discrimination scores deteriorated by 40%). • Patients who failed conservative management had clinical outcomes that were not different from those who underwent primary treatment without a period of conservative management.