INTRODUCTION: In the last two decades, an increasing incidence of vestibular schwannomas (VS) has been reported and overall medium and small sized tumours are more frequently detected. Therefore, considering the slow or absent growth rate of the tumour, a conservative management of VS is sometimes adopted. MATERIAL AND METHOD: Between January 1990 and March 2004, 354 patients affected by VS have been submitted to our interdisciplinary group. Among them 84 patients (23.7%) have been primarily observed (43 females and 41 males, mean age 61.9 years, range 26-84 yrs.). Reasons for the “wait and scan” policy included tumour size, age, general conditions, symptoms, hearing function and will of the patient. The study group was comprehensive of 83 unilateral VS and one rare case of bilateral tumour (both NF2 and cystic VS were excluded). Each patient was examined by means of gadolinium enhanced MRI; a first scan six months after diagnosis and further annual checks were scheduled. The average size of the neoplasm was 10.4 mm (range 2-28 mm) and 37/85 (43.5%) cases were purely intracanalicular VS. The mean follow-up period was 4.5 years (range 6-155 months). RESULTS: In 54/85 (63.5%) cases tumour growth has never been recorded during the entire period of observation (three cases with tumour shrinkage), while 31/85 (36.4%) tumours grew. In 14/31 (45.1%) cases tumour growth was detected within the first year of observation, whilst in 10/31 (32.2%) cases a volumetric increase appeared three years after diagnosis at least. Among intracanalicular VS, not growing tumours were 23/37 (62.1%). CONCLUSIONS: A larger number of patients and a longer follow-up period strengthen the results drawn from previous studies regarding the reliable possibility of a conservative management of selected cases of VS. Nevertheless, the irregular behaviour of the tumour strongly suggests the necessity of periodic neuroradiologic examinations; in this way, an eventual growth of the tumour will not affect the surgical risks of morbidity.
Conservative management of vestibular schwannoma
FERRI, GIAN GAETANO;MODUGNO, GIOVANNI CARLO;PIRODDA, ANTONIO;RINALDI CERONI, ALBERTO
2004
Abstract
INTRODUCTION: In the last two decades, an increasing incidence of vestibular schwannomas (VS) has been reported and overall medium and small sized tumours are more frequently detected. Therefore, considering the slow or absent growth rate of the tumour, a conservative management of VS is sometimes adopted. MATERIAL AND METHOD: Between January 1990 and March 2004, 354 patients affected by VS have been submitted to our interdisciplinary group. Among them 84 patients (23.7%) have been primarily observed (43 females and 41 males, mean age 61.9 years, range 26-84 yrs.). Reasons for the “wait and scan” policy included tumour size, age, general conditions, symptoms, hearing function and will of the patient. The study group was comprehensive of 83 unilateral VS and one rare case of bilateral tumour (both NF2 and cystic VS were excluded). Each patient was examined by means of gadolinium enhanced MRI; a first scan six months after diagnosis and further annual checks were scheduled. The average size of the neoplasm was 10.4 mm (range 2-28 mm) and 37/85 (43.5%) cases were purely intracanalicular VS. The mean follow-up period was 4.5 years (range 6-155 months). RESULTS: In 54/85 (63.5%) cases tumour growth has never been recorded during the entire period of observation (three cases with tumour shrinkage), while 31/85 (36.4%) tumours grew. In 14/31 (45.1%) cases tumour growth was detected within the first year of observation, whilst in 10/31 (32.2%) cases a volumetric increase appeared three years after diagnosis at least. Among intracanalicular VS, not growing tumours were 23/37 (62.1%). CONCLUSIONS: A larger number of patients and a longer follow-up period strengthen the results drawn from previous studies regarding the reliable possibility of a conservative management of selected cases of VS. Nevertheless, the irregular behaviour of the tumour strongly suggests the necessity of periodic neuroradiologic examinations; in this way, an eventual growth of the tumour will not affect the surgical risks of morbidity.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
