Long-Term Follow-Up of Vestibular Schwannoma: A Review of 791 Cases

Objective: To analyze long-term conservative management, in patients of vestibular schwannoma (VS) to predict if there are any indicators of tumor behavior that would necessitate a change in management. Study Design: Retrospective study. Material and Methods: The clinical records of 791 patients with unilateral sporadic vestibular schwannoma, who were assigned to “wait and scan” as per the protocol at our center were reviewed. The demographic factors, clinical symptoms, tumor site, growth pattern, hearing outcomes were assessed for statistical significance. Results: Patient symptoms of tinnitus, vertigo or imbalance did not significantly predict tumor growth. Patients with progressive hearing loss at start of follow-up, had a larger tumor diameter at diagnosis than those without progressive hearing loss (p = 0.02). Growth as well as involution was demonstrated in both intracanalicular tumors as well as those with cerebellopontine angle extension, however, there was no statistically significant difference in their growth rates. There was no correlation between change in hearing status and tumor growth. Tumor growth was the most frequent reason for change in management (77.4%). Conclusion: “Wait and scan” is an accepted option in management of select patients of VS. In the absence of any symptoms predictive of tumor behavior we recommend periodic monitoring of tumor growth by magnetic resonance imaging.