When Should We Stop Scanning Older Patients with Vestibular Schwannomas?Funding None.
24 May 2018
13 November 2018
27 December 2018 (eFirst)
Objective Observation is a well-accepted management for small- to medium-sized vestibular schwannomas (VSs). Although there are good data on the natural history of this disease within adults, no studies have looked specifically at those aged over 70 years. Thus, there is a need for a surveillance protocol to determine if and when we can stop imaging safely patients aged 70 years and over with a new diagnosis of VSs when managed with observation.
Design Over a 13-year period, we retrospectively analyzed all skull base unit patients with a sporadic unilateral VSs managed with an imaging surveillance protocol. All data were collected prospectively with a minimum follow-up of 5 years.
Setting Tertiary referral skull base unit
Participants Patients aged 70 years and over with sporadic VSs at diagnosis
Main Outcome Measures Main outcome measures
Results A total of 112 patients met inclusion criteria. The median age at diagnosis was 74 years (range: 70–87 years). The mean follow-up was 82 months (range: 60–144). The size of the VSs at diagnosis was intracanalicular (IC) in 46%, small in 41%, medium in 12%, and large in 2%.
Growth was more likely where tumors were extracanalicular (EC) rather than IC at presentation (p = 0.036) and within the first 18 months after diagnosis (p < 0.001). Twenty-nine percent of VSs displayed growth (6% continued surveillance, 23% received active treatment). Good hearing at diagnosis did not predict tumor stability for IC or EC tumors (p = 0.162 and p = 0.536).
Conclusions Since no VSs grew after 42 months from diagnosis, our data support an initial magnetic resonance imaging (MRI) at 6 months after diagnosis followed by an annual MRI for 3 years. At this point, consideration could be given to discussing discontinuation or further imaging with patients.
This study was presented at the Annual Meeting of the British Skull Base Society, Liverpool, United Kingdom, January 25–26, 2018.
* The first two authors contributed equally to this work.
- 1 Stangerup SE, Caye-Thomasen P, Tos M, Thomsen J. The natural history of vestibular schwannoma. Otol Neurotol 2006; 27 (04) 547-552
- 2 Caye-Thomasen P, Dethloff T, Hansen S, Stangerup SE, Thomsen J. Hearing in patients with intracanalicular vestibular schwannomas. Audiol Neurotol 2007; 12 (01) 1-12
- 3 Stangerup SE, Caye-Thomasen P. Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin North Am 2012; 45 (02) 257-268 , vii
- 4 Stangerup SE, Tos M, Thomsen J, Caye-Thomasen P. True incidence of vestibular schwannoma?. Neurosurgery 2010; 67 (05) 1335-1340 , discussion 1340
- 5 Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg 1995; 113 (03) 179-180
- 6 Office for National Statistics. National Population Projections: 2016-based statistical bulletin. www.ons.gov.uk . Accessed October 26, 2017
- 7 Roehm PC, Gantz BJ. Management of acoustic neuromas in patients 65 years or older. Otol Neurotol 2007; 28 (05) 708-714
- 8 Moffat DA, Kasbekar A, Axon PR, Lloyd SK. Growth characteristics of vestibular schwannomas. Otol Neurotol 2012; 33 (06) 1053-1058
- 9 Bakkouri WE, Kania RE, Guichard JP, Lot G, Herman P, Huy PT. Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment. J Neurosurg 2009; 110 (04) 662-669
- 10 Patnaik U, Prasad SC, Tutar H, Giannuzzi AL, Russo A, Sanna M. The long-term outcomes of wait-and-scan and the role of radiotherapy in the management of vestibular schwannomas. Otol Neurotol 2015; 36 (04) 638-646
- 11 Hunter JB, Francis DO, O'Connell BP. , et al. Single institutional experience with observing 564 vestibular schwannomas: factors associated with tumor growth. Otol Neurotol 2016; 37 (10) 1630-1636
- 12 Lees KA, Tombers NM, Link MJ. , et al. Natural history of sporadic vestibular schwannoma: a volumetric study of tumor growth. Otolaryngol Head Neck Surg 2018; 159 (03) 535-542
- 13 Kirchmann M, Karnov K, Hansen S, Dethloff T, Stangerup SE, Caye-Thomasen P. Ten-year follow-up on tumor growth and hearing in patients observed with an intracanalicular vestibular schwannoma. Neurosurgery 2017; 80 (01) 49-56
- 14 Tuleasca C, George M, Faouzi M. , et al. Acute clinical adverse radiation effects after Gamma Knife surgery for vestibular schwannomas. J Neurosurg 2016; 125 (Suppl. 01) 73-82