Clinical Predictors Leading to Change of Initial Conservative Treatment of 836 Vestibular Schwannomas
03 October 2018
11 January 2019
04 February 2019 (online)
Objective This study was aimed to determine the role of clinical presentation and tumor characteristics in vestibular schwannoma (VS) at diagnosis, initially treated with conservative management.
Design The study was designed as a retrospective chart review.
Setting The study was prepared at national tertiary referral center for VS patients.
Participants A total of 836 VS patients, initially treated conservatively, were included.
Main Outcome Measures Patient characteristics: age at diagnosis, gender, frequency, and duration of, hearing loss, tinnitus, balance disorder (unsteadiness, dizziness, and vertigo), respectively; and tumor characteristics: laterality, growth, cystic component, and location were analyzed in relation to tumor size at diagnosis and change in treatment strategy.
Results In total, 169 (20%) patients had a change in treatment strategy. Factors at diagnosis that had a high influence on intervention were a short duration of hearing loss (hazard ratio [HR]: 4.8, p < 0.001) and cystic tumors (HR = 2.6, p < 0.001). Balance disorders and extracanalicular (EC) tumor location have a medium influence on intervention (HR = 1.6, p < 0.01). Tumour growth was seen in 55% of the intervention group; we found a significant correlation with a short duration of hearing loss. Cystic VS was significantly higher between the medium and large tumors, 24.3% and 38.1%. (p = 0.001), respectively.
Conclusions Patients with a short duration of hearing loss, balance disorders, EC located tumors, and cystic tumors have a significantly higher chance of a change in treatment strategy. Large tumor size at diagnosis and a cystic component were related to age > 65 years at diagnosis.
- 1 Samii M, Turel KE, Penkert G. Management of seventh and eighth nerve involvement by cerebellopontine angle tumors. Clin Neurosurg 1985; 32: 242-272
- 2 Valvassori GE, Shannon M. Natural history of acoustic neuromas. Skull Base Surg 1991; 1 (03) 165-167
- 3 Kleijwegt M, Ho VKY, Visser O, Godefroy W, van der Mey A. Real incidence of vestibular schwannoma? Estimations from a national registry. Otol Neurotol 2016; 37 (09) 1411-1417
- 4 Stangerup SE, Caye-Thomasen P. Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin North Am 2012; 45 (02) 257-268 , vii vii.
- 5 Stangerup SE, Tos M, Thomsen J, Caye-Thomasen P. True incidence of vestibular schwannoma?. Neurosurgery 2010; 67 (05) 1335-1340 , discussion 1340
- 6 Tos M, Charabi S, Thomsen J. Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results. Eur Arch Otorhinolaryngol 1998; 255 (01) 1-6
- 7 Kentala E, Pyykkö I. Clinical picture of vestibular schwannoma. Auris Nasus Larynx 2001; 28 (01) 15-22
- 8 Springborg JB, Fugleholm K, Poulsgaard L, Cayé-Thomasen P, Thomsen J, Stangerup SE. Outcome after translabyrinthine surgery for vestibular schwannomas: report on 1244 patients. J Neurol Surg B Skull Base 2012; 73 (03) 168-174
- 9 Kanzaki J, Tos M, Sanna M, Moffat DA, Monsell EM, Berliner KI. New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma. Otol Neurotol 2003; 24 (04) 642-648 , discussion 648–649
- 10 Fucci MJ, Buchman CA, Brackmann DE, Berliner KI. Acoustic tumor growth: implications for treatment choices. Am J Otol 1999; 20 (04) 495-499
- 11 Nikolopoulos TP, Fortnum H, O'Donoghue G, Baguley D. Acoustic neuroma growth: a systematic review of the evidence. Otol Neurotol 2010; 31 (03) 478-485
- 12 Timmer FC, Artz JC, Beynon AJ. , et al. Prediction of vestibular schwannoma growth: a novel rule based on clinical symptomatology. Ann Otol Rhinol Laryngol 2011; 120 (12) 807-813
- 13 Kleijwegt MC, van der Mey AG, Wiggers-deBruine FT, Malessy MJ, van Osch MJ. Perfusion magnetic resonance imaging provides additional information as compared to anatomical imaging for decision-making in vestibular schwannoma. Eur J Radiol Open 2016; 3: 127-133
- 14 Marston AP, Jacob JT, Carlson ML, Pollock BE, Driscoll CLW, Link MJ. Pretreatment growth rate as a predictor of tumor control following Gamma Knife radiosurgery for sporadic vestibular schwannoma. J Neurosurg 2017; 127 (02) 380-387
- 15 Artz JC, Timmer FC, Mulder JJ, Cremers CW, Graamans K. Predictors of future growth of sporadic vestibular schwannomas obtained by history and radiologic assessment of the tumor. Eur Arch Otorhinolaryngol 2009; 266 (05) 641-646
- 16 Jethanamest D, Rivera AM, Ji H, Chokkalingam V, Telischi FF, Angeli SI. Conservative management of vestibular schwannoma: Predictors of growth and hearing. Laryngoscope 2015; 125 (09) 2163-2168
- 17 Fayad JNSM, Semaan MT, Lin J, Berliner KI, Brackmann DE. Conservative management of vestibular schwannoma: expectations based on the length of the observation period. Otol Neurotol 2014; 35 (07) 1258-1265
- 18 Hajioff D, Raut VV, Walsh RM. , et al. Conservative management of vestibular schwannomas: third review of a 10-year prospective study. Clin Otolaryngol 2008; 33 (03) 255-259
- 19 Falcioni M, Fois P, Taibah A, Sanna M. Facial nerve function after vestibular schwannoma surgery. J Neurosurg 2011; 115 (04) 820-826