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J Neurol Surg B Skull Base
DOI: 10.1055/s-0044-1792035
Original Article

British Skull Base Society Consensus on Vestibular Schwannoma Surveillance

Mantegh Sethi    *
1   Department of Otolaryngology, University Hospitals Birmingham, Birmingham, United Kingdom
,
Daniele Borsetto   *
2   Department of Skull Base Surgery, Cambridge University Hospitals, Cambridge, United Kingdom
,
James Tysome
2   Department of Skull Base Surgery, Cambridge University Hospitals, Cambridge, United Kingdom
,
Juliette Buttimore
2   Department of Skull Base Surgery, Cambridge University Hospitals, Cambridge, United Kingdom
,
Nicola Gamazo
2   Department of Skull Base Surgery, Cambridge University Hospitals, Cambridge, United Kingdom
,
Richard Mannion
2   Department of Skull Base Surgery, Cambridge University Hospitals, Cambridge, United Kingdom
,
Matthew Guilfoyle
2   Department of Skull Base Surgery, Cambridge University Hospitals, Cambridge, United Kingdom
,
Manohar Bance
2   Department of Skull Base Surgery, Cambridge University Hospitals, Cambridge, United Kingdom
,
Rupert Obholzer
3   Department of Skull Base Surgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
,
Tilak Das
4   Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Dan Scoffings
4   Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Thais Minett
4   Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Jonathan Jones
4   Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Yogish Joshi
4   Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Francis Scott
4   Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Tomasz Matys
4   Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Simon Freeman
5   Department of Skull Base Surgery, Salford Royal Hospital, Manchester, United Kingdom
,
Simon Lloyd
5   Department of Skull Base Surgery, Salford Royal Hospital, Manchester, United Kingdom
,
Scott Rutherford
5   Department of Skull Base Surgery, Salford Royal Hospital, Manchester, United Kingdom
,
Gillian Potter
6   Department of Radiology, Salford Royal Hospital, Manchester, United Kingdom
,
Rekha Siripurapu
6   Department of Radiology, Salford Royal Hospital, Manchester, United Kingdom
,
Sarah Abdulla
6   Department of Radiology, Salford Royal Hospital, Manchester, United Kingdom
,
Roger Laitt
6   Department of Radiology, Salford Royal Hospital, Manchester, United Kingdom
,
Ziyad Saloojee
7   Department of Radiology, University Hospital Southampton, Southampton, United Kingdom
,
David Summers
8   Department of Radiology, NHS Lothian, Edinburgh, United Kingdom
,
Shakeel R. Saeed
9   Department of Otolaryngology, University College London Ear Institute, London, United Kingdom
,
Fabrizio Bandino
9   Department of Otolaryngology, University College London Ear Institute, London, United Kingdom
,
Samuel MacKeith
10   Skull Base Department, John Radcliffe, Oxford, United Kingdom
,
Sanjeeva Jeyaretna
10   Skull Base Department, John Radcliffe, Oxford, United Kingdom
,
Carl Philpott
11   ENT Department, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, United Kingdom
,
Jagrit Shah
12   Department of Radiology, Nottingham University Hospital, Nottingham, United Kingdom
,
Iain Robertson
13   Department of Skull Base, Nottingham University Hospital, Nottingham, United Kingdom
,
Sebastian Thomas
14   Department of Skull Base, Southampton University Hospital, Southampton, United Kingdom
,
Nameet Hattangadi
15   Department of Radiology, Barking, Havering and Redbridge University Hospitals, Romford, United Kingdom
,
Alessandro Paluzzi
16   Department of Neurosurgery, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
,
Andrew Kay
16   Department of Neurosurgery, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
,
Bushra Awan
17   Department of Radiology, Salisbury District Hospital, Salisbury, United Kingdom
,
Rhian Rhys
18   Department of Radiology, Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taf, United Kingdom
,
Senthil Muthu
19   Department of Radiology, Wrexham Maelor Hospital, Wrexham, United Kingdom
,
Philip J Clamp
20   Department of Skull Base, University Hospitals Bristol and Weston, Bristol, United Kingdom
,
Ravi Nannapaneni
21   Department of Skull Base, University Hospital of Wales, Cardiff, United Kingdom
,
Caroline Hayhurst
21   Department of Skull Base, University Hospital of Wales, Cardiff, United Kingdom
,
Nihal Gurusinghe
22   Department of Skull Base, Lancashire Teaching Hospital NHS Trust, Preston, Lancashire, United Kingdom
,
Andrew Alalade
22   Department of Skull Base, Lancashire Teaching Hospital NHS Trust, Preston, Lancashire, United Kingdom
,
Catherine Gilkes
23   Department of Skull Base, The Walton Centre, Liverpool, United Kingdom
,
Nazia Munir
23   Department of Skull Base, The Walton Centre, Liverpool, United Kingdom
,
Ahmed Yousseff
23   Department of Skull Base, The Walton Centre, Liverpool, United Kingdom
,
Parag Patel
24   Department of Skull Base, St George's Hospital, London, United Kingdom
,
Susanne Hampton
25   Department of Skull Base, Royal Victoria Hospital, Belfast, United Kingdom.
,
Charlotte Hammerbeck-Ward
26   Department of Skull Base, Royal Sussex County Hospital, Brighton, United Kingdom
,
Nick Saunders
26   Department of Skull Base, Royal Sussex County Hospital, Brighton, United Kingdom
,
Richard Irving
1   Department of Otolaryngology, University Hospitals Birmingham, Birmingham, United Kingdom
,
Peter Monksfield
1   Department of Otolaryngology, University Hospitals Birmingham, Birmingham, United Kingdom
,
Nicholas Thomas
27   Department of Skull Base, King's College Hospital, London, United Kingdom
,
Neil Kitchen
28   Department of Skull Base, National Hospital for Neurology and Neurosurgery, London, United Kingdom
,
Sinan Barazi
28   Department of Skull Base, National Hospital for Neurology and Neurosurgery, London, United Kingdom
,
Eleni Maratos
28   Department of Skull Base, National Hospital for Neurology and Neurosurgery, London, United Kingdom
,
Steve Connor 
29   Department of Radiology, Guy's Hospital and St Thomas' Hospital, London, United Kingdom
,
Colin Leonard
30   Department of Skull Base, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
,
Nicholas Dawe
31   Department of Skull Base, The Newcastle Upon Tyne Hospitals, Newcastle, United Kingdom
,
Hassan Mohamed
31   Department of Skull Base, The Newcastle Upon Tyne Hospitals, Newcastle, United Kingdom
,
Patrick Axon
2   Department of Skull Base Surgery, Cambridge University Hospitals, Cambridge, United Kingdom
,
Neil Donnelly
2   Department of Skull Base Surgery, Cambridge University Hospitals, Cambridge, United Kingdom
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Abstract

Objective Surveillance plays a crucial role in managing patients with vestibular schwannomas (VSs). Consensus is lacking on the optimal duration, frequency, and modality of imaging. Standardizing this approach would ensure safe and effective care, reduce patient distress, and promote consistency in management decisions among clinicians.

Methods In July 2022, a multi-disciplinary Delphi consensus was conducted at the British Skull Base Society Meeting. Expert United Kingdom-based skull-base surgeons and neuroradiologists were presented semi-systematic literature reviews summarizing current evidence on VS management. Anonymized opinions were collated and discussed to reach a majority vote, which was deemed the final consensus opinion.

Results Recommendations for VS managed by surveillance are: (1) surveillance frequency should decrease over time; (2) surveillance may be discontinued when the remaining lifetime risk of VS growth is <0.5% (∼8.5 years); (3) factors such as age, VS size, VS location, and cystic components should be considered. Surveillance after surgery or radiotherapy has limited evidence but recommendations are: (4) surveillance should be adjusted based on residual tumor size or nodular enhancement. Imaging modality and sequences are recommended to be (5) high-resolution magnetic resonance imaging with T1, T2, FIESTA/CISS multiplanar sequences, contrast is not required in untreated cases, and linear reporting of measurements is pragmatically sufficient.

Conclusion This consensus and literature review provides an evidence and expert opinion–based guide to help clinicians with the surveillance of patients with VS. Further research should focus on better understanding the dynamic nature of growth risks and the growth characteristics of postintervention VS to enable personalized growth risk stratification.

Keywords

consensus - vestibular schwannomas - surveillance - growth risk

* The first two authors contributed equally to the paper.




Publication History

Received: 26 February 2024

Accepted: 06 October 2024

Article published online:
05 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Babu R, Sharma R, Bagley JH, Hatef J, Friedman AH, Adamson C. Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management. J Neurosurg 2013; 119 (01) 121-130
    CrossrefPubMedSearch in Google Scholar
  • 2 Marinelli JP, Grossardt BR, Lohse CM, Carlson ML. Prevalence of sporadic vestibular schwannoma: reconciling temporal bone, radiologic, and population-based studies. Otol Neurotol 2019; 40 (03) 384-390
    CrossrefPubMedSearch in Google Scholar
  • 3 Axon P. Second National Vestibular Schwannoma Audit Report 2019. Technical Report. British Skull Base Society; 2019
    Search in Google Scholar
  • 4 Zanoletti E, Mazzoni A, Martini A. et al. Surgery of the lateral skull base: a 50-year endeavour. Acta Otorhinolaryngol Ital 2019; 39 (Suppl. 01) S1-S146
    CrossrefPubMedSearch in Google Scholar
  • 5 Stangerup SE, Caye-Thomasen P. Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin North Am 2012; 45 (02) 257-268 , vii
    CrossrefPubMedSearch in Google Scholar
  • 6 Shapey J, Barkas K, Connor S. et al. A standardised pathway for the surveillance of stable vestibular schwannoma. Ann R Coll Surg Engl 2018; 100 (03) 216-220
    CrossrefPubMedSearch in Google Scholar
  • 7 Kondziolka D, Lunsford LD, Flickinger JC. Acoustic tumors: operation versus radiation–making sense of opposing viewpoints. Part II. Acoustic neuromas: sorting out management options. Clin Neurosurg 2003; 50: 313-328
    PubMedSearch in Google Scholar
  • 8 OCEBM Levels of Evidence Working Group*. “The Oxford Levels of Evidence 2”. Oxford Centre for Evidence-Based Medicine. Accessed October 17, 2024 at: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence
    PubMed
  • 9 Paldor I, Chen AS, Kaye AH. Growth rate of vestibular schwannoma. J Clin Neurosci 2016; 32: 1-8
    CrossrefPubMedSearch in Google Scholar
  • 10 Moffat DA, Kasbekar A, Axon PR, Lloyd SK. Growth characteristics of vestibular schwannomas. Otol Neurotol 2012; 33 (06) 1053-1058
    CrossrefPubMedSearch in Google Scholar
  • 11 Reznitsky M, Petersen MMBS, West N, Stangerup SE, Cayé-Thomasen P. The natural history of vestibular schwannoma growth-prospective 40-year data from an unselected national cohort. Neuro-oncol 2021; 23 (05) 827-836
    CrossrefPubMedSearch in Google Scholar
  • 12 Sethi M, Borsetto D, Cho Y. et al. The conditional probability of vestibular schwannoma growth at different time points after initial stability on an observational protocol. Otol Neurotol 2020; 41 (02) 250-257
    CrossrefPubMedSearch in Google Scholar
  • 13 Borsetto D, Sethi M, Clarkson K. et al. Evidence-based surveillance protocol for vestibular schwannomas: a long-term analysis of tumor growth using conditional probability. J Neurosurg 2022; 137 (04) 1026-1033
    CrossrefPubMedSearch in Google Scholar
  • 14 Borsetto D, Gair J, Kenyon O. et al. When should we stop scanning older patients with vestibular schwannomas?. J Neurol Surg B Skull Base 2019; 80 (04) 333-337
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Stangerup SE, Caye-Thomasen P, Tos M, Thomsen J. The natural history of vestibular schwannoma. Otol Neurotol 2006; 27 (04) 547-552
    CrossrefPubMedSearch in Google Scholar
  • 16 Martin TP, Senthil L, Chavda SV, Walsh R, Irving RM. A protocol for the conservative management of vestibular schwannomas. Otol Neurotol 2009; 30 (03) 381-385
    CrossrefPubMedSearch in Google Scholar
  • 17 Goldbrunner R, Weller M, Regis J. et al. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro-oncol 2020; 22 (01) 31-45
    CrossrefPubMedSearch in Google Scholar
  • 18 Manuele FA. Acceptable risk: time for SH&E professionals to adopt the concept. Prof Saf 2010; 55 (05) 30-38
    PubMedSearch in Google Scholar
  • 19 Agrawal Y, Clark JH, Limb CJ, Niparko JK, Francis HW. Predictors of vestibular schwannoma growth and clinical implications. Otol Neurotol 2010; 31 (05) 807-812
    CrossrefPubMedSearch in Google Scholar
  • 20 Sethi M. et al. Determinants of vestibular schwannoma growth. Otol Neurotol 2021; 42 (05) 746-754
    CrossrefPubMedSearch in Google Scholar
  • 21 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
    CrossrefPubMedSearch in Google Scholar
  • 22 Roehm PC, Gantz BJ. Management of acoustic neuromas in patients 65 years or older. Otol Neurotol 2007; 28 (05) 708-714
    CrossrefPubMedSearch in Google Scholar
  • 23 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
    CrossrefPubMedSearch in Google Scholar
  • 24 Whitley H, Benedict NT, Tringali S. et al. Identifying factors associated with the growth of vestibular schwannomas: a systematic review. World Neurosurg 2021; 149: e766-e779
    CrossrefPubMedSearch in Google Scholar
  • 25 Eljamel S, Hussain M, Eljamel MS. Should initial surveillance of vestibular schwannoma be abandoned?. Skull Base 2011; 21 (01) 59-64
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Benech F, Perez R, Fontanella MM, Morra B, Albera R, Ducati A. Cystic versus solid vestibular schwannomas: a series of 80 grade III-IV patients. Neurosurg Rev 2005; 28 (03) 209-213
    CrossrefPubMedSearch in Google Scholar
  • 27 Carlson ML, Van Abel KM, Driscoll CL. et al. Magnetic resonance imaging surveillance following vestibular schwannoma resection. Laryngoscope 2012; 122 (02) 378-388
    CrossrefPubMedSearch in Google Scholar
  • 28 Bennett ML, Jackson CG, Kaufmann R, Warren F. Postoperative imaging of vestibular schwannomas. Otolaryngol Head Neck Surg 2008; 138 (05) 667-671
    CrossrefPubMedSearch in Google Scholar
  • 29 Miller ME, Lin H, Mastrodimos B, Cueva RA. Long-term MRI surveillance after microsurgery for vestibular schwannoma. Laryngoscope 2017; 127 (09) 2132-2138
    CrossrefPubMedSearch in Google Scholar
  • 30 Lemée J-M, Delahaye C, Laccourreye L, Mercier P, Fournier HD. Post-surgical vestibular schwannoma remnant tumors: what to do?. Neurochirurgie 2014; 60 (05) 205-215
    CrossrefPubMedSearch in Google Scholar
  • 31 Kim W-H. et al. The use of cochlear-enhancement imaging to predict hearing preservation following vestibular schwannoma removal. J Neurosurg Sci 2024; 68 (02) 174-180
    PubMedSearch in Google Scholar
  • 32 Dunn IF, Bi WL, Mukundan S. et al. Congress of neurological surgeons systematic review and evidence-based guidelines on the role of imaging in the diagnosis and management of patients with vestibular schwannomas. Neurosurgery 2018; 82 (02) E32-E34
    CrossrefPubMedSearch in Google Scholar
  • 33 Murphy ES, Suh JH. Radiotherapy for vestibular schwannomas: a critical review. Int J Radiat Oncol Biol Phys 2011; 79 (04) 985-997
    CrossrefPubMedSearch in Google Scholar
  • 34 Weissman JL, Hirsch BE, Fukui MB, Rudy TE. The evolving MR appearance of structures in the internal auditory canal after removal of an acoustic neuroma. AJNR Am J Neuroradiol 1997; 18 (02) 313-323
    PubMedSearch in Google Scholar
  • 35 Nagano O, Serizawa T, Higuchi Y. et al. Tumor shrinkage of vestibular schwannomas after Gamma Knife surgery: results after more than 5 years of follow-up. J Neurosurg 2010; 113 (Suppl): 122-127
    CrossrefPubMedSearch in Google Scholar
  • 36 Matsuo T, Okunaga T, Kamada K, Izumo T, Hayashi N, Nagata I. Long-term follow-up results of linear accelerator-based radiosurgery for vestibular schwannoma using serial three-dimensional spoiled gradient-echo MRI. J Clin Neurosci 2015; 22 (02) 320-325
    CrossrefPubMedSearch in Google Scholar
  • 37 Okunaga T, Matsuo T, Hayashi N. et al. Linear accelerator radiosurgery for vestibular schwannoma: measuring tumor volume changes on serial three-dimensional spoiled gradient-echo magnetic resonance images. J Neurosurg 2005; 103 (01) 53-58
    CrossrefPubMedSearch in Google Scholar
  • 38 Germano IM, Sheehan J, Parish J. et al. Congress of Neurological Surgeons systematic review and evidence-based guidelines on the role of radiosurgery and radiation therapy in the management of patients with vestibular schwannomas. Neurosurgery 2018; 82 (02) E49-E51
    CrossrefPubMedSearch in Google Scholar
  • 39 Zealley IA, Cooper RC, Clifford KM. et al. MRI screening for acoustic neuroma: a comparison of fast spin echo and contrast enhanced imaging in 1233 patients. Br J Radiol 2000; 73 (867) 242-247
    CrossrefPubMedSearch in Google Scholar
  • 40 Singh K, Singh MP, Thukral C, Rao K, Singh K, Singh A. Role of magnetic resonance imaging in evaluation of cerebellopontine angle schwannomas. Indian J Otolaryngol Head Neck Surg 2015; 67 (01) 21-27
    CrossrefPubMedSearch in Google Scholar
  • 41 Stuckey SL, Harris AJ, Mannolini SM. Detection of acoustic schwannoma: use of constructive interference in the steady state three-dimensional MR. AJNR Am J Neuroradiol 1996; 17 (07) 1219-1225
    PubMedSearch in Google Scholar
  • 42 Hermans R, Van der Goten A, De Foer B, Baert AL. MRI screening for acoustic neuroma without gadolinium: value of 3DFT-CISS sequence. Neuroradiology 1997; 39 (08) 593-598
    CrossrefPubMedSearch in Google Scholar
  • 43 Dang L, Tu NC, Chan EY. Current imaging tools for vestibular schwannoma. Curr Opin Otolaryngol Head Neck Surg 2020; 28 (05) 302-307
    CrossrefPubMedSearch in Google Scholar
  • 44 Selleck AM, Rodriguez JD, Brown KD. Vestibular schwannoma measurements-is volumetric analysis clinically necessary?. Otol Neurotol 2021; 42 (06) 906-911
    CrossrefPubMedSearch in Google Scholar