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
,
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
› Author Affiliations

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.

* 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

 
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