Multidisciplinary Approach to Vestibular Schwannomas

Background/Objectives: Decision making in vestibular schwannoma (VS) surgery is often the key to favourable outcomes in terms of tumor control and patient quality of life. In our unit, joint surgical and clinical oncology service is provided with multidisciplinary clinic consultations and both surgery and stereotactic radiosurgery (SRS) are offered in the same unit.

The goal of this study was to evaluate the outcomes of our multidisciplinary approach in VS with reference to the factors behind this management decision in a multidisciplinary skull base clinic as well as the surgical and radiosurgery outcomes.

Methods: Retrospective analysis of all new patients seen in joint clinic since its establishment in 2013 until 2019 and patients treated with SRS since installation and surgical resection between 2011 and 2021. Demographic factors, imaging/clinical factors and outcomes were recorded.

Results: There were 394 patient consultations in the multidisciplinary clinic. The majority (91.5%) had tumor growth with a mean growth rate of 3mm/year. Tumor size was Koos grade 2 in 76% and Koos grades 3 and 4 in 12%. Patients <50 years old predominantly opted for surgery while >50 years old tended to choose SRS. Continued scan surveillance was similar in all age groups. Patients with bigger tumors were more likely to have surgery. With solid tumors, SRS was the main choice, whereas with cystic tumors surgery and SRS were equally distributed.

The SRS group composed of 264 patients with a mean age at treatment of 65 years. Mean growth rate prior to treatment was 2.5 mm/year. Koos 2 formed the majority of cases, with cystic/microcystic tumors being 71% of treated tumors. Only five patients (0.02%) required subsequent surgery or second SRS within a mean follow-up of 50.7 months (18–124 months).

In the surgical group 423 operations were recorded, predominantly via translabyrinthine route (95%). Tumor size was Koos 2 in 40% and Koos grades 3 and 4 in 55%. Total and near-total resection was achieved in 98% of the cases, with 81% retaining normal facial function postoperatively. Postoperative radiotherapy was required in 2% of the patients and redo-resection was required only in two patients.

Further subgroup analysis of the patients who underwent treatment showed excellent tumor control in both arms (97% for surgery and 99% for SRS) for an average follow-up of 53 months for SRS and 30 months for surgery. No significant adverse events were recorded for either arm. Facial nerve function was comparable to the literature.

Conclusion: Multidisciplinary consultation streamlines the patient experience facilitating appropriate choice of treatment based on clinical and patient-related factors. Outcomes from treatment with either modality confirm excellent tumor control.

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Artikel online veröffentlicht:
07. Februar 2025