Clinical, Radiographic, and Audiometric Predictors in Conservative Management of Vestibular Schwannoma

Hypointensity on T2-weighted image of the affected labyrinth will result in a significant faster deterioration of hearing. Hearing loss was more profound, and hearing will deteriorate significantly faster in patients presenting with complaints of hearing loss. Significant growth during the first year of FU predicts further growth during FU. Sequential MRI cannot be substituted by audiologic examinations solely because increase in VS volume does not correlate with audiologic deterioration significantly.

Section: Predictors Of Changes In Volumesupporting

confidence: 92%

Predictors of Volumetric Growth and Auditory Deterioration in Vestibular Schwannomas Followed in a Wait and Scan Policy

Langenberg¹,

Bondt²,

Nelemans³

et al. 2011

“…Park et al (11) reports that FNS represent 18% of all intracanalicular tumors. The diagnosis of FNS should be strongly considered for IAC tumors with FN weakness on examination as only 1% to 4.7% of patients with vestibular schwannoma have this symptom (12,13).…”

Section: Discussionmentioning

confidence: 99%

Facial Nerve Outcomes in Facial Nerve Schwannomas

McRackan

Rivas²,

Wanna³

et al. 2012

“…(22) In another study, while not necessarily predicting growth, Malhotra et al reviewed 202 conservatively managed VS patients, reporting that for every 1-mm increase of the initial tumor size, the chance the patient would require intervention increased 14%. (23)…”

Section: Discussionmentioning

confidence: 99%

Single Institutional Experience With Observing 564 Vestibular Schwannomas

Hunter

Francis

O’Connell

et al. 2016

Objective To characterize the risk and predictors of growth during observation of vestibular schwannomas (VS). Study Design Retrospective case series. Setting Single academic, tertiary care center. Patients 564 consecutive VS patients who underwent at least two MRI studies prior to intervention. Intervention(s) Serial MRI studies Main outcome measure(s) Tumor growth, defined as a ≥2 mm increase in the maximum tumor diameter between consecutive MRI studies, or between the first and last study. Results A total of 1,296 patients (1995–2015) with VS were identified. Of those, 564 patients (median age 59.2 years; 53.5% female) were initially observed and underwent multiple MRI studies (median follow-up 22.9 months, interquartile range [IQR] 11.7 – 42.7). The median maximum tumor diameter at presentation was 1.00 cm (IQR 0.6 – 1.51 cm). In all, 40.8% of tumors demonstrated growth and 32.1% underwent intervention (21.5% microsurgery, 10.5% radiation) during the surveillance period. Multivariable Cox regression analysis showed that for each tumor, the risk of growth or intervention was significantly increased for larger initial VS diameters (HR=2.22; 95% CI: 1.90 – 2.61) and when disequilibrium was a presenting symptom (HR=1.70; 95% CI: 1.30 – 2.23). Patient age, gender, aspirin use and presenting symptoms of asymmetric hearing loss, tinnitus, and vertigo, were not associated with tumor growth. Conclusions To date, this is the largest series of observed VS reported in the literature. Risk of VS growth is significantly increased among patients who present with larger tumors and who have concomitant disequilibrium. IRB 151481 Define Professional Practice Gap & Educational Need No cohort with this sample size has assessed vestibular schwannoma growth rates in conjunction with this number of variables. Learning Objective To characterize vestibular schwannoma growth rates and predictors of growth.