Spontaneous shrinkage of vestibular schwannoma

Abstract

Background:“Watch, wait, and rescan” (WWR) has an established place as a successful management option for a significant proportion of vestibular schwannomas (VS) as an alternative to microsurgical removal or stereotactic radiotherapy. VS may grow slowly and continuously, followed by stagnation or even shrinkage. We present two case reports of spontaneous shrinkage of VS along with a review of the literature.Case Description:A 29-year-old female presented with a progressive history of visual blurring and intermittent diplopia over 2 months. A 29 mm of maximum intracranial diameter (ICD) VS with secondary obstructive hydrocephalus was diagnosed. The patient underwent a ventriculo-peritoneal shunt with resolution of her symptoms and opted for initial WWR management. Interval scanning between 2007 and 2014 showed progressive reduction in the maximum ICD together with reduction in the degree of central tumor enhancement. Maximum ICD at most recent follow up was 22 mm. A 28-year-old female was referred with right sensorineural deafness. A right VS of maximum ICD of 27 mm was diagnosed. Initial WWR management was planned after discussion. Serial imaging showed an initial increase in the size of the tumor followed by progressive reduction in size. The most recent follow up showed a maximum ICD of 20 mm.Conclusion:Early WWR management can be associated with spontaneous shrinkage of VS over time. Prospective clinical study of larger numbers of such cases using the UK VS database may help to identify predictive factors for the spontaneous regression of VS.

Natural History of Cystic Vestibular Schwannomas

“…10 We also found that 14.2% (3/21) of cystic tumors decreased in size, falling within previously reported rates of spontaneous shrinkage of VS ranging between 1%and 22%. 11 -13 While the proportions of tumors demonstrating growth were similar to that in the literature, we also found that the rate of growth of this cystic cohort aligned with that of overall VS in the literature. Whereas a recent systematic review by Paldor et al revealed that the linear growth rate of VS is between 0.99 and 1.1 mm/year.…”

Spontaneous Shrinkage of a Dumbbell-Shaped Schwannoma in the Cervical Spine: A Case Report

“…In the case of vestibular schwannoma (VS) of World Health Organization Grade I, some patients have demonstrated natural shrinkage. Between 1988 and 2013, 21 studies 11) . reported shrinkage of these tumors that ranged from 1% to 29% during follow-up periods that lasted from 6 months-27 years.…”

“…Keywords: Cervical vertebrae; Neoplasm regression, spontaneous; Neurilemmoma ed. In the case of intracranial schwannoma, spontaneous shrinkage has been reported in more than 21 studies 11) . there are only 2 cases reports of spontaneous shrinkage of the spinal schwannoma 7,8) .…”

Spontaneous regression of solid-cystic vestibular schwannoma: A case report

“…In the largest study (n = 729) of the natural history of VS, Slangerup et al reported a spontaneous size reduction of 0.9% of 322 extramental tumors. Other studies have reported shrinkage of VS in 1.2-22% of VS. [5,9,15,18] Almost all the studies reporting a sporadic decrease based their analyses on 2D postinjection T1-weighted imaging measurements. ey reported between 3.8% and 13% spontaneous involution, with a basal shrinkage rate of between 0.74 and 1.6 mm/year.…”

“…reported a spontaneous size reduction of 0.9% of 322 extramental tumors. Other studies have reported shrinkage of VS in 1.2– 22% of VS.[ 5 , 9 , 15 , 18 ]…”