“Wait and scan” management of patients with vestibular schwannoma and the relevance of non-contrast MRI in the follow-up

Abstract

Vestibular schwannoma (VS) is a slow-growing benign neoplasm. There has been an evolution in the management of VS from active treatments (microsurgery and stereotactic radiotherapy) to conservative management (wait and scan). Regular MRI scanning is necessary to monitor tumor progression. Conservative management causes significantly less complications and offers a higher quality of life compared with active treatments. The mean growth rate of VS varies from 0.4 to 2.9 mm/year, and spontaneous shrinkage is observed in 3.8 percent of tumors during observation. If significant growth occurs, active treatment is considered. Significant growth is defined as an increase of at least 3 mm in the largest extrameatal diameter in any plane between the first and last available scans. The vestibulocochlear nerve is surrounded by cerebrospinal fluid, which provides natural contrast for MRI; thus, gadolinium may not be needed to detect VS. Specific sequences have high sensitivity, specificity, and accuracy for detection of progression. Hypointense signal in the ipsilateral inner ear fluid might be a useful sign to distinguish VS from meningioma. In this paper, we summarize the current status of research on conservative management and non-contrast MRI for the detection of VS.

The natural history of incidental retroperitoneal schwannomas

“…Kichman et al reported that in their cohort, 37% of vestibular schwannomas exhibited tumor growth and 15% required invasive treatment during the 10-year follow-up period [13]. Zou et al noted that conservative management using the “wait and scan” method was suitable for 87% of vestibular schwannomas [14]. Surgery is therefore not currently recommended immediately after tumor diagnosis in asymptomatic vestibular schwannomas [13,14].…”

“…Zou et al noted that conservative management using the “wait and scan” method was suitable for 87% of vestibular schwannomas [14]. Surgery is therefore not currently recommended immediately after tumor diagnosis in asymptomatic vestibular schwannomas [13,14].…”

Epidemiology of the vestibular schwannomas in Ukraine and our experience of surgical and radiosurgical treatment

“…Світові тенденції і наш підхід полягає в активній хірургічній тактиці, спрямованій на максимально можливе видалення новоутворення з урахуванням як анатомічного, так і функціонального збереження залучених ЧН. Щодо пацієнтів похилого та старечого віку зі шванномами малого розміру (І-ІІ за Koos) з мінімальною симптоматикою чи безсимптомними, у яких висока вірогідність відсутності росту новоутворення [20][21][22], тактика зазвичай полягає в динамічному спостереженні з періодичним МРТ-контролем.…”

The role of a virtual telephone clinic in the follow-up management of lateral skull base tumours

“…Various treatment and management strategies are available, varying from surgical resection, stereotactic radiosurgery and conservative observation (‘wait and scan’). 4–6…”