The wait and see strategy for intracanalicular vestibular schwannomas

Prog Neurol Surg. 2008:21:83-88. doi: 10.1159/000156710.

Abstract

To refine our therapeutic policy for intracanalicular tumors, we reviewed our series of patients who where initially treated conservatively. Forty-seven patients (22 men and 25 women) harboring an intracanalicular vestibular schwannoma were followed prospectively. Mean age at the time of inclusion was 54.4 (20-71) years. The mean follow-up period was 43.8 months (+/-40 months) ranging from 9 to 222 months. Failure was defined as significant tumor growth and/or hearing deterioration that required a microsurgical or radiosurgical treatment. Failure was observed in 35 cases while a conservative treatment is still ongoing in 12 patients. Ten patients kept an unchanged tumor size (21.3%), while 36 patients experienced a tumor growth (76.6%), and 1 patient experienced a mild decreased tumor size (2.1%). Among the 40 patients who where available for hearing level study, 24 patients (60%) did not change their Gardner and Robertson hearing class. Fifteen patients (37.5%) experienced a >10-dB hearing loss and 2 of them became deaf. One patient (2.5%) improved her hearing level from 56.3 to 43.8 dB over a 39.5-month follow-up period. These data suggest that the wait and see policy exposes the patient to degradation of hearing and tumor growth. Both events may occur in an independent way in the middle-term period. This information has to be given to the patient, and a careful sequential follow-up may be adopted when the wait and see strategy is chosen.

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Ear Neoplasms / complications
  • Ear Neoplasms / pathology*
  • Ear Neoplasms / therapy*
  • Ear, Inner*
  • Female
  • Hearing Loss / etiology
  • Hearing Loss / prevention & control*
  • Humans
  • Male
  • Middle Aged
  • Neuroma, Acoustic / complications
  • Neuroma, Acoustic / pathology*
  • Neuroma, Acoustic / therapy*
  • Radiosurgery
  • Retrospective Studies
  • Survival Analysis
  • Treatment Failure
  • Young Adult