Skip Navigation LinksHome > June 2013 - Volume 72 - Issue 6 > Conservative Management of Bilateral Vestibular Schwannomas...
Neurosurgery:
doi: 10.1227/NEU.0b013e31828bae28
Research-Human-Clinical Studies: Editor's Choice

Conservative Management of Bilateral Vestibular Schwannomas in Neurofibromatosis Type 2 Patients: Hearing and Tumor Growth Results

Peyre, Matthieu MD*,‡; Goutagny, Stéphane MD, PhD*,‡; Bah, Alpha MD*,‡; Bernardeschi, Daniele MD‡,§; Larroque, Béatrice MD, PhD; Sterkers, Olivier MD‡,§; Kalamarides, Michel MD, PhD*,‡

Editor's Choice
SANS CME
Collapse Box

Abstract

BACKGROUND: As new treatment modalities develop for the management of vestibular schwannomas (VS) in patients with neurofibromatosis type 2, it remains crucial to ascertain the natural history of the disease.

OBJECTIVE: To determine the relationship between hearing and tumor growth in patients undergoing conservative VS management.

METHODS: Patients harboring bilateral VS with at least 1 year of radiological follow-up were selected. Conservative management was proposed based on the small tumor size and/or serviceable hearing at presentation. Tumor size was calculated by using the 2-component box model and reported as mean tumor diameter. Hearing was evaluated by using pure-tone average and the American Academy of Otololaryngologists and Head and Neck Surgery classification.

RESULTS: Forty-six patients harboring 92 VS were included. The mean clinical and radiological follow-up times were 6.0 and 4.2 years, respectively. The mean tumor diameter was 13 mm at presentation and 20 mm at the end of follow-up. Mean tumor growth rate was 1.8 mm/year. During follow-up, 17 patients (37%) underwent surgery for VS. Surgery-free rate for VS was 88% at 5 years. The number of patients with at least 1 serviceable ear was 39 (85%) at presentation and 34 (74%) at the end of follow-up, including 22 (66%) with binaural serviceable hearing maintained. There was no statistical correlation between tumor growth rate and preservation of serviceable hearing. Tumor growth rates and age at presentation were inversely correlated.

CONCLUSION: This study illustrates the high variability among neurofibromatosis type 2 patients regarding hearing status and VS growth rate and justifies the choice of initial conservative management in selected cases.

ABBREVIATIONS: AAO-HNS, American Academy of Otololaryngologists and Head and Neck Surgery classification

MTD, mean tumor diameter

NF2, neurofibromatosis type 2

PTA, pure-tone average

SDS, speech discrimination score

VS, vestibular schwannomas

Copyright © by the Congress of Neurological Surgeons

Login

Article Tools

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.