A Cross-sectional Survey of the North American Skull Base Society: Current Practice Patterns of Vestibular Schwannoma Evaluation and Management in North America

Abstract

Background Very few studies have examined vestibular schwannoma (VS) management trends across centers and between providers. The objective of this study is to examine current practice trends, variance in treatment philosophies, and nuanced or controversial aspects of VS care across North America.

Methods This is a cross-sectional survey of North American Skull Base Society (NASBS) members who report regular involvement in VS care.

Results A total of 57 completed surveys were returned. Most respondents claimed to have over 20 years of experience and the majority reported working in an academic practice with an affiliated otolaryngology and/or neurosurgery residency program. Sixty-three percent of respondents claimed to evaluate VS patients in clinic with both an otolaryngologist and neurosurgeon involved. Eighty-six percent of respondents claimed to operate on VS with both an otolaryngologist and neurosurgeon involved, while only 18% of neurosurgeons and 9% of otolaryngologists performed surgery alone. There was a wide range in the number of cases evaluated at each center annually. Similarly, there was wide variation in the number of patients treated with microsurgery and radiation at each center. Additional details regarding management preferences for microsurgery, stereotactic radiosurgery, stereotactic radiotherapy, and conservative observation are presented.

Conclusion VS management practices vary between providers and centers. Overall, most centers employ a multidisciplinary approach to management with collaboration between otolaryngology and neurosurgery. Overall, survey responses concur with previous studies suggesting a shift toward conservatism in management.

Keywords

vestibular schwannoma - acoustic neuroma - skull base surgery - cranial fossa - microsurgery - radiosurgery

Financial Material and Support

Internal departmental funding was utilized without commercial sponsorship or support.

Institutional Review Board Approval

Institutional review board exempts this study from review.

• References

• 1 Sandifort E. De duram quodam corpusculo, nervo auditorio adherente. In: Van de Eyk P, Vygh D. , eds. Observationes Anatomico-Pathologicae, Book 1. 1777: 116-120
• 2 Cushing H. Tumors of the Nervus Acusticus and the Syndrome of the Cerebellopontile Angle. W.B. Saunders Company; 1917
• 3 Dandy WE. Results of removal of acoustic tumours by the unilateral approach. Arch Surg 1941; 42: 1026-1033
• 4 Ramsden RT. The bloody angle: 100 years of acoustic neuroma surgery. J R Soc Med 1995; 88 (08) 464P-468P
• 5 Akard W, Tubbs RS, Seymour ZA, Hitselberger WE, Cohen-Gadol AA. Evolution of techniques for the resection of vestibular schwannomas: from saving life to saving function. J Neurosurg 2009; 110 (04) 642-647
• 6 House WF. Transtemporal bone microsurgical removal of acoustic neuromas. Evolution of transtemporal bone removal of acoustic tumors. Arch Otolaryngol 1964; 80: 731-742
• 7 Pulec JL, House WF. Transtemporal bone microsurgical removal of acoustic neuromas. Facial nerve involvement and testing in acoustic neuromas. Arch Otolaryngol 1964; 80: 685-692
• 8 House HP, House WF. Transtemporal bone microsurgical removal of acoustic neuromas. Historical review and problem of acoustic neuroma. Arch Otolaryngol 1964; 80: 601-604
• 9 House WF. Transtemporal bone microsurgical removal of acoustic neuromas. Report of cases. Arch Otolaryngol 1964; 80: 617-667
• 10 House WF. Surgical exposure of the internal auditory canal and its contents through the middle, cranial fossa. Laryngoscope 1961; 71: 1363-1385
• 11 Carlson ML, Link MJ, Wanna GB, Driscoll CL. Management of sporadic vestibular schwannoma. Otolaryngol Clin North Am 2015; 48 (03) 407-422
• 12 Ganz JC. Stockholm radiosurgery developing 1968-1982. Prog Brain Res 2014; 215: 85-94
• 13 Lasak JM, Gorecki JP. The history of stereotactic radiosurgery and radiotherapy. Otolaryngol Clin North Am 2009; 42 (04) 593-599
• 14 Leksell L. A note on the treatment of acoustic tumours. Acta Chir Scand 1971; 137 (08) 763-765
• 15 Strasnick B, Glasscock III ME, Haynes D, McMenomey SO, Minor LB. The natural history of untreated acoustic neuromas. Laryngoscope 1994; 104 (09) 1115-1119
• 16 Carlson ML, Habermann EB, Wagie AE. , et al. The changing landscape of vestibular schwannoma management in the United States--a shift toward conservatism. Otolaryngol Head Neck Surg 2015; 153 (03) 440-446
• 17 Fusco MR, Fisher WS, McGrew BM, Walters BC. Current practices in vestibular schwannoma management: a survey of American and Canadian neurosurgeons. Clin Neurol Neurosurg 2014; 127: 143-148
• 18 Saeed SR, Suryanarayanan R, Dezso A, Ramsden RT. Vestibular schwannoma management: current practice amongst UK otolaryngologists--time for a national prospective audit. Ann R Coll Surg Engl 2006; 88 (05) 490-495
• 19 British Association of Otorhinolaryngologists – Head and Neck Surgeons Clinical Practice Advisory Group. Clinical Effectiveness Guidelines Acoustic Neuroma (Vestibular Schwannoma). BAO-HNS document 5; 2002
• 20 Goodden JR, Tranter R, Hardwidge C. Setting the standard--UK neurosurgical acoustic neuroma practice. Ann R Coll Surg Engl 2006; 88 (05) 486-489
• 21 Barker II FG, Carter BS, Ojemann RG, Jyung RW, Poe DS, McKenna MJ. Surgical excision of acoustic neuroma: patient outcome and provider caseload. Laryngoscope 2003; 113 (08) 1332-1343
• 22 McClelland III S, Guo H, Okuyemi KS. Morbidity and mortality following acoustic neuroma excision in the United States: analysis of racial disparities during a decade in the radiosurgery era. Neuro-oncol 2011; 13 (11) 1252-1259
• 23 Charabi S, Tos M, Thomsen J, Børgesen SE. Suboccipital acoustic neuroma surgery: results of decentralized neurosurgical tumor removal in Denmark. Acta Otolaryngol 1992; 112 (05) 810-815
• 24 Ward BK, Gourin CG, Francis HW. Vestibular schwannoma surgical volume and short-term outcomes in Maryland. Arch Otolaryngol Head Neck Surg 2012; 138 (06) 577-583
• 25 Baser ME, Friedman JM, Aeschliman D. , et al. Predictors of the risk of mortality in neurofibromatosis 2. Am J Hum Genet 2002; 71 (04) 715-723
• 26 Carlson ML, Tveiten OV, Driscoll CL. , et al. Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls. J Neurosurg 2015; 122 (04) 833-842
• 27 Gauden A, Weir P, Hawthorne G, Kaye A. Systematic review of quality of life in the management of vestibular schwannoma. J Clin Neurosci 2011; 18 (12) 1573-1584
• 28 Babu R, Sharma R, Bagley JH, Hatef J, Friedman AH, Adamson C. Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management. J Neurosurg 2013; 119 (01) 121-130
• 29 Gal TJ, Shinn J, Huang B. Current epidemiology and management trends in acoustic neuroma. Otolaryngol Head Neck Surg 2010; 142 (05) 677-681
• 30 Lau T, Olivera R, Miller Jr T. , et al. Paradoxical trends in the management of vestibular schwannoma in the United States. J Neurosurg 2012; 117 (03) 514-519
• 31 Pollock BE, Lunsford LD, Norén G. Vestibular schwannoma management in the next century: a radiosurgical perspective. Neurosurgery 1998; 43 (03) 475-481 , discussion 481–483
• 32 Stangerup SE, Caye-Thomasen P, Tos M, Thomsen J. The natural history of vestibular schwannoma. Otol Neurotol 2006; 27 (04) 547-552
• 33 Carlson ML, Glasgow AE, Grossardt BR, Habermann EB, Link MJ. Does where you live influence how your vestibular schwannoma is managed? Examining geographical differences in vestibular schwannoma treatment across the United States. J Neurooncol 2016; 129 (02) 269-279
• 34 Hamilton T, Dade Lunsford L. Worldwide variance in the potential utilization of Gamma Knife radiosurgery. J Neurosurg 2016; 125 (Suppl. 01) 160-165
• 35 German MA, Zardouz S, Sina MK, Ziai K, Djalilian HR. Stereotactic radiosurgery for vestibular schwannomas: a survey of current practice patterns of neurotologists. Otol Neurotol 2011; 32 (05) 834-837