Beyond Antoni: A Surgeon's Guide to the Vestibular Schwannoma Microenvironment

Abstract

Introduction Vestibular schwannomas (VS) are histologically benign tumors arising from cranial nerve VIII. Far from a homogenous proliferation of Schwann cells, mounting evidence has highlighted the complex nature of the inflammatory microenvironment in these tumors.

Methods A review of the literature pertaining to inflammation, inflammatory molecular pathways, and immune-related therapeutic targets in VS was performed. Relevant studies published up to June 2020 were identified based on a literature search in the PubMed and MEDLINE databases and the findings were synthesized into a concise narrative review of the topic.

Results The VS microenvironment is characterized by a dense infiltrate of inflammatory cells, particularly macrophages. Significantly higher levels of immune cell infiltration are observed in growing versus static tumors, and there is a demonstrable interplay between inflammation and angiogenesis in growing VS. While further mechanistic studies are required to ascertain the exact role of inflammation in angiogenesis, tumor growth, and Schwann cell control, we are beginning to understand the key molecular pathways driving this inflammatory microenvironment, and how these processes can be monitored and targeted in vivo.

Conclusion Observational research has revealed a complex and heterogeneous tumor microenvironment in VS. The functional landscape and roles of macrophages and other immune cells in the VS inflammatory infiltrate are, however, yet to be established. The antiangiogenic drug bevacizumab has shown the efficacy of targeted molecular therapies in VS and there is hope that agents targeting another major component of the VS microenvironment, inflammation, will also find a place in their future management.

Keywords

vestibular schwannoma - inflammation - tumor-associated macrophages - tumor immunology - immunotherapy - immunomodulation - angiogenesis - antiangiogenic - bevacizumab - biomarkers

Note

Aspects of this work were presented at the British Skull Base Society Meetings in January 2019 in Glasgow, UK, and January 2020 in London, UK. Further presentations were made at the Society of British Neurological Surgeons Meeting in March 2019 in Manchester, UK.

^* Contributed equally and share first authorship.

Publication History

Received: 19 June 2020

Accepted: 25 July 2020

Article published online:
10 September 2020

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