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J Neurol Surg B Skull Base 2021; 82(S 03): e15-e21
DOI: 10.1055/s-0040-1701222
Original Article

Initial Observation among Patients with Vestibular Schwannoma

Henry Ruiz-Garcia
1   Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States
,
Jennifer Peterson
1   Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States
2   Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, United States
,
Janet Leon
1   Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States
,
Timothy Malouff
1   Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States
,
Laura Vallow
1   Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States
,
Larry Lundy
3   Department of Otolaryngology, Mayo Clinic, Jacksonville, Florida, United States
,
Kaisorn L. Chaichana
2   Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, United States
,
Prasanna Vibhute
4   Department of Radiology, Mayo Clinic, Jacksonville, Florida, United States
,
Daniel M. Trifiletti 
1   Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States
2   Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, United States
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Abstract

Introduction Vestibular schwannomas (VS) are slow growing tumors. Although there are a wide variety of available treatment options, these tumors are often initially observed. We aimed to establish the presenting symptoms and outcomes of patients treated with initial observation at our institution.

Methods The medical records of patients with radiographically diagnosed VS were reviewed from 1989 to 2018. Actuarial estimates of radiographic tumor control and freedom of local therapy were calculated and compared using Cox regression analyses.

Results A total of 360 patients were diagnosed with VS at our institution from 1989 through 2018 with a median age of 59.9 years. After radiographic diagnosis, 243 patients (67.5%) opted for initial observation. Local control at 1, 5, and 10 years was 91, 67, and 58%, respectively. On multivariable analysis, factors associated with shorter time to radiographic tumor progression included younger patient age (p = 0.016) and tumors with an extracanalicular component (p = 0.032). Regarding time until definitive treatment only larger baseline American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) tumor size predicted for earlier initiation of therapy (p < 0.001), although this was restricted to tumors with an extracanalicular component (p = 0.004), as opposed to purely internal auditory canal tumors (p = 0.839).

Conclusion Many patients who were initially observed continued to have satisfactory local control rates at 10 years. In patients with extracanalicular tumors, larger AAO-HNS tumor measurements were associated with earlier radiographic tumor progression and shorter time to local therapy, with 7 mm serving as a potential threshold value for extracanalicular tumors. Younger patients and tumors with primarily an extracanalicular portion may warrant closer observation.

Keywords

acoustic neuroma - gamma knife - cyberknife - SRS - surgery - conservative


Publication History

Received: 02 May 2019

Accepted: 02 December 2019

Article published online:
24 January 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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