A Review of Contemporary Management of Vestibular Schwannomas

What are important parameters that should be considered in the treatment decisions for vestibular schwannomas?

Background: The advent of stereotactic radiosurgery and its widespread use during the past decade have led to a reappraisal of the various management options for vestibular schwannomas, also known as acoustic neuromas. At the same time, novel chemotherapeutic agents, although still in their infancy, have proven to hold significant promise for the successful treatment of such lesions, particularly in the face of recurrence and the presence of neurofibromatosis type 2 (NF2). The refinement of surgical options has moved in recent years from a traditional focus of complete tumor resection toward patient-centered functional outcomes.

Study Design: Contemporary literature review.

Synopsis: A review of the literature determined that radiosurgical treatment appears to maintain strong tumor control through an ever-increasing number of years of follow up. Fractionated radiation therapy, with attention to limiting the cochlear radiation dose, seems to afford the best hearing-nerve functional outcomes. Microsurgical treatment remains the best cytoreductive therapy, and, although it cannot achieve the facial and hearing nerve outcomes of radiosurgery, is still the preferred treatment for large lesions causing mass effect and obstructive hydrocephalus. Bevacizumab holds substantial promise for the treatment of NF2-associated progressive lesions.

Bottom Line: Near-total or extensive subtotal resection of vestibular schwannomas may confer much improved functional outcomes without significant detriment to acceptable rates of tumor control. However, further follow-up is needed in patients treated with this relatively novel surgical paradigm.

Citation: Theodosopoulos PV, Pensak ML. Contemporary management of acoustic neuromas. Laryngoscope. 2011;121:1133-1137.

—Reviewed by Sue Pondrom