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European Archives of Oto-Rhino-Laryngology

Erschienen in:

17.05.2023 | Otology

Evolution in the management of vestibular schwannoma: a single-center 15-year experience

verfasst von: Youssef El Sayed Ahmad, Yohan Gallois, Jean Christophe Sol, Sergio Boetto, Justine Attal, Jean Sabatier, Rachel Debs, Olivier Deguine, Mathieu Marx

Erschienen in: European Archives of Oto-Rhino-Laryngology | Ausgabe 11/2023

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Abstract

Purpose

To highlight the changes in the management of vestibular schwannoma (VS) since 2004 with a focus on small- to middle-size VS.

Methods

Retrospective analysis of the decisions made in skull base tumor board between 2004 and 2021.

Results

1819 decisions were analyzed (average age 59.25, 54% females). Overall, 850 (47%) cases were allocated to a Wait and Scan (WS) approach, 416 (23%) received radiotherapy and 553 (30%) were treated surgically (MS). All stages considered WS increased from 39% before 2010 to 50% after 2010. Similarly, Stereotactic Radio Therapy (SRT) increased from 5 to 18%. MS decreased from 46 to 25%. It was more commonly proposed to younger patients and larger tumors, p < 0.001. For Koos stages 1, 2, and 3 there was a statistically significant increase in SRT, and a decrease in MS, p < 0.001. WS also increased for stages 1 and 2. However, such a trend was not observed for stage 3. MS remained the primary treatment modality for stage 4 tumors throughout the study period, p = 0.057. The significance of advanced age as a factor favoring SRT decreased over time. The opposite is true for serviceable hearing. There was also a decrease in the percentage of the justification “young age” in the MS category.

Conclusion

The is a continuing trend towards non-surgical treatment. Small- to medium-sized VS witnessed an increase in both WS and SRT. There is only an increase in SRT for moderately large VS. Physicians are less and less considering young age as a factor favoring MS over SRT. There is a tendency towards favoring SRT when hearing is serviceable.

Ramsden RT (1995) The bloody angle: 100 years of acoustic neuroma surgery. J R Soc Med 88: 464P-468P. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1295305/

Tos M, Charabi S, Thomsen J (1999) Incidence of vestibular schwannomas. Laryngoscope 109:736–740. https://doi.org/10.1097/00005537-199905000-00011CrossRefPubMed

Selesnick SH, Deora M, Drotman MB, Heier LA (2016) Incidental discovery of acoustic neuromas. Otolaryngol Neck Surg. https://doi.org/10.1016/S0194-5998(99)70319-0CrossRef

Reznitsky M, Petersen MMBS, West N, Stangerup S-E, Cayé-Thomasen P (2019) Epidemiology of vestibular schwannomas—prospective 40-year data from an unselected national cohort. Clin Epidemiol 11:981–986. https://doi.org/10.2147/CLEP.S218670CrossRefPubMedPubMedCentral

Singh K, Singh MP, Thukral CL, Rao K, Singh K, Singh A (2015) Role of magnetic resonance imaging in evaluation of cerebellopontine angle schwannomas. Indian J Otolaryngol Head Neck Surg 67:21–27. https://doi.org/10.1007/s12070-014-0736-0CrossRefPubMed

Cummings Otolaryngology-5th Edition, n.d. https://www.elsevier.com/books/cummings-otolaryngology/flint/978-0-323-61179-4. Accessed 8 Aug 2021

Carlson ML, Habermann EB, Wagie AE, Driscoll CL, Gompel JJV, Jacob JT, Link MJ (2015) The changing landscape of vestibular schwannoma management in the United States—a shift toward conservatism. Otolaryngol Neck Surg. https://doi.org/10.1177/0194599815590105CrossRef

Apicella G, Paolini M, Deantonio L, Masini L, Krengli M (2016) Radiotherapy for vestibular schwannoma: review of recent literature results. Rep Pract Oncol Radiother 21:399–406. https://doi.org/10.1016/j.rpor.2016.02.002CrossRefPubMedPubMedCentral

Quaranta N, Pontrelli M, Ciprelli S, Signorelli F, Denaro L, d’Avella D, Danesi G, Cazzador D, Zanoletti E (2021) Defining current practice patterns of vestibular schwannoma management in Italy: results of a nationwide survey. Acta Otorhinolaryngol Ital 41:185–191. https://doi.org/10.14639/0392-100X-N1107CrossRefPubMedPubMedCentral

10.

Wu H, Zhang L, Han D, Mao Y, Yang J, Wang Z, Jia W, Zhong P, Jia H (2016) Summary and consensus in 7th International Conference on acoustic neuroma: AN update for the management of sporadic acoustic neuromas. World J Otorhinolaryngol-Head Neck Surg 2:234–239. https://doi.org/10.1016/j.wjorl.2016.10.002CrossRefPubMedPubMedCentral

11.

Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma) (1995) American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol-Head Neck Surg 113: 179–180. https://doi.org/10.1016/S0194-5998(95)70101-X

12.

Govindaraj R, Khong J, Byrne A, Zacest A, Roos D (2022) The effect of cochlear dose on hearing preservation after low-dose stereotactic radiosurgery for vestibular schwannomas: a systematic review. Adv Radiat Oncol 7:101059. https://doi.org/10.1016/j.adro.2022.101059CrossRefPubMedPubMedCentral

13.

Somers T, Kania R, Waterval J, Van Havenbergh T (2018) What is the required frequency of MRI scanning in the wait and scan management? J Int Adv Otol 14:85–89. https://doi.org/10.5152/iao.2018.5348CrossRefPubMedPubMedCentral

14.

Goshtasbi K, Abouzari M, Moshtaghi O, Sahyouni R, Sajjadi A, Lin HW, Djalilian HR (2020) The changing landscape of vestibular schwannoma diagnosis and management: a cross-sectional study. Laryngoscope 130:482–486. https://doi.org/10.1002/lary.27950CrossRefPubMed

15.

Lau T, Olivera R, Miller T, Downes K, Danner C, van Loveren HR, Agazzi S (2012) Paradoxical trends in the management of vestibular schwannoma in the United States. J Neurosurg 117:514–519. https://doi.org/10.3171/2012.5.JNS111858CrossRefPubMed

16.

Stangerup S-E, Caye-Thomasen P, Tos M, Thomsen J (2006) The natural history of vestibular schwannoma. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 27:547–552. https://doi.org/10.1097/01.mao.0000217356.73463.e7CrossRef

17.

Ferri GG, Modugno GC, Pirodda A, Fioravanti A, Calbucci F, Ceroni AR (2008) Conservative management of vestibular schwannomas: an effective strategy. Laryngoscope 118:951–957. https://doi.org/10.1097/MLG.0b013e31816a8955CrossRefPubMed

18.

Boucher AB, Mendoza P, Neill SG, Eaton B, Olson JJ (2020) High-grade sarcoma arising within a previously irradiated vestibular schwannoma: a case report and literature review. World Neurosurg 144:99–105. https://doi.org/10.1016/j.wneu.2020.08.170CrossRefPubMed

19.

Carlson ML, Glasgow AE, Jacob JT, Habermann EB, Link MJ (2016) The short-term and intermediate-term risk of second neoplasms after diagnosis and treatment of unilateral vestibular schwannoma: analysis of 9460 cases. Int J Radiat Oncol 95:1149–1157. https://doi.org/10.1016/j.ijrobp.2016.03.005CrossRef

20.

H.J. Smith, N. Durakovic, B. Patel, K. Varagur, S. Gupta, A.M. Khan, D. Kallogjeri, A.H. Kim, J.F. Piccirillo, C.A. Buchman, Clinical Staging to Estimate the Probability of Severe Postoperative Complications in Patients With Vestibular Schwannoma, JAMA Otolaryngol.-- Head Neck Surg. 147 (2021) 991–998. https://doi.org/10.1001/jamaoto.2021.2626

21.

Bowers CA, Gurgel RK, Brimley C, Hawryluk GWJ, Taggart M, Braden S, Collett T, Gale D, Salzman KL, MacDonald JD (2016) Surgical treatment of vestibular schwannoma: does age matter? World Neurosurg 96:58–65. https://doi.org/10.1016/j.wneu.2016.08.054CrossRefPubMed

22.

Paldor I, Chen AS, Kaye AH (2016) Growth rate of vestibular schwannoma. J Clin Neurosci Off J Neurosurg Soc Australas 32:1–8. https://doi.org/10.1016/j.jocn.2016.05.003CrossRef

23.

Stangerup S-E, Thomsen J, Tos M, Cayé-Thomasen P (2010) Long-term hearing preservation in vestibular schwannoma. Otol Neurotol 31:271–275. https://doi.org/10.1097/MAO.0b013e3181c34bdaCrossRefPubMed

24.

Gan J, Zhang Y, Wu J, Lei D, Zhang F, Zhao H, Wang L (2021) Current understanding of hearing loss in sporadic vestibular schwannomas: a systematic review. Front Oncol. https://doi.org/10.3389/fonc.2021.687201CrossRefPubMedPubMedCentral

25.

Carlson ML, Dowling EM, Lohse CM, O’Connell BP, Driscoll CLW, Haynes DS, Link MJ, Hunter JB (2019) Rate of initial hearing loss during early observation predicts time to non-serviceable hearing in patients with conservatively managed sporadic vestibular schwannoma. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 40:e1012–e1017. https://doi.org/10.1097/MAO.0000000000002390CrossRef

26.

Gait C, Frew EJ, Martin TPC, Jowett S, Irving R (2014) Conservative management, surgery and radiosurgery for treatment of vestibular schwannomas: a model-based approach to cost-effectiveness. Clin Otolaryngol 39:22–31. https://doi.org/10.1111/coa.12205CrossRefPubMed

27.

Rueß D, Pöhlmann L, Grau S, Hamisch C, Hoevels M, Treuer H, Baues C, Kocher M, Ruge M (2020) Outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system. Sci Rep 10:1–9. https://doi.org/10.1038/s41598-020-66213-4CrossRef

28.

Windisch PY, Tonn J-C, Fürweger C, Wowra B, Kufeld M, Schichor C, Muacevic A (2019) Clinical results after single-fraction radiosurgery for 1,002 vestibular schwannomas. Cureus. https://doi.org/10.7759/cureus.6390CrossRefPubMedPubMedCentral

29.

Persson O, Bartek J, Shalom NB, Wangerid T, Jakola AS, Förander P (2017) Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review. Acta Neurochir (Wien) 159:1013–1021. https://doi.org/10.1007/s00701-017-3164-6CrossRefPubMed

30.

Coughlin AR, Hunt AA, Gubbels SP (2019) Is hearing preserved following radiotherapy for vestibular schwannoma? Laryngoscope 129:775–776. https://doi.org/10.1002/lary.27421CrossRefPubMed

31.

Breivik CN, Nilsen RM, Myrseth E, Pedersen PH, Varughese JK, Chaudhry AA, Lund-Johansen M (2013) Conservative management or gamma knife radiosurgery for vestibular schwannoma: tumor growth, symptoms, and quality of life. Neurosurgery 73:48–56. https://doi.org/10.1227/01.neu.0000429862.50018.b9. (discussion 56-57)CrossRefPubMed

32.

Han M-S, Jung S, Lim S-H, Kim I-Y, Moon K-S, Jung T-Y, Jang W-Y (2020) What clinicians should consider to determine a more beneficial treatment strategy for small to medium sized vestibular schwannoma with serviceable hearing: a single surgeon’s long-term outcome of microsurgery and gamma knife radiosurgery. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 41:1122–1130. https://doi.org/10.1097/MAO.0000000000002721CrossRef

33.

Irving RM, Jackler RK, Pitts LH (1998) Hearing preservation in patients undergoing vestibular schwannoma surgery: comparison of middle fossa and retrosigmoid approaches. J Neurosurg 88:840–845. https://doi.org/10.3171/jns.1998.88.5.0840CrossRefPubMed

34.

Friedman RA, Kesser B, Brackmann DE, Fisher LM, Slattery WH, Hitselberger WE (2016) Long-term hearing preservation after middle fossa removal of vestibular schwannoma. Otolaryngol Neck Surg. https://doi.org/10.1016/j.otohns.2003.08.002CrossRef

35.

Wallerius KP, Macielak RJ, Lawlor SK, Lohse CM, Neff BA, Van Gompel JJ, Driscoll CLW, Link MJ, Carlson ML (2022) Hearing preservation microsurgery in vestibular schwannomas: worth attempting in “Larger” tumors? Laryngoscope 132:1657–1664. https://doi.org/10.1002/lary.29968CrossRefPubMed

36.

Macielak RJ, Wallerius KP, Lawlor SK, Lohse CM, Marinelli JP, Neff BA, Van Gompel JJ, Driscoll CLW, Link MJ, Carlson ML (2021) Defining clinically significant tumor size in vestibular schwannoma to inform timing of microsurgery during wait-and-scan management: moving beyond minimum detectable growth. J Neurosurg. https://doi.org/10.3171/2021.4.JNS21465CrossRefPubMed

37.

Zhu W, Chen H, Jia H, Chai Y, Yang J, Wang Z, Wu H (2018) Long-term hearing preservation outcomes for small vestibular schwannomas: retrosigmoid removal versus observation. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 39:e158–e165. https://doi.org/10.1097/MAO.0000000000001684CrossRef

38.

Goldbrunner R, Weller M, Regis J, Lund-Johansen M, Stavrinou P, Reuss D, Evans DG, Lefranc F, Sallabanda K, Falini A, Axon P, Sterkers O, Fariselli L, Wick W, Tonn J-C (2020) EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro-Oncol 22:31–45. https://doi.org/10.1093/neuonc/noz153CrossRefPubMed

Titel: Evolution in the management of vestibular schwannoma: a single-center 15-year experience
verfasst von: Youssef El Sayed Ahmad
Yohan Gallois
Jean Christophe Sol
Sergio Boetto
Justine Attal
Jean Sabatier
Rachel Debs
Olivier Deguine
Mathieu Marx
Publikationsdatum: 17.05.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: European Archives of Oto-Rhino-Laryngology / Ausgabe 11/2023
Print ISSN: 0937-4477
Elektronische ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-023-08009-6

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Evolution in the management of vestibular schwannoma: a single-center 15-year experience