Vestibular Schwannoma (acoustic neuroma)

Question 1

Surgery?

Answer 1

High rates of control with rates of significant complications low.
(1) George Washington University (NSY 1997)
15% had CSF leak, 1 % died, no patients who had complete resection developed recurrence.

(2) Germany (NSY 1997)
1. 1% died, preserved facial nerve 93%.

(3) Mayo Clinic (2012)
Nodular enhancement on postop MRI had 16 fold higher risk of recurrence.

Question 2

SRS?

Answer 2

Norway (NSY 2013), prospective cohort
GK SRS vs observation
Hearing loss 76% of pts on obs, vs 64% pts who got SRS
No diff in QOL or symptoms.
Pts who got SRS had much less need for future treatment.

Question 3

RT vs microsurgery?

Answer 3

Equivalent tumor control, better functional outcomes and less impact on QOL with SRS. No consensus, but surgery may be preferred in larger tumors, esp if mass effects.

(1) Mayo Clinic (NSY 2006), prospective cohort
36 pts got surgery and 46 got GK SRS
Same tumor control (96-100%).
GK had better facial nerve preservation and hearing preservation. GK also had better physical functioning, energy, and pain on f/u.
France and Montreal study with similar findings.