- Charabi S, Tos M, Thomsen J, et al (Gentofte Univ, Hellerup, Denmark)
Vestibular Schwannoma Growth: The Continuing Controversy
Laryngoscope 110: 1720-1725, 2000
The growth rate and patterns of vestibular schwannoma (VS) are of great academic interest and may contribute to comprehensive understanding of the natural history of VS.
A retrospective review of prospectively registered data of 123 patients with 127 tumors allocated to a wait and scan group was conducted to assess growth of VS during 3 periods (1) 1973-1993 (3.4 years), (2) 1973-1996 (3.8 years) and (3) 1973 – 1999 (4.2 years).
Results- 1st observation 94 (74%) showed measurable growth, 23 (18%), 40 measurable growth, 10 tumors (8%) shared negative growth. 2nd observation 108 (82%) showed growth, no growth in 15 (12%) and negative in 8 (6%). For 3rd observation 108 growth (85%), no growth in 11 (9%) and negative in 8 (6%).
52 patients (42%) were alive at completion of period and did not require any intervention.
This helps in elderly patients, if growth is slow and the tumor is small, a watch and wait attitude seems to be clinically logical.
- Luetje CM (Otologic Ctr Inc, Kansas City, Mo)
Spontaneous Involution of Acoustic Tumors
Am J Otol 21: 393-398, 2000
Several studies documented spontaneous involution of unilateral acoustic tumors. Growth rate of these tumors is unpredictable. Long-term follow-up of 29 women and 18 men (mean age 65) with unilateral tumors was done to assess possibility of potential involution. Mean follow-up was of 4 years.
13% patient showed involution with mean decrease of 7 mm in tumor size. 6% remained stable, while 28% increased. The authors suggest long term follow-up and follow-up imaging be done.
This would help in assessing a following up of patients (elderly) for longer time conservatively.
- Green JD Jr, Beatty CW, Czervionke LF, et al (Mayo Clinic Jacksonville, Fla; Mayo Clinic and Found, Rochester, Minn)
Intracochlear Vestibular Schwannoma: A Potential Source for Recurrence After Translabyrinthine Resection
Otolaryngol Head Neck Surg 123: 281-282, 2000
Translabyrinthine approach offers excellent view of fundus of the internal auditory canal. However basal turn of cochlea is not visualized in this approach.
Therefore if carefully assessed preoperative MRI scan demonstrates involvement of cochlea by schwannoma, then transotic approach for removal should be considered alternative, to avoid incomplete removal and recurrence of the tumor.
This article points out the facts seen in our otopathology, the involvement of cochlea on histopathology. This may escape removal during resection. This is an important contribution in the management of these tumors.