J G Wolbers1, A H G Dallenga1, A van Linge2, M Te West1, E E Kummer3, A Méndez Romero4, B K H Pauw2, M H Wieringa2. 1. Department of Neurosurgery, Erasmus University Medical Centre, Rotterdam, the Netherlands. 2. Department of Otolaryngology, Erasmus University Medical Centre, Rotterdam, the Netherlands. 3. Department of Otolaryngology, Zaans Medical Centre, Zaandam, the Netherlands. 4. Department of Radiation Oncology, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Abstract
OBJECTIVES: Identification at time of diagnosis of those vestibular schwannomas that will not grow. DESIGN: Retrospective cohort study of consecutive patients diagnosed with a sporadic vestibular schwannoma that were entered in the wait-and-scan protocol. SETTING: Academic referral centre. PARTICIPANTS: The study group contained 155 patients with a sporadic vestibular schwannoma first seen in the full 8-year period 2000-2007: continual wait-and-scan (n = 89) and initial wait-and-scan until intervention (n = 66). MAIN OUTCOME MEASURES: Tumour growth, defined as more than 2 mm linear difference in any plane between the diagnostic MRI-scan and the last available scan, was related to clinical parameters at diagnosis: localisation of the tumour (solely intracanalicular versus cisternal extension), sudden sensorineural hearing loss, sensorineural hearing loss longer than 2 years and vertigo/instability. RESULTS: Hearing loss longer than 2 years and an entirely intracanalicular localisation were associated with no tumour growth by univariate and multivariate Cox analysis. Combining both factors at time of diagnosis resulted in a group with low risk of growth (n = 36, median follow-up of 6.2 years) with a Hazard Ratio for growth of 0.37 (95% CI, 0.19-0.69). This subgroup is about 25% of the wait-and-scan population. Thirty-one percent showed growth, while in the remaining higher risk group of 119 patients 62% showed growth. For the growing schwannomas, the median time for growth becoming manifest is 1.9 years after diagnostic MRI. CONCLUSIONS: In this study on vestibular schwannoma patients that start in a wait-and-scan protocol, about a quarter may be set apart having a low risk for growth. These patients at diagnosis combine a history of hearing loss longer than 2 years and a fully intracanalicular schwannoma. They seem to be not needed yearly MRI checks.
OBJECTIVES: Identification at time of diagnosis of those vestibular schwannomas that will not grow. DESIGN: Retrospective cohort study of consecutive patients diagnosed with a sporadic vestibular schwannoma that were entered in the wait-and-scan protocol. SETTING: Academic referral centre. PARTICIPANTS: The study group contained 155 patients with a sporadic vestibular schwannoma first seen in the full 8-year period 2000-2007: continual wait-and-scan (n = 89) and initial wait-and-scan until intervention (n = 66). MAIN OUTCOME MEASURES: Tumour growth, defined as more than 2 mm linear difference in any plane between the diagnostic MRI-scan and the last available scan, was related to clinical parameters at diagnosis: localisation of the tumour (solely intracanalicular versus cisternal extension), sudden sensorineural hearing loss, sensorineural hearing loss longer than 2 years and vertigo/instability. RESULTS:Hearing loss longer than 2 years and an entirely intracanalicular localisation were associated with no tumour growth by univariate and multivariate Cox analysis. Combining both factors at time of diagnosis resulted in a group with low risk of growth (n = 36, median follow-up of 6.2 years) with a Hazard Ratio for growth of 0.37 (95% CI, 0.19-0.69). This subgroup is about 25% of the wait-and-scan population. Thirty-one percent showed growth, while in the remaining higher risk group of 119 patients 62% showed growth. For the growing schwannomas, the median time for growth becoming manifest is 1.9 years after diagnostic MRI. CONCLUSIONS: In this study on vestibular schwannomapatients that start in a wait-and-scan protocol, about a quarter may be set apart having a low risk for growth. These patients at diagnosis combine a history of hearing loss longer than 2 years and a fully intracanalicular schwannoma. They seem to be not needed yearly MRI checks.
Authors: Mirre Scholte; Mayke A Hentschel; Gerjon Hannink; Henricus P M Kunst; Stefan C Steens; Maroeska M Rovers; Janneke P C Grutters Journal: Clin Otolaryngol Date: 2019-04-11 Impact factor: 2.597
Authors: Mayke A Hentschel; Gerjon Hannink; Stefan C A Steens; Jef J S Mulder; Maroeska M Rovers; Henricus P M Kunst Journal: Clin Otolaryngol Date: 2020-11-06 Impact factor: 2.597
Authors: Oliver Profant; Zbyněk Bureš; Zuzana Balogová; Jan Betka; Zdeněk Fík; Martin Chovanec; Jan Voráček Journal: Sci Rep Date: 2021-09-15 Impact factor: 4.379