Introduction:
Management
of vestibular schwannomas has undergone lots of changes during the past
decade. Review of published literature
exemplifies this fact. Various currently
available management modalities to treat this condition are:
1. Observation
2. Stereotactic radiosurgery
3. Microsurgery
Among these
three modalities stereotactic radiosurgery is evincing keen interest because of
the precision of the procedure and lesser incidence of side effects. Advances in imaging technology have enabled
early diagnosis of these lesions. About
a decade back the sensitivity of imaging techniques used to identify lesions
measuring 30 mm. Recent imaging modalities
are accurate enough to identify even lesions measuring less than 10 mm. A stage has reached when surgeons are
managing more intracanalicular lesions than ever before.
The current
management modality of these tumors focusses on:
Preservation
of hearing
Preservation
of facial nerve functions.
Observation
/ Watchful waiting: This modality is
preferred in managing patients with small asymptomatic / minimally symptomatic
intracanalicular tumors. Since tumor
doubling time of these lesions is prolonged (1-2 mm / year) this method
warrants a trial. Advantages of this
method are preservation of hearing and facial nerve function in these
patients. Studies have also revealed
that growth rates between intracanalicular and extracanalicular tumors are not
significantly different. It is ideal to
perform imaging at least twice a year within the first year of diagnosis and
once a year from there on.
Positive
features that could warrant this management modality include:
1. Excellent speech discrimination
scores
2. Growth rate of less than 2.5 mm /
year
Microscopic
surgery:
This is
indicated for small intracanalicular lesions with vestibular symptoms. Amount of tumor growth also is one important
factor that could force the hands of a surgeon.
Growth rate of more than 3mm / year is an indication for surgical
intervention. Hearing can be conserved
by using retrosigmoid / middle cranial fossa approach.
Stereotactic
radiosurgery:
This is
indicated in residual lesions after microscopic excision or rapidly enlarging
canalicular lesions. Advantages of radiosurgery
include:
1. Hearing preservation
2. Conservation of facial nerve function
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