Acta Neurochirurgica

, Volume 152, Issue 6, pp 973–984 | Cite as

Decision-making of vestibular schwannoma patients

  • Sabine Müller
  • Judith Arnolds
  • Ansel van Oosterhout
Clinical Article



Patients suffering from vestibular schwannoma can choose between four modalities of management: (1) wait-and-scan, (2) tumour resection, (3) radiosurgery and (4) fractionated radiotherapy.


This study is based on postal questionnaire survey of 739 vestibular schwannoma patients (survey response rate, 78%). It not only investigates the decision-making of patients, especially the medical consultation, but also further influences on the therapy decision and the patients’ evaluation of possible side-effects of the treatment.


Only a minority of the patients was informed about radiosurgery and radiotherapy at all.


The praxis of patient counselling of acoustic neuroma patients in Germany is far from the ideal condition of medical consultation: The most important shortcoming is that it is unilateral: About 69% of the patients are informed about only one treatment option, generally surgery. Furthermore, information about side effects is usually insufficient. We recommend to advice all patients on all treatment options by an interdisciplinary team. The counselling should firstly be based on evidence-based medicine and secondly respond to the patients’ individual life situation and preferences.


Vestibular schwannoma Acoustic neuroma Decision-making Radiosurgery Counselling 



We thank Dieter Marten from the Vereinigung Akustikus Neurinom e. V. (VAN) for sending the questionnaires to the VAN members.


  1. 1.
    Aghi M, Barker FG (2006) Benign adult brain tumors: evidence-based medicine review. In: Pollock BE (ed) Guiding neurosurgery by evidence: Progress in Neurological Surgery 19. Karger, Basel, pp 80–96CrossRefGoogle Scholar
  2. 2.
    Backous DD, Pham HT (2007) Guiding patients through the choices for treating vestibular schwannomas: balancing options and ensuring informed consent. Otolaryngol Clin N Am 40:521–540CrossRefGoogle Scholar
  3. 3.
    Bari ME, Forster DM, Kemeny AA, Walton L, Hardy D, Anderson JR (2002) Malignancy in a vestibular schwannoma. Report of a case with central neurofibromatosis, treated by both stereotactic radiosurgery and surgical excision, with a review of the literature. Br J Neurosurg 16(3):284–289CrossRefPubMedGoogle Scholar
  4. 4.
    Berman EL, Eade TN, Brown D, Weaver M, Glass J, Zorman G, Feigenberg SJ (2007) Radiation-induced tumor after stereotactic radiosurgery for an arteriovenous malformation: case report. Neurosurgery 61(5):1099CrossRefGoogle Scholar
  5. 5.
    British Association of Otorhinolaryngologists, Head and Neck Surgeons at The Royal College of Surgeons of England (2002) Clinical effectiveness guidelines: acoustic neuroma (Vestibular Schwannoma). British Association of Otorhinolaryngologists, LondonGoogle Scholar
  6. 6.
    Chakrabarti I, Apuzzo MLJ, Giannotta SL (2003) Acoustic tumors: operation versus radiation—making sense of opposing viewpoints: Clinical Neurosurgery 50. Williams, Baltimore, pp 293–312Google Scholar
  7. 7.
    Chan AW, Black P, Ojemann RG, Barker FG, Kooy HM, Lopes VV, McKenna MJ, Shrieve DC, Martuza RL, Loeffler JS (2005) Stereotactic radiotherapy for vestibular schwannomas: favorable outcome with minimal toxicity. Neurosurgery 57(1):60–70CrossRefPubMedGoogle Scholar
  8. 8.
    Chao ST, Thakkar VV, Jamison B, Reuther AM, Barnett GH, Vogelbaum MA, Angelov L, Toms SA, Neyman G, Suh JH (2007) Prospective study on the short-term adverse effects from gamma knife radiosurgery. Int J Radiat Oncol Biol Phys 3:587–588Google Scholar
  9. 9.
    Combs SE, Volk S, Schulz-Ertner D, Huber PE, Thilmann C, Debus J (2005) Management of acoustic neuromas with fractionated stereotactic radiotherapy (FSRT): long-term results in 106 patients treated in a single institution. Int J Rad Oncol Biol Phys 63(1):75–81Google Scholar
  10. 10.
    Giller CA, Berger BD (2005) New frontiers in radiosurgery for the brain and body. BUMC Proc 18:311–319Google Scholar
  11. 11.
    Jørgensen BG, Pedersen CB (1994) Acoustic neuroma. Follow-up of 78 patients. Clin Otolaryngol 19:478–484CrossRefPubMedGoogle Scholar
  12. 12.
    Koh ES, Millar BA, Ménard C, Michaels H, Heydarian M, Ladak S, McKinnon S, Rutka JA, Guha A, Pond GR, Laperriere NJ (2007) Fractionated stereotactic radiotherapy for acoustic neuroma. Cancer 109(6):1203–1210CrossRefPubMedGoogle Scholar
  13. 13.
    Kondziolka D, Lunsford LD, Flickinger JC (2003) Comparison of management options for patients with acoustic neuromas. Neurosurg Focus 14(5):1–7Google Scholar
  14. 14.
    Lin VYW, Stewart C, Grebenyuk J, Tsao M, Rowed D, Chen J, Nedzelski J (2005) Unilateral acoustic neuromas: long-term hearing results in patients managed with fractionated stereotactic radiotherapy, hearing preservation surgery, and expectantly. Laryngoscope 115:292–296CrossRefPubMedGoogle Scholar
  15. 15.
    Loeffler JS, Niemierko A, Chapman PH (2003) Second tumors after radiosurgery: tip of the iceberg or a bump in the road? Neurosurgery 52(6):1436–1442CrossRefPubMedGoogle Scholar
  16. 16.
    Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D (2005) Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg (Suppl) 102:195–199Google Scholar
  17. 17.
    Maire J, Huchet A, Milbeo Y, Darrouzet V, Causse N, Célérier D, Liguoro D, Bébéar JP (2006) Twenty years’ experience in the treatment of acoustic neuromas with fractionated radiotherapy: a review of 45 cases. Int J Rad Oncol Biol Phys 66(1):170–178Google Scholar
  18. 18.
    Martin HC, Sethi J, Lang D, Neil-Dwyer G, Lutman ME, Yardley L (2001) Patient-assessed outcomes after excision of acoustic neuroma: postoperative symptoms and quality of life. J Neurosurg 94:211–216CrossRefPubMedGoogle Scholar
  19. 19.
    McLean CA, Laidlaw JD, Brownbill DSB, Gonzales MF (1990) Recurrence of acoustic neurilemona as malignant spindle-cell neoplasm. J Neurosurg 73:946–950CrossRefPubMedGoogle Scholar
  20. 20.
    Myrseth E, Møller P, Pedersen PH, Vassbotn FS, Wentzel-Larsen T, Lund-Johansen M (2005) Vestibular schwannomas: clinical results and quality of life after microsurgery and gamma knife radiosurgery. Neurosurgery 56(5):927–935PubMedGoogle Scholar
  21. 21.
    Nikolopoulos TP, Johnson I, O’Donoghue GM (1998) Quality of life after acoustic neuroma surgery. Laryngoscope 108(9):1382–1385CrossRefPubMedGoogle Scholar
  22. 22.
    Parving A, Tos M, Thomsen J, Møller H, Buchwald C (1992) Some aspects of life quality after surgery for acoustic neuroma. Arch Otolaryngol Head Neck Surg 118:1061–1062PubMedGoogle Scholar
  23. 23.
    Poen JC, Golby A, Forster KM, Martin DP, Chinn DM, Hancock SL, Adler JR Jr (1999) Fractionated stereotactic radiosurgery and preservation of hearing in patients with vestibular schwannoma: a preliminary report. Neurosurgery 45(6):1299–1305CrossRefPubMedGoogle Scholar
  24. 24.
    Pollock BE, Driscoll CLW, Foote RL, Link MJ, Gorman DA, Bauch CD, Mandrekar JN, Krecke KN, Johnson CH (2006) Patient outcomes after vestibular schwannoma management. Neurosurgery 59(1):77–85CrossRefPubMedGoogle Scholar
  25. 25.
    Régis J, Roche PH, Delsanti C, Thomassin JM, Ouaknine M, Gabert K, Pellet W (2007) Modern management of vestibular schwannomas. In: Szeifert GT, Kondziolka D, Levivier M, Lunsford LD (eds) Radiosurgery and pathological fundamentals: radiosurgery and pathological fundamentals. Karger, Basel, pp 129–141CrossRefGoogle Scholar
  26. 26.
    Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40(1):11–23CrossRefPubMedGoogle Scholar
  27. 27.
    Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery 40(2):248–262CrossRefPubMedGoogle Scholar
  28. 28.
    Sandooram D, Grunfeld EA, McKinney C, Gleeson MJ (2004) Quality of life following microsurgery, radiosurgery and conservative management for unilateral vestibular schwannoma. Clin Otolaryngol 29:621–627CrossRefPubMedGoogle Scholar
  29. 29.
    Sanosi AA, Fagan PA, Biggs NDW (2006) Conservative management of acoustic neuroma. Skull Base 16(2):95–99CrossRefPubMedGoogle Scholar
  30. 30.
    Sawamura Y, Shirato H, Sakamoto T, Aoyama H, Suzuki K, Onimaru R, Isu T, Fukuda S, Miyasaka K (2003) Management of vestibular schwannoma by fractionated stereotactic radiotherapy and associated cerebrospinal fluid malabsorption. J Neurosurg 99:685–692CrossRefPubMedGoogle Scholar
  31. 31.
    Selch MT, Pedroso A, Lee SP, Solberg TD, Agazaryan N, Cabatan-Awang C, DeSalles AAF (2004) Stereotactic radiotherapy for the treatment of acoustic neuromas. J Neurosurg 101(Suppl 3):362–372PubMedGoogle Scholar
  32. 32.
    Shamisa A, Bance M, Nag S, Tator C, Wong S, Norén G, Guha A (2001) Glioblastoma multiforme occurring in a patient treated with gamma knife surgery. Case report and review of the literature. J Neurosurg 94:816–821CrossRefPubMedGoogle Scholar
  33. 33.
    Swan IRC (2000) Is early management of acoustic neuroma important? J R Soc Med 93:614–617PubMedGoogle Scholar
  34. 34.
    Thilmann C, Schulz-Ertner D, Unterberg A, Wannenmacher M, Debus J (2004) Stereotaktische strahlenbehandlung schädelbasisnaher meningeome und schwannome. Dtsch Arztebl 101(15):A1022–A1026Google Scholar
  35. 35.
    Tos T, Caye-Thomasen P, Stangerup SE, Tos M, Thomsen J (2003) Long-term socio-economic impact of vestibular schwannoma for patients under observation and after surgery. J Laryngol Otol 117(12):955–964CrossRefPubMedGoogle Scholar
  36. 36.
    Unger F, Walch C, Papaefthymiou G, Eustacchio S, Feichtinger K, Quehenberger F, Pendl G (2002) Long term results of radiosurgery for vestibular schwannomas. Zentralbl Neurochir 63:52–58CrossRefPubMedGoogle Scholar
  37. 37.
    Van Roijen L, Nijs HGT, Avezaat CJJ, Karlsson G, Linquist C, Pauw KH, Rutten FFH (1997) Costs and effects of microsurgery versus radiosurgery in treating acoustic neuroma. Acta Neurochir 139:942–948CrossRefGoogle Scholar
  38. 38.
    Yamakami I, Uchino Y, Kobayashi E, Yamaura A (2003) Conservative management, gamma-knife radiosurgery, and microsurgery for acoustic neurinomas: a systematic review of outcome and risk of three therapeutic options. Neurol Res 25:682–690CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Sabine Müller
    • 1
  • Judith Arnolds
    • 2
  • Ansel van Oosterhout
    • 3
  1. 1.Division of Medical Psychology, Department of Psychiatry and PsychotherapyUniversity Hospital BonnBonnGermany
  2. 2.Clinic and Policlinic for Ear, Nose and Throat MedicineUniversity EssenEssenGermany
  3. 3.Gamma Knife CenterUniversity Hospital AachenAachenGermany

Personalised recommendations