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Evolution in the management of vestibular schwannoma: a single-center 15-year experience

  • Otology
  • Published:
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Abstract

Purpose

To highlight the changes in the management of vestibular schwannoma (VS) since 2004 with a focus on small- to middle-size VS.

Methods

Retrospective analysis of the decisions made in skull base tumor board between 2004 and 2021.

Results

1819 decisions were analyzed (average age 59.25, 54% females). Overall, 850 (47%) cases were allocated to a Wait and Scan (WS) approach, 416 (23%) received radiotherapy and 553 (30%) were treated surgically (MS). All stages considered WS increased from 39% before 2010 to 50% after 2010. Similarly, Stereotactic Radio Therapy (SRT) increased from 5 to 18%. MS decreased from 46 to 25%. It was more commonly proposed to younger patients and larger tumors, p < 0.001. For Koos stages 1, 2, and 3 there was a statistically significant increase in SRT, and a decrease in MS, p < 0.001. WS also increased for stages 1 and 2. However, such a trend was not observed for stage 3. MS remained the primary treatment modality for stage 4 tumors throughout the study period, p = 0.057. The significance of advanced age as a factor favoring SRT decreased over time. The opposite is true for serviceable hearing. There was also a decrease in the percentage of the justification “young age” in the MS category.

Conclusion

The is a continuing trend towards non-surgical treatment. Small- to medium-sized VS witnessed an increase in both WS and SRT. There is only an increase in SRT for moderately large VS. Physicians are less and less considering young age as a factor favoring MS over SRT. There is a tendency towards favoring SRT when hearing is serviceable.

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Author notes

  1. Olivier Deguine and Mathieu Marx contribuated equally to the manuscript.

Authors and Affiliations

  1. Department of Otology, Otoneurology and Pediatric Otolaryngology, Pierre-Paul Riquet Hospital, Toulouse University hospital, Toulouse, France

    Youssef El Sayed Ahmad, Yohan Gallois, Olivier Deguine & Mathieu Marx

  2. Neuro-Surgery Department, CHU de Toulouse, Purpan, 31000, Toulouse, France

    Jean Christophe Sol & Sergio Boetto

  3. Radiotherapy Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France

    Justine Attal

  4. Department of Neuroradiology, Purpan Hospital, Toulouse, France

    Jean Sabatier

  5. Department of Neurology, Pierre-Paul Riquet/Purpan University Hospital, Toulouse, France

    Rachel Debs

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Correspondence to Youssef El Sayed Ahmad.

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El Sayed Ahmad, Y., Gallois, Y., Sol, J.C. et al. Evolution in the management of vestibular schwannoma: a single-center 15-year experience. Eur Arch Otorhinolaryngol 280, 4885–4894 (2023). https://doi.org/10.1007/s00405-023-08009-6

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