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Multimodality Treatment of Large Vestibular Schwannomas

  • OTOLOGY: Vestibular Schwannomas (RA Friedman and M Schwartz, Section Editors)
  • Published:
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Abstract

Purpose of Review

Vestibular schwannomas are WHO grade I tumors of the eighth cranial nerve that lead to hearing loss, tinnitus, vestibular dysfunction, and facial nerve compromise. The management of vestibular schwannomas consists of observation, radiosurgery, or microsurgical resection. In this review, we discuss the various treatment modalities specifically targeting large vestibular schwannomas in addition to their treatment risk profiles.

Recent Findings

Although there has been a trend towards treatment with radiosurgery for smaller lesions, consensus reports still advocate for surgical debulking in patients with large vestibular schwannomas. There has been a shift in management philosophy towards functional preservation at the cost of more extensive resection, yet subtotal resection of vestibular schwannomas is associated with higher rates of recurrence on follow-up. Some groups have demonstrated new promise for the management of large vestibular schwannomas with stereotactic radiosurgery alone and multimodality therapy involving subtotal surgical resection with planned postoperative radiosurgery to residual tumor.

Summary

Although most groups would still advocate for microsurgical debulking of large vestibular schwannomas with evidence of brainstem compression, hybrid treatment strategies have become preferable. More work is required to determine which patients are at risk of progression after a subtotal resection to stratify those who should or should not receive postoperative stereotactic radiosurgery.

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Funding

This study was funded by the National Center for Advancing Translational Sciences of the NIH (RAM) and the Neurosurgery Research and Education Foundation (RAM).

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Authors and Affiliations

  1. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA

    Ramin A. Morshed, Tarun Arora & Philip V. Theodosopoulos

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  1. Ramin A. Morshed
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  2. Tarun Arora
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  3. Philip V. Theodosopoulos
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Correspondence to Philip V. Theodosopoulos.

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Morshed, R.A., Arora, T. & Theodosopoulos, P.V. Multimodality Treatment of Large Vestibular Schwannomas. Curr Otorhinolaryngol Rep 9, 155–161 (2021). https://doi.org/10.1007/s40136-021-00336-8

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