Guidelines Summary

In 2018, the Congress of Neurological Surgeons released a series of guidelines on the diagnosis and management of vestibular schwannomas.^{[31, 32, 33, 34, 35, 36]}The group’s guidelines concerning hearing preservation in patients with sporadic vestibular schwannomas include the following^[37]:

Patients whose baseline hearing meets the criteria for American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or Gardner-Robertson hearing classification (GR) grade I and who are considering stereotactic radiosurgery utilizing modern dose planning, should be counseled that there is a high probability (>75-100%) of hearing preservation at 2 years, a moderately high probability (>50-75%) of hearing preservation at 5 years, and a moderately low probability (>25-50%) of hearing preservation at 10 years
Patients with AAO-HNS class A or GR grade I hearing at baseline who are considering microsurgical resection of small to medium-sized sporadic vestibular schwannomas should be counseled that there is a moderately high probability (>50-75%) of hearing preservation immediately following surgery, a moderately high probability (>50-75%) of hearing preservation at 2 years, a moderately high probability (>50-75%) of hearing preservation at 5 years, and a moderately low probability (>25-50%) of hearing preservation at 10 years
Patients with AAO-HNS class A or GR grade I hearing at baseline should be counseled that, if they undergo management with conservative observation, there is a high probability (>75-100%) of hearing preservation at 2 years and a moderately high probability (>50-75%) of hearing preservation at 5 years; insufficient data were available to determine the probability of hearing preservation at 10 years for these patients

Questions

Foley RW, Shirazi S, Maweni RM, et al. Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis. Cureus. 2017 Nov 15. 9 (11):e1846. [QxMD MEDLINE Link]. [Full Text].
Tan M, Myrie OA, Lin FR, et al. Trends in the management of vestibular schwannomas at Johns Hopkins 1997-2007. Laryngoscope. 2010 Jan. 120 (1):144-9. [QxMD MEDLINE Link]. [Full Text].
Carlson ML, Habermann EB, Wagie AE, et al. The Changing Landscape of Vestibular Schwannoma Management in the United States--A Shift Toward Conservatism. Otolaryngol Head Neck Surg. 2015 Sep. 153 (3):440-6. [QxMD MEDLINE Link].
Lin D, Hegarty JL, Fischbein NJ, et al. The prevalence of "incidental" acoustic neuroma. Arch Otolaryngol Head Neck Surg. 2005 Mar. 131(3):241-4. [QxMD MEDLINE Link].
Pettersson D, Mathiesen T, Prochazka M, et al. Long-term mobile phone use and acoustic neuroma risk. Epidemiology. 2014 Mar. 25 (2):233-41. [QxMD MEDLINE Link]. [Full Text].
Lee SH, Choi SK, Lim YJ, et al. Otologic manifestations of acoustic neuroma. Acta Otolaryngol. 2015 Feb. 135(2):140-6. [QxMD MEDLINE Link].
Koos WT, Spetzler RF, Lang J. Color Atlas of Microneurosurgery. 2nd ed. New York: Thieme Medical Pubs; 1993. 530-2.
Frischer JM, Gruber E, Schoffmann V, et al. Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study. J Neurosurg. 2018 Mar 2. 1-10. [QxMD MEDLINE Link]. [Full Text].
Tveiten OV, Carlson ML, Goplen F, Vassbotn F, Link MJ, Lund-Johansen M. Long-term Auditory Symptoms in Patients With Sporadic Vestibular Schwannoma: An International Cross-Sectional Study. Neurosurgery. 2015 Aug. 77 (2):218-27; discussion 227. [QxMD MEDLINE Link].
Goldbrunner R, Weller M, Regis J, et al. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro Oncol. 2020 Jan 11. 22 (1):31-45. [QxMD MEDLINE Link]. [Full Text].
Telian SA. Management of the small acoustic neuroma: a decision analysis. Am J Otol. 1994 May. 15(3):358-65. [QxMD MEDLINE Link].
D'Haese S, Parmentier H, Keppler H, et al. Vestibular schwannoma: natural growth and possible predictive factors. Acta Otolaryngol. 2019 Sep. 139 (9):753-8. [QxMD MEDLINE Link].
Whitehouse K, Foroughi M, Shone G, Hatfield R. Vestibular schwannomas - when should conservative management be reconsidered?. Br J Neurosurg. 2010 Apr. 24 (2):185-90. [QxMD MEDLINE Link].
Reznitsky M, Caye-Thomasen P. Systematic Review of Hearing Preservation in Observed Vestibular Schwannoma. J Neurol Surg B Skull Base. 2019 Apr. 80 (2):165-8. [QxMD MEDLINE Link]. [Full Text].
Stangerup SE, Tos M, Thomsen J, Caye-Thomasen P. Hearing outcomes of vestibular schwannoma patients managed with 'wait and scan': predictive value of hearing level at diagnosis. J Laryngol Otol. 2010 May. 124 (5):490-4. [QxMD MEDLINE Link].
Hunter JB, Dowling EM, Lohse CM, et al. Hearing Outcomes in Conservatively Managed Vestibular Schwannoma Patients With Serviceable Hearing. Otol Neurotol. 2018 Sep. 39 (8):e704-11. [QxMD MEDLINE Link].
Lees KA, Tombers NM, Link MJ, et al. Natural History of Sporadic Vestibular Schwannoma: A Volumetric Study of Tumor Growth. Otolaryngol Head Neck Surg. 2018 Sep. 159 (3):535-42. [QxMD MEDLINE Link].
Ostler B, Killeen DE, Reisch J, et al. Patient Demographics Influencing Vestibular Schwannoma Size and Initial Management Plans. World Neurosurg. 2020 Apr. 136:e440-6. [QxMD MEDLINE Link]. [Full Text].
Hoa M, Drazin D, Hanna G, Schwartz MS, Lekovic GP. The approach to the patient with incidentally diagnosed vestibular schwannoma. Neurosurg Focus. 2012 Sep. 33 (3):E2. [QxMD MEDLINE Link]. [Full Text].
Hansen MR, Clark JJ, Gantz BJ, et al. Effects of ErbB2 signaling on the response of vestibular schwannoma cells to gamma-irradiation. Laryngoscope. 2008 Jun. 118(6):1023-30. [QxMD MEDLINE Link].
Boari N, Bailo M, Gagliardi F, et al. Gamma Knife radiosurgery for vestibular schwannoma: clinical results at long-term follow-up in a series of 379 patients. J Neurosurg. 2014 Dec. 121 Suppl:123-42. [QxMD MEDLINE Link].
Kim YH, Kim DG, Ho Han J, Chung HT, Kim IK, Song SW, et al. Hearing Outcomes After Stereotactic Radiosurgery for Unilateral Intracanalicular Vestibular Schwannomas: Implication of Transient Volume Expansion. Int J Radiat Oncol Biol Phys. 2012 May 12. [QxMD MEDLINE Link].
Nellis JC, Sharon JD, Pross SE, et al. Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment. Otol Neurotol. 2016 Dec 7. [QxMD MEDLINE Link].
Sylvester MJ, Shastri DN, Patel VM, et al. Outcomes of Vestibular Schwannoma Surgery among the Elderly. Otolaryngol Head Neck Surg. 2017 Jan. 156 (1):166-172. [QxMD MEDLINE Link].
Miller ME, Lin H, Mastrodimos B, Cueva RA. Long-term MRI surveillance after microsurgery for vestibular schwannoma. Laryngoscope. 2017 Sep. 127 (9):2132-8. [QxMD MEDLINE Link].
Carlson ML, Van Abel KM, Driscoll CL, et al. Magnetic resonance imaging surveillance following vestibular schwannoma resection. Laryngoscope. 2012 Feb. 122 (2):378-88. [QxMD MEDLINE Link].
Luryi AL, Babu S, Michaelides EM, Kveton JF, Bojrab DI, Schutt CA. Association Between Body Mass Index and Complications in Acoustic Neuroma Surgery. Otolaryngol Head Neck Surg. 2020 Apr. 162 (4):538-43. [QxMD MEDLINE Link].
Bell JR, Anderson-Kim SJ, Low C, Leonetti JP. The Persistence of Tinnitus after Acoustic Neuroma Surgery. Otolaryngol Head Neck Surg. 2016 Apr 19. [QxMD MEDLINE Link].
Alvarez L, Ugarte A, Goiburu M, Urreta Barallobre I, Altuna X. Change in tinnitus after acoustic neuroma removal using a translabyrinthine approach. A Prospective study. Acta Otorrinolaringol Esp. 2016 Apr 8. [QxMD MEDLINE Link].
Rosenberg SI. Natural history of acoustic neuromas. Laryngoscope. 2000 Apr. 110(4):497-508. [QxMD MEDLINE Link].
Sweeney AD, Carlson ML, Shepard NT, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Otologic and Audiologic Screening for Patients With Vestibular Schwannomas. Neurosurgery. 2018 Feb 1. 82 (2):E29-E31. [QxMD MEDLINE Link].
Dunn IF, Bi WL, Mukundan S, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Imaging in the Diagnosis and Management of Patients With Vestibular Schwannomas. Neurosurgery. 2018 Feb 1. 82 (2):E32-4. [QxMD MEDLINE Link].
Sughrue ME, Fung KM, Van Gompel JJ, Peterson JEG, Olson JJ. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Pathological Methods and Prognostic Factors in Vestibular Schwannomas. Neurosurgery. 2018 Feb 1. 82 (2):E47-8. [QxMD MEDLINE Link].
Vivas EX, Carlson ML, Neff BA, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Intraoperative Cranial Nerve Monitoring in Vestibular Schwannoma Surgery. Neurosurgery. 2018 Feb 1. 82 (2):E44-6. [QxMD MEDLINE Link].
Van Gompel JJ, Agazzi S, Carlson ML, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Emerging Therapies for the Treatment of Patients With Vestibular Schwannomas. Neurosurgery. 2018 Feb 1. 82 (2):E52-4. [QxMD MEDLINE Link].
Hadjipanayis CG, Carlson ML, Link MJ, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Surgical Resection for the Treatment of Patients With Vestibular Schwannomas. Neurosurgery. 2018 Feb 1. 82 (2):E40-3. [QxMD MEDLINE Link].
Carlson ML, Vivas EX, McCracken DJ, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Hearing Preservation Outcomes in Patients With Sporadic Vestibular Schwannomas. Neurosurgery. 2018 Feb 1. 82 (2):E35-9. [QxMD MEDLINE Link].

Media Gallery

This table shows the distribution of presenting symptoms, ie, the symptom that brought the patient to a physician and that constituted the patient's chief ailment.
A small acoustic neuroma within the internal auditory canal is easily observed on postgadolinium MRI.
These large bilateral acoustic neuromas are easily observed on MRI. This patient has neurofibromatosis II. Both tumors were eventually removed, leading to anacusis. Facial nerve function remained entirely normal bilaterally.
The nerves of the internal auditory canal as observed in a cadaveric dissection are shown. The posterior wall of the internal auditory canal has been removed. F indicates the facial nerve. S is the superior vestibular nerve. VIII indicates the statoacoustic nerve as it leaves the brain stem, and P indicates the posterior ampullary nerve. The hollow arrow points to the posterior lip of the boney porous acusticus, and the solid arrow indicates the position of the vestibule. C indicates the cochlear aqueduct.
The bone that must be removed for a middle cranial fossa approach is indicated in yellow. The tumor is in orange.
The bone that must be removed for a translabyrinthine approach is indicated in yellow. The tumor is in orange.
The bone that must be removed for a posterior fossa approach is indicated in yellow. The tumor is in orange.

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Author

Joe Walter Kutz, Jr, MD, FACS Associate Professor, Associate Residency Director, Neurotology Fellowship Director, Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School

Joe Walter Kutz, Jr, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Neurotology Society, Otosclerosis Study Group, Texas Medical Association, Triological Society

Disclosure: Received income in an amount equal to or greater than $250 from: Alcon; Medtronic; Eloxx.

Coauthor(s)

Brandon Isaacson, MD, FACS Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center

Brandon Isaacson, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, North American Skull Base Society, Texas Medical Association, Triological Society, American Neurotology Society

Disclosure: Received consulting fee from Medtronic Midas Rex Insitute for consulting; Received medical advisory board from Advanced Bionics for board membership; Received consulting fee from Stryker for speaking and teaching.

Ellen Wang, MD Resident Physician, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gerard J Gianoli, MD Clinical Associate Professor, Departments of Otolaryngology-Head and Neck Surgery and Pediatrics, Tulane University School of Medicine; President, The Ear and Balance Institute; Board of Directors, Ponchartrain Surgery Center

Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, Triological Society

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

Peter S Roland, MD Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director, Clinical Center for Auditory, Vestibular, and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Chief of Pediatric Otology, Children’s Medical Center of Dallas; President of Medical Staff, Parkland Memorial Hospital; Adjunct Professor of Communicative Disorders, School of Behavioral and Brain Sciences, Chief of Medical Service, Callier Center for Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Neurotology Society, American Otological Society, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, The Triological Society

Disclosure: Received honoraria from Alcon Labs for consulting; Received honoraria from Advanced Bionics for board membership; Received honoraria from Cochlear Corp for board membership; Received travel grants from Med El Corp for consulting.

Acknowledgements

Douglas D Backous, MD Director of Listen for Life Center, Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center

Douglas D Backous, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Association for Research in Otolaryngology, North American Skull Base Society, Society for Neuroscience, and Washington State Medical Association

Disclosure: Nothing to disclose.

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