Guidelines
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] :
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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
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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
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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
Media Gallery
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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.
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A small acoustic neuroma within the internal auditory canal is easily observed on postgadolinium MRI.
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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.
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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.
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The bone that must be removed for a middle cranial fossa approach is indicated in yellow. The tumor is in orange.
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The bone that must be removed for a translabyrinthine approach is indicated in yellow. The tumor is in orange.
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The bone that must be removed for a posterior fossa approach is indicated in yellow. The tumor is in orange.
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