Artikel
Observation in vestibular schwannomas: a clinical study
Beobachtung bei Vestibularisschwannomen: eine klinische Studie
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Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: To compare the advantages and disadvantages of observation of patients with vestibular schwannomas (VS).
Methods: Patient counselling by the interdisciplinary team includes description of observation, microsurgical resection and radiosurgery. Over a period of 3 years, 52 patients decided in favour of observing their VS instead of invasive treatment. In a retrospective study, the development of clinical symptoms such as hypacusis, tinnitus, dizziness and disease progression were analysed along with factors leading to microsurgery or radiotherapy or ongoing observation.
Results: The average observation period was 49 months. During this observation period, auditory function never improved, but remained stable in 18 patients, while 34 patients experienced a significant deterioration in hearing. Out of 52 patients, 25 did not wish or did not need any treatment. In 27 patients treatment became necessary, 21 of those were operated and 6 opted for radiosurgery. Regarding patients’ reasons for postponing surgery, the anxiety about facial palsy (14) and deafness (13) were listed whereas general surgical risks, anesthesia or hemorrhage were of minor importance. A further major reason for rejecting or postponing therapy was a contralateral auditory deficit in 8 patients.
Conclusions: After an average observation period of 49 months, the wait and scan policy could be continued in 48% of patients. While the patients’ dominant argument against invasive therapy was cranial nerve deficits, 63% of patients with VS experienced deterioration of auditory function during observation. Chances for functional nerve preservation are reduced in delayed treatment which had to be performed in 52%.