gms | German Medical Science

The vestibular schwannoma (VS) is a benign neoplasm originating from the neurolemmal sheath of the vestibular branch of the VIIIth cranial nerve. Decisions about the therapy option could benefit from a better understanding of biological and clinical behaviour of VS and the conditions that influence tumor growth. The present study was undertaken to determine the clinical growth index (CGI) of a series of 118 unilateral VSs and investigate whether VS growth, symptom duration and tumor size are related to tumor localization and patient sex and age.

We analyzed the findings of a series of 118 patients with a diagnosis of unilateral VS based on clinical history, audiometry and radiological appearances (MRI). CGI was calculated by dividing tumor size by the length of clinical history. CGI, symptom duration and tumor size were tested for a relationship with tumor localization and patient sex and age. All tests were performed for the total group and also separately for the three subgroups: intrameatal tumors (IT group, 46 VSs), intrameatal and extrameatal tumors (IET group, 60 VSs), and extrameatal tumors (ET group, 12 VSs).

VS diameter ranged from 3 to 40 mm (mean size, 14.3 ± 7.6 mm). The maximum tumor diameter was highly significantly greater for the IET group (17.9 ± 6.5 mm) and the ET group (19.3 ± 8.5 mm) than for the IT group (8.5 ± 4.3 mm)(p=0.000). The mean CGI was determined as being 31.3 ± 55.7 mm/yr for the total group. A significant lower CGI was found for the IT group (14.7 ± 25.3 mm/yr) compared with the IET group (41.9 ± 69.2 mm/yr) and the ET group (43.3 ± 52.4 mm/yr) (p=0.031). A significant negative correlation between the CGI and the age of the patients could be noted for both the total group (p=0.010) and the IET group (p=0.017). A significant negative correlation between the tumor size and the age of the patients was determined for the ET group (p=0.22).

This study demonstrates a lower clinical growth index and smaller tumors in the older population supporting previous results of extensive radiological studies. Even though the clinical appearance is still the basis for decisions about the therapy our data might support the role of conservative management (“wait-and-scan” policy) of vestibular schwannoma in the elderly.