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59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Observation in vestibular schwannomas: a clinical study

Beobachtung bei Vestibularisschwannomen: eine klinische Studie

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  • corresponding author T. Schweitzer - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum Würzburg
  • J. Coburger - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum Würzburg
  • E. Peltz - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum Würzburg
  • R. Hagen - Klinik für HNO-Heilkunde, Universitätsklinikum Würzburg
  • K. Roosen - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum Würzburg
  • C. Matthies - Neurochirurgische Klinik und Poliklinik, Universitätsklinikum Würzburg

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMI.01.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc212.shtml

Published: May 30, 2008

© 2008 Schweitzer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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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%.