Incidental vestibular schwannomas: A review of prevalence, growth rate, and management challenges

TY - JOUR

T1 - Incidental vestibular schwannomas

T2 - A review of prevalence, growth rate, and management challenges

AU - Schmidt, Richard F.

AU - Boghani, Zain

AU - Choudhry, Osamah J.

AU - Eloy, Jean Anderson

AU - Jyung, Robert W.

AU - Liu, James K.

PY - 2012/9

Y1 - 2012/9

N2 - With the relatively recent increase in the use of MRI techniques, there has been a concurrent rise in the number of vestibular schwannomas (VSs) detected as incidental findings. These incidental VSs may be prevalent in up to 0.02%-0.07% of individuals undergoingMRI and represent a significant portion of all diagnosed VSs. The management of these lesions poses a significant challenge for practitioners. Most incidental VSs tend to be small and associated with minimal symptoms, permitting them to be managed conservatively at the time of diagnosis.However,relatively few indicators consistently predict tumor growthand patient outcomes.Furthermore, growth rates have been shown to vary significantly overtime with a large variety of long-term growth patterns.Thus,early MRI screening for continued tumor growth followed by repeated MRI studies and clinical assessments throughout thepatient's life is an essential component in a conservative management strategy.Note that tumor growth is typically associated with a worsening of symptoms in patientswho undergo conservative management, and many of these symptoms have been shown to significantly impact the patient's quality of life. Specific indications for the termination of conservative management vary across studies, but secondary intervention has been shown to be a relatively safe option in most patients with progressive disease. Patients with incidental VSswill probably qualify for a course of conservative management at diagnosis,and regular imaging combined with the expectation that the tumor and symptoms may change at any interval is crucial to ensuring positive long-term outcomes in these patients. In this report, the authors discuss the current literature pertaining to the prevalence of incidental VSs and various considerations in the management of these lesions. It is hoped that by incorporating an understanding of tumor growth, patient outcomes, and management strategies,practitioners will be able to effectively address this challenging disease entity.

AB - With the relatively recent increase in the use of MRI techniques, there has been a concurrent rise in the number of vestibular schwannomas (VSs) detected as incidental findings. These incidental VSs may be prevalent in up to 0.02%-0.07% of individuals undergoingMRI and represent a significant portion of all diagnosed VSs. The management of these lesions poses a significant challenge for practitioners. Most incidental VSs tend to be small and associated with minimal symptoms, permitting them to be managed conservatively at the time of diagnosis.However,relatively few indicators consistently predict tumor growthand patient outcomes.Furthermore, growth rates have been shown to vary significantly overtime with a large variety of long-term growth patterns.Thus,early MRI screening for continued tumor growth followed by repeated MRI studies and clinical assessments throughout thepatient's life is an essential component in a conservative management strategy.Note that tumor growth is typically associated with a worsening of symptoms in patientswho undergo conservative management, and many of these symptoms have been shown to significantly impact the patient's quality of life. Specific indications for the termination of conservative management vary across studies, but secondary intervention has been shown to be a relatively safe option in most patients with progressive disease. Patients with incidental VSswill probably qualify for a course of conservative management at diagnosis,and regular imaging combined with the expectation that the tumor and symptoms may change at any interval is crucial to ensuring positive long-term outcomes in these patients. In this report, the authors discuss the current literature pertaining to the prevalence of incidental VSs and various considerations in the management of these lesions. It is hoped that by incorporating an understanding of tumor growth, patient outcomes, and management strategies,practitioners will be able to effectively address this challenging disease entity.

KW - Acoustic neuroma

KW - Conservative management

KW - Hearing preservation

KW - Incidental lesion

KW - Quality of life

KW - Tumor growth

KW - Vertigo

KW - Vestibular schwannoma

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U2 - 10.3171/2012.7.FOCUS12186

DO - 10.3171/2012.7.FOCUS12186

M3 - Article

C2 - 22937855

SN - 1092-0684

VL - 33

JO - Neurosurgical focus

JF - Neurosurgical focus

IS - 3

M1 - E4

ER -