Abstract
Objective:
To review the literature on the diagnosis and treatment of vestibular schwannoma.
Methods:
Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.
Results:
The topics were divided into 2 parts: (1) Diagnosis – audiologic, electrophysiologic tests, and imaging; (2) Treatment – wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy.
Conclusions:
Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.
KEYWORDS
Vestibular schwannoma; Neuroma, acoustic; Hearing loss, sensorineural; Single sided deafness; Radiotherapy; Neurofibromatosis 2; Auditory brain stem implants; Cochlear implant; Surgery
HIGHLIGHTS
In asymmetric SNHL, MRI should be performed regardless of ABR results.
Gadolinium-enhanced MRI is the gold standard exam for suspected VS.
Intervention is indicated for tumors with significant growth (≥2 mm/year) and/or on Koos grade III and IV.
Radiotherapy may be indicated as primary treatment in selected cases; however, there is still controversy surrounding long-term effectiveness and safety, especially in young patients.
Surgery is superior to radiotherapy in order to preserve serviceable hearing in patients with VS.
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