CONSERVATIVE OR SURGICAL TREATMENT OF A VESTIBULAR SCHWANNOMA

Abstract

To the Editor: In the recent publication of Malhotra et al. "Clinical, radiographic, and audiometric predictors in conservative management of vestibular schwannoma" (1), we have noticed 2 flaws. In their article, which we read with interest, the conservative management of 202 patients with a vestibular schwannoma is discussed, and univariate and multivariate analyses were performed. We subscribe the need and use of a wait-and-scan policy in vestibular schwannomas because their tendency for growth and complications is on average low. Our main remark is regarding their discussion. Regarding radiotherapy and surgical treatment of vestibular schwannomas, they are stating that "these treatments carry nonnegligible consequences in terms of morbidity, mortality and quality of life." For mortality and facial nerve preservation, the risk is quoted and referred to recent articles. However, cerebrospinal fluid (CSF) leakage is quoted as approximately 15% with no reference. This is a wrong presumption and, without reference, not a sustainable figure. We have studied our result for many years with one of the largest series of surgical removal of vestibular schwannomas with a CSF leak rate of 0 and 1.4% (2,3). Even when not quoting the least amount of CSF rate reported in literature (2,3), a recent review has calculated an overall rate of 9.5% (4). We think that CSF leak in vestibular schwannoma surgery can be reduced to an absolute minimum with the use of the right surgical procedure (5). Malhotra et al. is furthermore stating in their introduction that "the present article describes the largest single-institution series of VS patients followed by conservative management," whereas for many years, the ENT Department of the Gentofte University Hospital in Copenhagen, Denmark, has the largest series. They even quote and refer (ref. [29]) to this series of 552 patients in their own article (6). Paul Merkus, M.D., Ph.D. Mario Sanna, M.D. Department of Otology and Skull Base Surgery Grupo Otologico Piacenza, Italy