Abstract
Vestibular schwannomas (VSs, also known as acoustic neuromas) are relatively rare benign brain tumors stem from the Schwann cells of the eighth cranial nerve. Tumor growth is the paramount factor for neurosurgeons to decide whether to choose aggressive treatment approach or careful follow-up with regular magnetic resonance imaging (MRI), as surgery and radiation can introduce significant trauma and affect neurological function, while tumor enlargement during long-term follow-up will compress the adjacent nerves and tissues, causing progressive hearing loss, tinnitus and vertigo. Recently, with the deepening research of VS biology, some proteins that regulate merlin conformation changes, inflammatory cytokines, miRNAs, tissue proteins and cerebrospinal fluid (CSF) components have been proposed to be closely related to tumor volume increase. In this review, we discuss advances in the study of biomarkers that associated with VS growth, providing a reference for exploring the growth course of VS and determining the optimal treatment strategy for each patient.
Highlights
VSs are histologically benign lesions deriving from the Schwan cells of the vestibulo-cochlear nerve commonly occur unilaterally, or bilaterally in the pathognomonic for the hereditary disorder neurofibromatosis type 2 (NF2) [1, 2]
Merlin exerts its growth suppressive function by modulating the activity of intracellular promitogenic signal cascades related to tumor
VS is a benign but potentially devastating tumor whose aggressively growth can be associated with significant morbidity including deafness and facial neuropathy
Summary
VSs are histologically benign lesions deriving from the Schwan cells of the vestibulo-cochlear nerve commonly occur unilaterally, or bilaterally in the pathognomonic for the hereditary disorder neurofibromatosis type 2 (NF2) [1, 2]. The goal of VS treatment has shifted from saving lives towards functional preservation, with multifaceted decision including watch-wait-rescan protocol, surgical resection and radiation [4, 5]. We can see from the literature that two-thirds of VS did not grow during 3.6 years of follow-up, the average growth rate of sporadic VS was 1.1 mm/year diameter, and for NF2-related tumors 1.7 mm/year [8, 9], supporting the wait and watch policy in appropriate patients. A study showed that conservative management in small‐ to medium‐ sized VS (less than 2cm) can improve rates of facial nerve preservation and hearing protection in comparison to patients who undergo primary surgical treatment [10]. For stable or Vestibular Schwannoma Growth Biomarkers involuting tumors with no mass effect, or elderly patients who will suffer higher risk of comorbidities, the continuing trend toward observation with regular follow-up imaging is reasonable [5, 11]
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