Principles of diagnosis and treatment of vestibular schwannoma: a literature review

Abstract

Background. Vestibular schwannoma is a formation of Schwann cells in the vestibulocochlear zone. Despite the benign nature of the tumor, it carries risks for life, as its massiveness poses a threat to intracranial structures and their functional capacity. The purpose of the study is to conduct an analysis of modern information on the diagnosis and methods of treatment of schwannoma. Materials and methods. A literature search using keywords was conducted in Web of Science, Scopus, PubMed, Elsevier, and Springer databases. Results. In most cases, vestibular schwannoma is diagnosed after a number of symptoms are detected such as dizziness, hearing loss, etc. According to modern research, magnetic resonance imaging and audiogram are the most informative and at the same time gold standard for diagnosis, and verification is carried out based on pathohistology. Most schwannomas are clinically stable; however, when analyzing the information, the main approaches in the presence of such a diagnosis were determined. The safest and most non-invasive one is observation, with control of the dynamics of the clinical picture and the size of the formation. However, there are several surgical techniques for complete tumor removal. The most common of them is access through the middle cranial fossa, which, unfortunately, has several limitations. Translabyrinthine and retrosigmoid approaches are also used. The choice of treatment depends on the size, growth and symptoms of the patients. Radiotherapy is one of the relatively new methods of treatment, it is sometimes combined with a surgery. Conclusions. Thus, vestibular schwannoma requires active monitoring and the use of other treatment methods. In the presence of clinical indications, a combination of different types of treatment allows achieving positive therapeutic outcomes. A perspective for future research is the study of targeted gene therapy.