Abstract
Background and objectiveThe optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective.Material and methodsA systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. A subgroup analysis screening all surgical series published within the last 20 years (January 2000 to March 2020) was performed. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using meta-analysis models. This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management.ResultsTumor classification grades should be systematically used in the perioperative management of patients, with large vestibular schwannomas (VS) defined as > 30 mm in the largest extrameatal diameter. Grading scales for pre- and postoperative hearing (AAO-HNS or GR) and facial nerve function (HB) are to be used for reporting functional outcome. There is a lack of consensus to support the superiority of any surgical strategy with respect to extent of resection and use of adjuvant radiosurgery. Intraoperative neuromonitoring needs to be routinely used to preserve neural function. Recommendations for postoperative clinico-radiological evaluations have been elucidated based on the surgical strategy employed.ConclusionThe main goal of management of large vestibular schwannomas should focus on maintaining/improving quality of life (QoL), making every attempt at facial/cochlear nerve functional preservation while ensuring optimal oncological control, thereby allowing to meet patient expectations. Despite the fact that this analysis yielded only a few Class B evidences and mostly expert opinions, it will guide practitioners to manage these patients and form the basis for future clinical trials.
Highlights
Vestibular schwannomas (VS) are histologically benign and typically slow-growing tumors that most commonly ariseThis article is part of the Topical Collection on Tumor - SchwannomaExtended author information available on the last page of the article from the vestibular component of the vestibulocochlear nerve [73]
They represent the most common tumor of the cerebellopontine angle (CPA) and account for about 8% of all intracranial tumors [73]. They usually originate within the internal auditory meatus (IAM) and grow out into the CPA, resulting in an “ice cream cone” shape
5% of VS are associated with neurofibromatosis type 2 (NF2)
Summary
Extended author information available on the last page of the article from the vestibular component of the vestibulocochlear nerve [73] They represent the most common tumor of the cerebellopontine angle (CPA) and account for about 8% of all intracranial tumors [73]. They usually originate within the internal auditory meatus (IAM) and grow out into the CPA, resulting in an “ice cream cone” shape. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using metaanalysis models This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management
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