Vestibular Schwannoma Management: Current Practice Amongst UK Otolaryngologists – Time for a National Prospective Audit

Abstract

It is generally agreed that the successful management of a vestibular schwannoma (VS) usually involves close collaboration between a neuro-otologist and neurosurgeon. In addition, it is accepted that the experience of the team managing such tumours is one of the key determinants of outcome after surgical intervention. The aim of this study was to identify current practice in the management of such tumours amongst otolaryngologists in the UK and to observe whether such collaborative working practices exist. A cross sectional postal questionnaire survey of consultant members of the British Association of Otorhinolaryngologists-Head and Neck Surgeons (n = 542). A total of 336 replies were received (62%). Of respondents, 299 consultants referred their patients to another surgeon for further management; 242 referred to another ENT surgeon (80.9%), 29 to a neurosurgeon (9.7%) and 28 to a combined team (9.4%). Twenty-eight of the responding otolaryngologists (8.6%) managed the tumours themselves, of whom 22 worked with a neurosurgeon. Of these 28 neuro-otologists, nearly two-thirds (64%) had been undertaking VS surgery for more than 10 years. The total number of patients with a VS referred to these 28 consultants during 2001 was 775, with a mean caseload of 29.8, median 23 and a range of 4 to 102 per surgeon. Seven of the 28 otolaryngologists chose their surgical approach entirely based on the size of the tumour. Eight consultants preferred the sub-occipital (SO) approach, 10 the translabyrinthine (TL) approach, three chose between SO and TL approaches. The majority of surgeons had a prospective, computer-based data collection and were willing to give further information about their outcomes and complications. Amongst the otolaryngologists surveyed in the UK, we have identified 28 neuro-otologists who undertake VS surgery. The majority work with neurosurgical colleagues, confirming collaborative practice. The wide range in caseload raises the issue of training and maintaining standards and in the first instance we recommend a prospective national audit of VS management and outcomes with our neurosurgical colleagues. This would also be of value in manpower planning particularly if a minimum caseload could be identified below which results were seen to be less good.