Vestibular Schwannoma

Abstract

To the Editor, We read with interest the article by Myrseth et al published in the April 2009 issue of Neurosurgery (2009;64(4):654–663) and we were interested in finding an answer to the highly controversial question of what is the best treatment option for small- and medium-sized vestibular schwanoma (VS)? This controversy is highlighted in the published reviewers' comments. However, this paper and the comments did not address a more basic question in the management of small and medium sized VS: is treatment necessary in the 2 years the authors had reported on? Several publications demonstrated small and medium size VS do not grow in the short term (2 years), and many authors recommended that “wait and scan” approach is a reasonable choice of management for small and medium size VS as the majority remain unchanged in 2 years and 8 to 16% regress.1,2,3,4 Several authors recommended that intervention should only be considered in tumors that have been shown to grow 2 mm/year5,6 and a recent study had shown no discernible significant difference between the growth patterns of untreated and radiosurgically treated VS7. Therefore in addition to the criticisms already highlighted by some of the reviewers: small numbers in each treatment arm with the surgical arm numbers even smaller, the short term follow up of 2 years, and the substandard surgical results in this study, there was no “wait and scan” arm of this study. We would suggest that if the authors included such arm, that arm would have faired the best in their setup. Mario Teo M.S. Eljamel Dundee, United Kingdom