Overview
Vestibular schwannoma is a neoplasm arising from the Schwann cells of the vestibulocochlear nerve 1. The level of evidence for treatment recommendations is generally low compared to other intracranial neoplasms 1.Diagnosis
Radiological diagnosis is made by magnetic resonance imaging (MRI) 1.
Histological verification is not always required 1.Management
Treatment options include observation, surgical resection, fractionated radiotherapy, and radiosurgery 1.
The choice of treatment depends on clinical presentation, tumor size, and expertise of the treating center 1.
For small tumors, observation should be weighed against radiosurgery 1.
For large tumors, surgical decompression is mandatory, potentially followed by fractionated radiotherapy or radiosurgery 1.
Pharmacotherapy is not indicated except for bevacizumab in neurofibromatosis type 2 1.Key Recommendations
The radiological diagnosis of vestibular schwannoma is made by magnetic resonance imaging 1. (Evidence: Expert opinion)
Histological verification of the diagnosis is not always required 1. (Evidence: Expert opinion)
Current treatment options include observation, surgical resection, fractionated radiotherapy, and radiosurgery 1. (Evidence: Expert opinion)
In small tumors, observation has to be weighed against radiosurgery 1. (Evidence: Expert opinion)
In large tumors, surgical decompression is mandatory, potentially followed by fractionated radiotherapy or radiosurgery 1. (Evidence: Expert opinion)
There is no role for pharmacotherapy except for bevacizumab in neurofibromatosis type 2 1. (Evidence: Expert opinion)References
1 Goldbrunner R, Weller M, Regis J, Lund-Johansen M, Stavrinou P, Reuss D et al.. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro-oncology 2020. link