Materiały źródłowe

• #1 Vestibular Schwannoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562312/

  Schwannoma is the most common of all nerve sheath tumors in approximately 89% of cases. About 60% of benign schwannomas are vestibular schwannomas. Schwannomas usually affect persons between the ages of 50 to 60. No sex or racial predilection is recognized. Tumors are generally located in the upper limbs, followed by the head, trunk, and flexor surfaces of the lower extremities. Other locations include the posterior mediastinum, retroperitoneum, spinal roots, bone, gastrointestinal tract, pancreas, liver, thyroid, adrenal glands, and lymph nodes. […] The Central Brain Tumor Registry of the United States shows that nonmalignant nerve sheath tumors account for 8.6% of all central nervous system tumors reported, with no gender predominance, but a higher incidence in whites. The median age at diagnosis is 56 years. The incidence is 4.4 to 5.23 cases per 100,000 adults/year; in children and adolescents, it is 0.44 cases per 100,000/year. The incidence of malignant nerve sheath tumors is 0.03 cases per 100,000/year.

• #1 Vestibular Schwannoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562312/

  The incidence of vestibular schwannomas in the USA is 1.2 cases per 100,000/year. The median age of patients is 55 years. Similar rates occur among males and females, but higher in Whites than non-Whites. In Denmark, vestibular schwannomas have an incidence of 3.4 cases per 100,000/year, with a mean age at diagnosis of 60 years. Other reported incidences of vestibular schwannomas varied between 1.8 to 2.6 cases per 100,000/year. […] Spinal schwannoma incidence is 0.24 cases per 100,000/year. Spinal schwannomas are more common in white males, usually affecting persons between the ages of 65 and 74.

• #2 Epidemiology Of Vestibular Schwannomas – Prospective 40-Year Data From An Unselected National Cohort

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6850685/

  Reports on the epidemiology of vestibular schwannoma (VS) indicate an increase in diagnosed cases, often based on selected materials over a limited period of time. This report presents prospective 40-year epidemiological data from an unselected national cohort of all patients diagnosed with a VS in Denmark since 1976. […] Over the past 40 years, the incidence rate of vestibular schwannomas has increased steadily from 3 VS/million/year to 34 VS/million/year, primarily due to easier access to improved diagnostics and the finding of more tumors in older people. Concurrently, the diagnostic tumor size has decreased from 26mm to 7mm, and the age at diagnosis has increased from 49 to 60 years. […] This prospective study on 40-year epidemiological data from the unselected, unbiased national cohort of all Danish patients diagnosed with a VS since 1976 shows that the incidence rate of diagnosed tumors has been increasing steadily over the years, from 2.8 VS/million/year in 1976 to 33.8 VS/million/year in 2015. Improved diagnostics and increased availability of improved diagnostics are probably the main reasons for this increase, although an increased tumor occurrence cannot entirely be ruled out. […] Age at tumor diagnosis is steadily increasing, from 49.2 years of age to currently 60 years of age. Demography in Denmark, and in general, is shifting progressively towards older people, which may also be a major reason for the increasing age at diagnosis.

• #3 Epidemiology Of Vestibular Schwannomas – Prospective 40-Year Dat | CLEP

  https://www.dovepress.com/epidemiology-of-vestibular-schwannomas-prospective-40-year-data-from-peer-reviewed-fulltext-article-CLEP

  Objective: Reports on the epidemiology of vestibular schwannoma (VS) indicate an increase in diagnosed cases, often based on selected materials over a limited period of time. This report presents prospective 40-year epidemiological data from an unselected national cohort of all patients diagnosed with a VS in Denmark since 1976. […] Over the past 40 years, the incidence rate of vestibular schwannomas has increased steadily from 3 VS/million/year to 34 VS/million/year, primarily due to easier access to improved diagnostics and the finding of more tumors in older people. Concurrently, the diagnostic tumor size has decreased from 26mm to 7mm, and the age at diagnosis has increased from 49 to 60 years. […] This prospective study on 40-year epidemiological data from the unselected, unbiased national cohort of all Danish patients diagnosed with a VS since 1976 shows that the incidence rate of diagnosed tumors has been increasing steadily over the years, from 2.8 VS/million/year in 1976 to 33.8 VS/million/year in 2015. Improved diagnostics and increased availability of improved diagnostics are probably the main reasons for this increase, although an increased tumor occurrence cannot entirely be ruled out. […] Age at tumor diagnosis is steadily increasing, from 49.2 years of age to currently 60 years of age. Demography in Denmark, and in general, is shifting progressively towards older people, which may also be a major reason for the increasing age at diagnosis.

• #4

  https://link.springer.com/article/10.1007/s00701-023-05665-9

  Vestibular schwannoma (VS) is the most common benign tumour arising in the lateral skull base. Reported incidence rates of VS vary across geographical locations and over time. There is scarce updated evidence over the past decade on the epidemiology and mode of presentation of VS. […] To describe the epidemiology and mode of presentation of VS in the East of England between 2013 and 2016. […] There were 391 new cases identified resulting in an overall mean incidence of 2.2 VS cases per 100,000 person-year. The incidence rate for all patients in the 40 age group ranged between 0.3 and 0.7 per 100,000 person-year, increasing to a range of 5.7 to 6.1 per 100,000 person-year in the 6069 age group. […] The incidence of vestibular schwannoma has increased compared to previous studies in the UK and is similar to incidence rates reported in other countries during the past decade. It peaks in the seventh decade of life, mainly because of an increase in the diagnosis of small tumours with a long duration of audio-vestibular symptoms in older patients, compared to earlier studies.

• #4

  https://link.springer.com/article/10.1007/s00701-023-05665-9

  Epidemiological studies have suggested that the incidence of sporadic VS has been increasing globally. […] A recent systematic review showed that the incidence of VS between the years 2010 and 2020 ranged between 3.0 and 5.2 per 100,000 person-years. […] In the UK, mean incidence rates have been reported to range from 1.0 to 1.4 patients per 100,000 persons per year, but these studies are two to three decades old. […] The mean annual incidence of newly diagnosed cases of VS was 2.2 per 100,000 person-years. […] Our study shows that the incidence of VS has increased compared to the period between 1990 and 1999 and the period between 1994 and 2002, where the reported incidence was estimated to be 0.81.4 per 100,000 person-years. […] Incidence did not differ by sex and peaked in the seventh decade for both female and male patients at a mean rate of 5.8 per 100,000 person-years. […] Overall, our findings support the hypothesis that increasing utilisation of MRI has led to the detection of more cases, in particularly of smaller tumours in older patients. […] The rate of incidental cases of VS was uncommon at only 2.6%.

• #5 Incidence and presentation of vestibular schwannoma: a 3-year cohort registry study.

  https://www.repository.cam.ac.uk/items/3f4eaa6b-8b6d-4a5d-945c-f2ef4bad2307

  BACKGROUND: Vestibular schwannoma (VS) is the most common benign tumour arising in the lateral skull base. Reported incidence rates of VS vary across geographical locations and over time. […] OBJECTIVE: To describe the epidemiology and mode of presentation of VS in the East of England between 2013 and 2016. […] RESULTS: There were 391 new cases identified resulting in an overall mean incidence of 2.2 VS cases per 100,000 person-year. The incidence rate for all patients in the 40 age group ranged between 0.3 and 0.7 per 100,000 person-year, increasing to a range of 5.7 to 6.1 per 100,000 person-year in the 60-69 age group. […] CONCLUSIONS: The incidence of vestibular schwannoma has increased compared to previous studies in the UK and is similar to incidence rates reported in other countries during the past decade. It peaks in the seventh decade of life, mainly because of an increase in the diagnosis of small tumours with a long duration of audio-vestibular symptoms in older patients, compared to earlier studies.

• #6 Vestibular schwannoma (acoustic neuroma) – UpToDate

  https://www.uptodate.com/contents/vestibular-schwannoma-acoustic-neuroma

  Vestibular schwannomas (also known as acoustic neuromas) are Schwann cell-derived, histologically benign tumors of the eighth cranial nerve, most commonly arising from the vestibular portion of the nerve. They are the third most common nonmalignant primary brain tumor, after meningioma and pituitary tumors, and account for 80 to 90 percent of tumors in the cerebellopontine angle. […] The overall incidence of vestibular schwannoma is approximately 3 to 5 per 100,000 person-years. The incidence rises with advancing age. For patients over 70 years of age, the incidence may be as high as 21 per 100,000 person-years. […] The incidence appears to be increasing, due at least in part to the incidental diagnosis of asymptomatic lesions with the widespread use of magnetic resonance imaging (MRI) and computed tomography (CT).

• #7 Incidence and Risk Factors of Vestibular Schwannoma in Korea : A Population-Based Study

  https://www.jkns.or.kr/journal/view.php?number=7576

  The total number of VS patients was 5751. The average incidence rate was 0.71 per 100000 from 2005 to 2020, and the annual incidence rate increased from 0.33 in 2005 to 1.32 in 2019 but decreased to 0.80 in 2020. […] The overall annual incidence from 2005 to 2020 was 0.71 per 100000, ranging from 0.33 to 1.32. […] The annual incidence of VS was highest in the age range of 60 to 69 years (1.791/100000 persons) and second highest in the age range of 50 to 59 years (1.497/100000 persons). […] The annual incidence in females was higher than in males for all ages except those 80 years of age or older (female/male ratio, 0.616). The overall female to male incidence ratio was 1.225, and the sex difference in VS was statistically significant (p=0.0098). […] The chronic metabolic diseases (hypertension, diabetes, and dyslipidemia), smoking history, and alcohol history of VS group and control group is shown in Table 2.

• #7 Incidence and Risk Factors of Vestibular Schwannoma in Korea : A Population-Based Study

  https://www.jkns.or.kr/journal/view.php?number=7576

  In univariate analysis, VS was associated with all of three metabolic diseases; hypertension (hazard ratio [HR], 1.223; 95% confidence interval [CI], 1.161-1.289), diabetes mellitus (HR, 1.346; 95% CI, 1.274-1.421), dyslipidemia (HR, 1.459; 95% CI, 1.385-1.537). […] The incidence of VS exhibited an increasing trend from 2005 to 2019. Radiosurgery (46.64%) was the most common treatment modality. Diabetes, dyslipidemia, and alcohol consumption increased the risk of VS, while cigarette smoking reduced the risk of VS.

• #8 The epidemiology of spinal schwannoma in the United States between 2006 and 2014 in: Journal of Neurosurgery: Spine Volume 32 Issue 5 (2019) Journals

  https://thejns.org/spine/view/journals/j-neurosurg-spine/32/5/article-p661.xml

  Spinal schwannoma remains the third most common intradural spinal tumor following spinal meningioma and ependymoma. […] This article describes the epidemiology of spinal schwannoma in the United States from January 1, 2006, through December 31, 2014. […] There were 6989 spinal schwannoma cases between the years 2006 and 2014. The yearly incidence eminently increased between 2010 and 2014. Total incidence rate was 0.24 (95% CI 0.230.24) per 100,000 persons. The peak adjusted incidence rate was seen in patients who ranged in age from 65 to 74 years. Spinal schwannomas were less common in females than they were in males (incidence rate ratio = 0.85; p 0.001), and they were less common in blacks than they were in whites (IRR = 0.52; p 0.001) and American Indians/Alaska Natives (IRR = 0.50; p 0.001) compared to whites. There was no statistically significant difference in incidence rate between whites and Asian or Pacific Islanders (IRR = 0.92; p = 0.16).

• #9

  https://scholars.duke.edu/publication/1470409

  Spinal schwannoma remains the third most common intradural spinal tumor following spinal meningioma and ependymoma. […] This article describes the epidemiology of spinal schwannoma in the United States from January 1, 2006, through December 31, 2014. […] There were 6989 spinal schwannoma cases between the years 2006 and 2014. The yearly incidence eminently increased between 2010 and 2014. Total incidence rate was 0.24 (95% CI 0.23-0.24) per 100,000 persons. The peak adjusted incidence rate was seen in patients who ranged in age from 65 to 74 years. Spinal schwannomas were less common in females than they were in males (incidence rate ratio = 0.85; p 0.001), and they were less common in blacks than they were in whites (IRR = 0.52; p 0.001) and American Indians/Alaska Natives (IRR = 0.50; p 0.001) compared to whites.

• #10 Spinal schwannoma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/spinal-schwannoma?lang=us

  Spinal schwannomas are benign nerve sheath tumors within the spinal canal, typically arising from spinal nerve roots and it is the most common nerve sheath tumor of spine 11. They are one of the two most common intradural extramedullary spinal tumors, representing 15-50% of such lesions. […] They have a peak incidence in the fifth through seventh decades 10. There is no significant sex predilection. […] The vast majority of spinal schwannomas are solitary and sporadic (95%) 10. However, there is an association with neurofibromatosis type 2 (NF2). In patients with NF2, almost all spinal nerve root tumors are schwannomas or mixed tumors. In a young adult without the NF2 mutation, the finding of multiple schwannomas may meet criteria for schwannomatosis.

• #11

  https://www.ijsurgery.com/index.php/isj/article/view/9596

  Schwannomas are rare benign neoplasms, arising from Schwann cells of the peripheral nerve sheath. Retroperitoneal location is very rare accounting for less than 3% of cases. Schwannomas are usually asymptomatic and incidentally found. […] Since the patient was elderly and had no symptoms, surveillance was decided by oncological multidisciplinary group. At present, the patient has a 7 year follow up period, remains asymptomatic and the tumour dimensions are stable. Since schwannomas are benign tumours, when asymptomatic and grow slowly, watchful waiting approach may be an option, avoiding major high morbidity procedure.

• #12 Gastric Schwannoma: A Case Study | ACS

  https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v3n8/khalafi-gastric-schwannoma/

  Gastric schwannomas are a rare type of GI mesenchymal tumor and account for 0.02% of all gastric tumors. […] Gastric schwannomas are an extremely rare type of GI mesenchymal tumor that should be considered in the differential diagnosis when encountering gastric masses. […] Although gastric schwannomas are benign and often asymptomatic, complete surgical resection is the treatment modality of choice and is considered curative. […] Although uncommon, recurrence of the tumor is possible after resection, and we elected to follow up with a CT scan in one year. […] Gastric schwannomas are a rare form of mesenchymal gastric tumor. Though the incidence is low, this tumor should be considered in the differential diagnosis when encountering patients with subepithelial, exophytic lesions of the stomach. […] Gastric schwannomas may be challenging to differentiate from GISTs based on imaging and clinical presentation, but clear histological and IHC markers can help identify this tumor. […] Currently, the recommended treatment is complete surgical resection which is considered curative.

• #13 Management of presacral schwannomas—a 10-year multi-institutional series

  https://atm.amegroups.org/article/view/23917/html

  Presacral or sacral schwannomas are relatively rare clinical entities thought to account for only 1 in every 40,000 hospitalizations. […] Presacral/sacral schwannomas are quite rare, representing only 0.3-2% of all schwannomas and 0.4-15% of all retrorectal tumors. […] To date, more than 130 articles describing over 220 presacral schwannomas have been reported in the literature, including the seven cases presented here. […] Roughly 40% of reported lesions have been treated via open anterior approaches and 35% via posterior approaches, with the remaining 25% split evenly between staged anterior-posterior and endoscopic anterior approaches. […] The gold standard for identification is a pelvic MRI, which demonstrates a T2 hyperintense, T1-hypointense mass with smooth, well-defined margins and enhancement on post-contrast fat suppressed T1-weighted sequences.

• #14 Intrapulmonary Schwannoma: A Case Report | Archivos de Bronconeumología

  https://archbronconeumol.org/en-intrapulmonary-schwannoma-a-case-report-articulo-S0300289623002314

  Schwannomas represent 5% of all tumours that can affect humans. At the respiratory level, intrapulmonary and intrabronchial schwannomas are extremely rare, account for 0.2% of lung neoplasms. […] Intrapulmonary schwannomas occur asymptomatically and as a casual finding, producing different symptoms depending on the location and size, dyspnoea, cough, chest pain, and may even lead to the erroneous diagnosis of pneumonia or atelectasis. It is, therefore, important to make a good differential diagnosis. […] Intrapulmonary schwannomas are an extremely rare tumour, where the characterisation of its epidemiology in a relevant way is still controversial due to the low incidence, especially in our environment. This case is relevant because, as far as we know, it is the first documented in the Iberian Peninsula, and the first in Europe after 8 years. In contrast with other continents, such as Asia, where the number of publications is higher.

• #15 Intrapulmonary Schwannoma: A Case Report | Archivos de Bronconeumología

  https://www.archbronconeumol.org/en-intrapulmonary-schwannoma-a-case-report-articulo-S0300289623002314

  Schwannomas represent 5% of all tumours that can affect humans. At the respiratory level, intrapulmonary and intrabronchial schwannomas are extremely rare, account for 0.2% of lung neoplasms. […] Intrapulmonary schwannomas are an extremely rare tumour, where the characterisation of its epidemiology in a relevant way is still controversial due to the low incidence, especially in our environment. This case is relevant because, as far as we know, it is the first documented in the Iberian Peninsula, and the first in Europe after 8 years. In contrast with other continents, such as Asia, where the number of publications is higher.

• #16 Incidence and prevalence of vestibular schwannoma – Louis Hofmeyr

  https://lmhofmeyr.co.za/conditions/conditions-we-specialise-in/acoustic-neuroma/incidence-and-prevalence-of-vestibular-schwannoma/

  The mean age of diagnosis of sporadic vestibular schwannoma is 60 years. It has increased because life expectancy has risen, and magnetic resonance imaging has become readily available (6). […] The incidence of vestibular schwannoma is equal between men and women (7). […] The size of vestibular schwannoma at diagnosis has decreased (6).

• #17 Schwannoma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/schwannoma?lang=us

  The vast majority of schwannomas are sporadic, with a peak presentation in the 5th to 6th decades. There is no sex predilection. […] When they occur in patients with neurofibromatosis type 2 (NF2), schwannomas usually present by the 3rd decade. […] Most schwannomas are solitary (90%) and sporadic, however, there is an association with neurofibromatosis type 2 (NF2) (abnormality of chromosome 22). Multiple schwannomas are characteristic of neurofibromatosis type 2. Approximately 18% of solitary schwannomas occur in patients with neurofibromatosis type 2. […] There is also schwannomatosis, which consists of multiple schwannomas without the concomitant involvement of cranial nerve VIII.

• #18 Epidemiology and Risk Factors for Development of Sporadic Vestibular Schwannoma – EM consulte

  https://www.em-consulte.com/article/1587081/resume/epidemiology-and-risk-factors-for-development-of-s

  Epidemiology and Risk Factors for Development of Sporadic Vestibular Schwannoma – 29/04/23 […] Vestibular schwannomas (VSs) are benign, slow-growing tumors of the eighth cranial nerve. Sporadic unilateral VSs constitute approximately 95% of all newly diagnosed tumors. There is little known about risk factors for developing sporadic unilateral VS. Potential risk factors that have been reported are familial or genetic risk, noise exposure, cell phone use, and ionizing radiation, whereas protective factors may include smoking and aspirin use. More research is needed to elucidate the risk factors for development of these rare tumors. […] Keywords : Vestibular schwannoma, Acoustic neuroma, Risk factors, Incidence, Epidemiology, Familial risk, Noise exposure, Smoking

• #19 Schwannoma – NCI

  https://www.cancer.gov/pediatric-adult-rare-tumor/rare-tumors/rare-soft-tissue-tumors/schwannoma

  Schwannoma is not common. It is a rare disease, which means it affects fewer than 200,000 people. Schwannoma is the most common type of peripheral nerve tumors in adults. […] Schwannoma rarely runs in families. There are some genetic conditions which may run in families that may increase the risk of schwannoma, such as neurofibromatosis type 2 (NF2), schwannomatosis, and Carney Complex. […] The prognosis for a person with schwannoma depends on the size of the tumor and whether it has spread to other parts of the body. Depending on where the tumor is, people may have long term muscle weakness or hearing loss. If the entire tumor is removed by surgery, it is not likely to grow back.

• #20 Schwannoma | Other conditions | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/other-conditions/schwannoma

  Schwannomas are not common. They are seen more often in adults than in children. […] Rarely, schwannomas may change to become malignant peripheral nerve sheath tumours. […] These tumours do not spread to other parts of the body. […] They are usually diagnosed in older adults. […] Adults or children with multiple schwannomas and children who have a single schwannoma may have tests to see whether they have one of the rare genetic conditions: NF2-related Schwannomatosis or schwannomatosis – (non NF2-related). […] It is rare for NF2-related schwannomatosis to develop into a cancer. […] This condition can increase your risk of developing a tumor in the lining of the brain and spinal cord, called a meningioma. […] Non cancerous schwannomas form on the nerve sheath. […] Symptoms usually start in early adulthood but can develop in younger people. […] About 10 in 100 people (about 10%) with genetic changes in LZTR1 develop vestibular schwannomas on one side. […] People with SMARCB1 related schwannomatosis may develop meningiomas as well as schwannomas.

• #21 Epidemiology, tumour characteristics, treatment and outcomes associated with spinal nerve sheath tumours: a systematic review protocol | BMJ Open

  https://bmjopen.bmj.com/content/14/10/e083011

  Nerve sheath tumours arise from both the central and peripheral nervous systems. […] This systematic review aims to summarise the body of evidence regarding spinal nerve sheath tumours and assess its quality, to provide the current knowledge on epidemiology, tumour characteristics, diagnostics, treatment strategies and outcomes. […] The incidence of spinal schwannomas, the most common subtype among nerve sheath tumours, is reported to range between 0.3 and 0.4 cases/100,000/per year. […] Typically, there is no sex predisposition, and the peak age at diagnosis is between 40 and 70 years. […] Approximately 1% of spinal schwannomas and 4% of sporadic ones have been linked to NF2, a genetic condition resulting from the loss of function in the merlin (also known as schwannomin) coding NF2 tumour suppressor gene on chromosome 22.

• #22 British Skull Base Society Consensus on vestibular schwannoma surveillance – UEA Digital Repository

  https://ueaeprints.uea.ac.uk/id/eprint/98045/

  Objective Surveillance plays a crucial role in managing patients with vestibular schwannomas (VSs). […] Recommendations for VS managed by surveillance are: (1) surveillance frequency should decrease over time; (2) surveillance may be discontinued when the remaining lifetime risk of VS growth is 0.5% (8.5 years); (3) factors such as age, VS size, VS location, and cystic components should be considered. […] Surveillance after surgery or radiotherapy has limited evidence but recommendations are: (4) surveillance should be adjusted based on residual tumor size or nodular enhancement. […] This consensus and literature review provides an evidence and expert opinion-based guide to help clinicians with the surveillance of patients with VS. Further research should focus on better understanding the dynamic nature of growth risks and the growth characteristics of postintervention VS to enable personalized growth risk stratification.

• #23 Evidence-based surveillance protocol for vestibular schwannomas: a long-term analysis of tumor growth using conditional probability in: Journal of Neurosurgery Volume 137 Issue 4 (2022) Journals

  https://thejns.org/view/journals/j-neurosurg/137/4/article-p1026.xml

  Vestibular schwannomas (VSs) have an incidence of approximately 2 cases per 100,000 persons, a number that has been steadily increasing in recent decades. […] Consequently, an increasing proportion of patients is being managed conservatively, with an initial period of active observation being the most common management plan for sporadic VSs 15 mm in size within the internal acoustic meatus. […] However, a number of unanswered questions remain regarding this management strategy. One important consideration is the timeline for interval imaging; that is, should scans be obtained at regular intervals or progressively infrequently, and what should this protocol be? […] Ideally, it would be at a point at which the risks of growth-related complications are small enough to accept when balanced against the costs of continued surveillance.

• #23 Evidence-based surveillance protocol for vestibular schwannomas: a long-term analysis of tumor growth using conditional probability in: Journal of Neurosurgery Volume 137 Issue 4 (2022) Journals

  https://thejns.org/view/journals/j-neurosurg/137/4/article-p1026.xml

  Using long-term surveillance data, we found that the conditional probability of growth was 1.69% at 6 years (95% CI 0.62%3.65%), 0.86% at 7 years (95% CI 0.18%2.50%), 0.58% at 8 years (95% CI 0.07%2.08%), 0.00% at 9 years (95% CI 0.00%1.07%), and 0.29% at 10 years (95% CI 0.01%1.61%). […] By using these data to produce a regression model, we went on to determine that the residual lifetime risk of growth would be 1% from 7 years 7 months onward, 0.5% at 8 years 11 months onward, and 0.25% at 10 years 4 months onward. […] There is no consensus on the most appropriate timeline and duration of surveillance imaging for VS patients managed under a surveillance protocol. […] Conditional probability, we believe, represents a more clinically relevant statistical methodology for approximating growth risks in patients with VS, as it uses information about prior tumor behavior and therefore lends itself to answering questions about the optimum surveillance protocol.

• #23 Evidence-based surveillance protocol for vestibular schwannomas: a long-term analysis of tumor growth using conditional probability in: Journal of Neurosurgery Volume 137 Issue 4 (2022) Journals

  https://thejns.org/view/journals/j-neurosurg/137/4/article-p1026.xml

  We posited a surveillance protocol based on conditional probabilities. […] This protocol should allow the identification of patients whose VS might exhibit growth within the early years of follow-up (when growth risk is greatest), while progressively increasing scanning intervals in line with the reduction in the growth risk observed over time. […] Decisions about surveillance protocols are inherently a cost-benefit analysis, weighing the risks and costs of missing VS growth versus the risks and costs of surveillance itself. […] We have proposed 10.5 years (a growth risk 0.25%) as an acceptable cutoff on the basis of the ALARP concept, but this could be modeled for any risk that an institution believes is appropriate, which may vary from center to center. […] The results presented here allow insights into the long-term growth behavior of VS, which can be used to better inform patients of their risk of growth at particular time points along their surveillance timelinewith the residual lifetime risk of growth at 1% after 7 years 7 months, 0.5% after 8 years 11 months, and 0.25% after 10 years 4 months. […] Thus, we propose a 10.5-year growth riskbased surveillance protocol for VSs under observation, in which interval imaging is undertaken once at 6 months, annually for 3 years, twice at 2-year intervals, and a final scan after 3 years.

• #24 MRI Surveillance Should Extend to 10 Years Post- Op for Vestibular Schwannoma Patients – ENTtoday

  http://www.enttoday.org/article/mri-surveillance-extend-10-years-post-op-vestibular-schwannoma-patients/

  The current recommended MRI surveillance schedule after micro-surgery for VS includes MRIs at one, five, and 10 years postoperatively. Nonparametric survival analysis suggests that a majority of radiologic progression events occur in the first 10 years postoperatively. […] Postoperative imaging surveillance after microsurgery for VS is performed routinely by neurotologists to screen patients for growth of residual or recurrent tumor. […] Thus, serial imaging in cases with nodular enhancement on MRI is essential to determine whether residual tumor is present and growing. […] However, recommendations for the timing and frequency of MRI for VS surveillance after treatment have not been standardized. […] The first recommended MRI is at one year postoperatively. If the MRI is clean or linear, MRIs are recommended at five and 10 years postoperatively. If MRI results are nodular, MRIs should be conducted yearly until stable.

• #25 Guidelines on the Management of Patients with Vestibular Schwannoma

  https://www.cns.org/guidelines/management-patients-vestibular-schwannoma/5-role-of-imaging-in-diagnosis-management-of-patie

  Level 3: In general, vestibular schwannomas associated with NF2 should be imaged (similar to sporadic schwannomas) with the following caveats: More frequent imaging may be adopted in NF2 patients because of a more variable growth rate for vestibular schwannomas, and annual imaging may ensue once the growth rate is established. […] Level 3: For patients receiving gross total resection, a postoperative MRI may be considered to document the surgical impression and may occur as late as 1 year after surgery. For patients not receiving gross total resection, more frequent surveillance scans are suggested; annual MRI scans may be reasonable for 5 years. Imaging follow-up should be adjusted accordingly for continued surveillance if any change in nodular enhancement is demonstrated.

• #25 Guidelines on the Management of Patients with Vestibular Schwannoma

  https://www.cns.org/guidelines/management-patients-vestibular-schwannoma/5-role-of-imaging-in-diagnosis-management-of-patie

  Level 3: Imaging used to detect vestibular schwannomas should use high-resolution T2-weighted and contrast-enhanced T1-weighted MRI. […] Level 3: Preoperative surveillance for growth of a vestibular schwannoma should be followed with either contrast-enhanced 3D T1 MPRAGE or high-resolution T2 (including CISS or FIESTA sequences) MR imaging. […] Level 3: MRIs should be obtained annually for 5 years, with interval lengthening thereafter with tumor stability. […] Level 3: Adults with cystic vestibular schwannomas should be counseled that their tumors may more often be associated with rapid growth, lower rates of complete resection, and facial nerve outcomes that may be inferior in the immediate postoperative period but similar to non-cystic schwannomas over time. […] Level 3: The degree of lateral IAC involvement by tumor adversely affects facial nerve and hearing outcomes and should be emphasized when interpreting imaging for preoperative planning.

• #26 High-Resolution T2-Weighted Imaging for Surveillance in Postoperative Vestibular Schwannoma: Equivalence with Contrast-Enhanced T1WI for Measurement and Surveillance of Residual Tumor | American Journal of Neuroradiology

  https://www.ajnr.org/content/43/12/1792

  Patients with surgically resected vestibular schwannoma will undergo multiple postoperative surveillance examinations, typically including postcontrast sequences. […] In the postoperative setting, imaging surveillance is necessary for at least 10 years postprocedure, because reported recurrence/residual rates range from 0.17% to 7.7%, depending, in large part, on the completeness of the initial resection. […] On the basis of these results, high-resolution T2WI alone may be sufficient for early postoperative imaging surveillance in this patient population. […] The current recommendations of the American College of Radiology for screening in patients with asymmetric sensorineural hearing loss include both MR imaging of the head and internal auditory canal without and with IV contrast and MR imaging of the head and internal auditory canal without IV contrast, with the latter being an acceptable route when there is a contraindication to contrast administration.

• #27 High-Resolution T2-Weighted Imaging for Surveillance in Postoperative Vestibular Schwannoma: Equivalence with Contrast-Enhanced T1WI for Measurement and Surveillance of Residual Tumor.

  https://vivo.weill.cornell.edu/display/pubid36423954

  BACKGROUND AND PURPOSE: Patients with surgically resected vestibular schwannoma will undergo multiple postoperative surveillance examinations, typically including postcontrast sequences. […] On the basis of these results, high-resolution T2WI alone may be sufficient for early postoperative imaging surveillance in this patient population.

• #28 Vestibular Schwannoma: Epidemiology, Risk Factors, and Quality of Life – D-Scholarship@Pitt

  http://d-scholarship.pitt.edu/10555/

  INTRODUCTION:The goal of this study has been to describe the epidemiology of vestibular schwannoma and explore potential risk factors for this tumor. […] PUBLIC HEALTH SIGNIFICANCE:The epidemiology and risk factors of vestibular schwannoma are poorly understood. Continued research in this area will help to develop an understanding of brain tumor etiology and the role of potential carcinogens in the environment.

• #29

  https://journals.lww.com/neurosurgery/fulltext/9900/vestibular_schwannoma_koos_grade_i_international.1424.aspx

  This investigation evaluates the safety and efficacy of stereotactic radiosurgery (SRS) vs observation for Koos grade I vestibular schwannomas (VS). […] In a multicenter study, we retrospectively analyzed data of patients with Koos grade I VS who underwent SRS (SRS group) or were observed (observation group). […] The study matched 142 patients, providing a median follow-up period of 36 months. SRS significantly enhanced tumor control compared with observation, with a 100% control rate at both 5- and 8-year marks in the SRS group vs 48.6% and 29.5% in the observation group at the same time intervals, respectively (P .001). […] SRS management of patients with Koos grade I VS was associated with superior tumor control and reduced odds for cranial nerve dysfunction, while not compromising hearing preservation compared with observation. These findings support the safety and efficacy of SRS as a primary care approach for this patient population.

• #30 Cross-Post: Vestibular Schwannoma Koos Grade I International Study of Active Surveillance Versus Stereotactic Radiosurgery: The VISAS-K1 Study – Neurosurgery Blog

  https://www.neurosurgeryblog.org/2024/12/17/cross-post-vestibular-schwannoma-koos-grade-i-international-study-of-active-surveillance-versus-stereotactic-radiosurgery-the-visas-k1-study/

  Published online ahead of print on Nov. 6 and expected to appear in the January 2025 issue of Neurosurgery, the article indicates that as primary care for Koos grade I vestibular schwannomas, stereotactic radiosurgery (SRS) is superior to observation with regard to tumor control and preservation of neurologic function. […] According to the Wolters Kluwer press release, [T]he findings from this study, along with other published studies, indicate that even asymptomatic patients with smaller tumors may benefit from SRS over observation at the time of diagnosis. SRS afforded superior tumor control and significantly reduced neurological impairment compared to observation in vestibular schwannoma Koos grade I patients.

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