Multimodal Treatment for Large Vestibular Schwannomas

Abstract

Introduction: Vestibular schwannomas are lesions classified as grade I by the World Health Organization. Behavioral options include observation, radiosurgery or endoscopic microsurgical resection.

Objective: To describe the role of multimodal treatment for vestibular schwannomas.

Methods: A systematic search of medical literature, for the identification and inclusion of articles, was carried out in the databases PubMed/Medline, SciELO and Google Scholar, as well as in the preprint servers BioRvix and MedRvix. The following descriptors were used: vestibular schwannoma OR acoustic neuroma AND nerve centered approach OR combined approach AND partial resection OR subtotal resection OR near total resection. Editorials, letters to the editor, books, reviews and metaanalyses were excluded, as well as articles with deficient method of more than 20 years of publication or not mentioning the topic of interest. Sixteen articles were included.

Development: The articles included a total of 699 patients, of which only 228 (32.6 %) received radiotherapy in the postoperative period. The average follow-up period was 49.6 months. Preservation of facial function was achieved in 88.3 % of cases; and tumor control, in 80.7 %. Hearing preservation status was reported in only 50 % of the studies. The usage of adjuvant radiotherapy showed great variability.

Conclusions: Multimodal treatment for large vestibular schwannomas —composed of subtotal resection and intratumoral draining, followed by radiosurgery— has become a plausible option. The publication of a greater amount of reports is necessary to provide recommendations and stratify the behavior.