Year: 2024
Type: article
Abstract: Objective: Surveillance plays a crucial role in managing patients with vestibular schwannomas (VSs). Consensus is lacking on the optimal duration, frequency, and modality of imaging. Standardizing this approach would ensure safe and effective care, reduce patient distress, and promote consistency in management decisions among clinicians. Methods: In July 2022, a multi-disciplinary Delphi consensus was conducted at the British Skull Base Society Meeting. Expert United Kingdom-based skull-base surgeons and neuroradiologists were presented semi-systematic literature reviews summarizing current evidence on VS management. Anonymized opinions were collated and discussed to reach a majority vote, which was deemed the final consensus opinion. Results: 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. Imaging modality and sequences are recommended to be (5) high-resolution magnetic resonance imaging with T1, T2, FIESTA/CISS multiplanar sequences, contrast is not required in untreated cases, and linear reporting of measurements is pragmatically sufficient. Conclusion: 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.
Authors: Mantegh Sethi, Daniele Borsetto, James Tysome, Juliette Buttimore, Nicola Gamazo, Richard Mannion, Matthew Guilfoyle, Manohar Bance, Rupert Obholzer, Tilak Das, Dan Scoffings, Thais Minett, Jonathan Jones, Yogish Joshi, Francis Scott, Tomasz Matys, Simon Freeman, Simon Lloyd, Scott Rutherford, Gillian Potter, Rekha Siripurapu, Sarah Abdulla, Roger Laitt, Ziyad Saloojee, David Summers, Shakeel R. Saeed, Fabrizio Bandino, Samuel MacKeith, Sanjeeva Jeyaretna, Carl Philpott, Jagrit Shah, Iain Robertson, Sebastian Thomas, Nameet Hattangadi, Alessandro Paluzzi, Andrew Kay, Bushra Awan, Rhian Rhys, Senthil Muthu, Philip J Clamp, Ravi Nannapaneni, Caroline Hayhurst, Nihal Gurusinghe, Andrew Alalade, Catherine Gilkes, Nazia Munir, Ahmed Yousseff, Parag Patel, Susanne Hampton, Charlotte Hammerbeck-Ward, Nick Saunders, Richard Irving, Peter Monksfield, Nicholas Thomas, Neil Kitchen, Sinan Barazi, Eleni Maratos, Steve Connor, Colin Leonard, Nicholas Dawe, Hassan Mohamed, Patrick Axon, Neil Donnelly
Institutions: University Hospitals Birmingham NHS Foundation Trust, University of Cambridge, National Hospital for Neurology and Neurosurgery, Addenbrooke's Hospital, Salford Royal Hospital, University Hospital Southampton NHS Foundation Trust, NHS Lothian, University College London, James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, Nottingham University Hospitals NHS Trust, Barking, Havering And Redbridge University Hospitals NHS Trust, Queen Elizabeth Hospital Birmingham, Salisbury District Hospital, Royal Glamorgan Hospital, Wrexham Maelor Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, University Hospital of Wales, Lancashire Teaching Hospitals NHS Foundation Trust, Walton Centre, St George's Hospital, Royal Victoria Hospital, Royal Sussex County Hospital, King's College Hospital, Guy's Hospital, St Thomas' Hospital, Belfast Health and Social Care Trust, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne Hospital
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4404063954