British Skull Base Society consensus on Vestibular Schwannoma Surveillance
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.
Author
Sethi, Mantegh
Borsetto, Daniele
Tysome, James
Buttimore, Juliette
Gamazo, Nicola
Mannion, Richard
Guilfoyle, Matthew
Bance, Manohar
Obholzer, Rupert
Das, Tilak
Scoffings, Dan
Minett, Thais
Jones, Jonathan
Joshi, Yogish
Scott, Francis
Matys, Tomasz
Freeman, Simon
Lloyd, Simon
Rutherford, Scott
Potter, Gillian
Siripurapu, Rekha
Abdulla, Sarah
Laitt, Roger
Saloojee, Ziyad
Summers, David
Saeed, Shakeel R
Bandino, Fabrizio
MacKeith, Samuel
Jeyaretna, Sanjeeva
Philpott, Carl
Shah, Jagrit
Robertson, Iain
Thomas, Sebastian
Hattangadi, Nameet
Paluzzi, Alessandro
Kay, Andrew
Awan, Bushra
Rhys, Rhian
Muthu, Senthil
Clamp, Philip J
Nannapaneni, Ravi
Hayhurst, Caroline
Gurusinghe, Nihal
Alalade, Andrew
Gilkes, Catherine
Munir, Nazia
Yousseff, Ahmed
Patel, Parag
Hampton, Susanne
Hammerbeck-Ward, Charlotte
Saunders, Nick
Irving, Richard
Monksfield, Peter
Thomas, Nicholas
Kitchen, Neil
Barazi, Sinan
Maratos, Eleni
Connor, Steve
Leonard, Colin
Dawe, Nicholas
Mohamed, Hassan
Axon, Patrick
Donnelly, Neil
Borsetto, Daniele
Tysome, James
Buttimore, Juliette
Gamazo, Nicola
Mannion, Richard
Guilfoyle, Matthew
Bance, Manohar
Obholzer, Rupert
Das, Tilak
Scoffings, Dan
Minett, Thais
Jones, Jonathan
Joshi, Yogish
Scott, Francis
Matys, Tomasz
Freeman, Simon
Lloyd, Simon
Rutherford, Scott
Potter, Gillian
Siripurapu, Rekha
Abdulla, Sarah
Laitt, Roger
Saloojee, Ziyad
Summers, David
Saeed, Shakeel R
Bandino, Fabrizio
MacKeith, Samuel
Jeyaretna, Sanjeeva
Philpott, Carl
Shah, Jagrit
Robertson, Iain
Thomas, Sebastian
Hattangadi, Nameet
Paluzzi, Alessandro
Kay, Andrew
Awan, Bushra
Rhys, Rhian
Muthu, Senthil
Clamp, Philip J
Nannapaneni, Ravi
Hayhurst, Caroline
Gurusinghe, Nihal
Alalade, Andrew
Gilkes, Catherine
Munir, Nazia
Yousseff, Ahmed
Patel, Parag
Hampton, Susanne
Hammerbeck-Ward, Charlotte
Saunders, Nick
Irving, Richard
Monksfield, Peter
Thomas, Nicholas
Kitchen, Neil
Barazi, Sinan
Maratos, Eleni
Connor, Steve
Leonard, Colin
Dawe, Nicholas
Mohamed, Hassan
Axon, Patrick
Donnelly, Neil
Date
2024-11-05
Type
Article
Subject
Neuroma, Accoustic, Skull Base
Collections
Citation
Sethi M, Borsetto D, Tysome J, Buttimore J, Gamazo N, Mannion R, Guilfoyle M, Bance M, Obholzer R, Das T, Scoffings D, Minett T, Jones J, Joshi Y, Scott F, Matys T, Freeman S, Lloyd S, Rutherford S, Potter G, Siripurapu R, Abdulla S, Laitt R, Saloojee Z, Summers D, Saeed SR, Bandino F, MacKeith S, Jeyaretna S, Philpott C, Shah J, Robertson I, Thomas S, Hattangadi N, Paluzzi A, Kay A, Awan B, Rhys R, Muthu S, Clamp PJ, Nannapaneni R, Hayhurst C, Gurusinghe N, Alalade A, Gilkes C, Munir N, Yousseff A, Patel P, Hampton S, Hammerbeck-Ward C, Saunders N, Irving R, Monksfield P, Thomas N, Kitchen N, Barazi S, Maratos E, Connor S, Leonard C, Dawe N, Mohamed H, Axon P, Donnelly N. British Skull Base Society Consensus on Vestibular Schwannoma Surveillance. J Neurol Surg B Skull Base. 2024 Nov 5;86(6):619-625. doi: 10.1055/s-0044-1792035.
Journal / Source Title
Journal of Neurological Surgery. Part B, Skull Base
DOI
10.1055/s-0044-1792035
PMID
41140421
Publisher
Thieme
Publisher’s URL
https://www.thieme-connect.de/products/ejournals/journal/10.1055/s-00000181