Vestibular Schwannoma: What We Know and Where We are Heading

Research output: Contribution to journalReview articlepeer-review

Authors

  • Vinay Kumar Gupta
  • Arjuna Thakker
  • Keshav Kumar Gupta

Colleges, School and Institutes

External organisations

  • Royal Wolverhampton Hospitals NHS Trust

Abstract

Vestibular schwannoma (VS) is a Schwann cell-derived tumour arising from the vestibulocochlear nerve. Although benign, it represents a threat to intracranial structures due to mass effect and carries a small risk of malignant transformation. VS therefore represents an important healthcare burden. We review the literature regarding pathogenesis, risk factors, and diagnosis of VS. The current and future potential management strategies are also discussed. A narrative review of all relevant papers known to the authors was conducted. The majority of VS remain clinically stable and do not require interventional procedures. Nevertheless, various surgical techniques exist for removing VS, the most common of which are translabyrinthine and retrosigmoid approaches. Due to surgical risks such as hearing loss, facial nerve dysfunction, post-operative headache, and cerebrospinal fluid leakage, a "watch and rescan" approach is adopted for most patients. Radiotherapy is a useful alternative and has been shown to have a similar response for growth restriction. Due to the heterogeneous nature of VS, there is a lack of consensus regarding management of tumours that are too large for conservative management but too small to indicate surgery. Emerging biologic therapies, such as Bevacizumab, Everolimus, and Lapatinib, as well as anti-inflammatories like aspirin are promising potential treatments; however, long-term evidence of their efficacy is required. The knowledge base regarding VS continues to improve. With increased understanding of the pathogenesis of these tumors, we believe future work should focus on pharmacologic intervention. Biologic therapies aimed toward improved patient outcomes are particularly promising.

Details

Original languageEnglish
JournalHead and Neck Pathology
Early online date30 Mar 2020
Publication statusE-pub ahead of print - 30 Mar 2020

Keywords

  • Diagnosis, Management, Pathology, Review, Schwannoma, Vestibular