British Skull Base Society consensus on Vestibular Schwannoma Surveillance
Sethi, Mantegh Borsetto, Daniele Tysome, James Buttimore, Juliette Gamazo, Nicola Mannion, Richard Guilfoyle, Matthew Bance, Manohar Obholzer, Rupert Das, Tilak
Sethi, Mantegh
Borsetto, Daniele
Tysome, James
Buttimore, Juliette
Gamazo, Nicola
Mannion, Richard
Guilfoyle, Matthew
Bance, Manohar
Obholzer, Rupert
Das, Tilak
Affiliation
University Hospitals Birmingham NHS Foundation Trust; Cambridge University Hospitals NHS Foundation Trust; University College London Hospitals NHS Foundation Trust; Salford Royal NHS Foundation Trust; University Hospital Southampton NHS Foundation Trust; NHS Lothian; University College London Ear Institute; Oxford University Hospitals NHS Foundation Trust; James Paget University Hospitals NHS Foundation Trust; Nottingham University Hospitals NHS Trust; Barking, Havering and Redbridge University Hospitals NHS Trust; Salisbury NHS Foundation Trust; Cwm Taf Morgannwg University Health Board; Betsi Cadwaladr University Health Board; University Hospitals Bristol and Weston NHS Foundation Trust; Cardiff and Vale University Health Board; Lancashire Teaching Hospital NHS Trust; The Walton Centre NHS Foundation Trust; St George's University Hospitals NHS Foundation Trust; University Hospitals Sussex NHS Foundation Trust; King's College Hospital NHS Foundation Trust; Guy's and St Thomas' NHS Foundation Trust; Belfast Health and Social Care Trust; The Newcastle Upon Tyne Hospitals NHS Foundation Trust
Other Contributors
Publication date
2024-11-05
Subject
Collections
Research Projects
Organizational Units
Journal Issue
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.
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.
Type
Article