Decision Making on Vestibular Schwannoma: Lessons from a Multidisciplinary Board

Bruno Sergi; Mario Balducci; Gaetano Paludetti; Alessandro Olivi; Pasqualina Maria Picciotti; Eugenio De Corso; Giulio Cesare Passali; Anna Rita Fetoni; Daniela Lucidi

doi:10.1016/j.wneu.2021.10.140

Decision Making on Vestibular Schwannoma: Lessons from a Multidisciplinary Board

World Neurosurg. 2022 Jan:157:e506-e513. doi: 10.1016/j.wneu.2021.10.140. Epub 2021 Oct 26.

Authors

Bruno Sergi¹, Mario Balducci², Gaetano Paludetti¹, Alessandro Olivi³, Pasqualina Maria Picciotti⁴, Eugenio De Corso⁵, Giulio Cesare Passali¹, Anna Rita Fetoni¹, Daniela Lucidi⁶

Affiliations

¹ Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy; Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy.
² Department of Radiotherapy, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy.
³ Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy.
⁴ Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy; Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy. Electronic address: pasqualinamaria.picciotti@unicatt.it.
⁵ Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy.
⁶ Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy.

PMID: 34710576
DOI: 10.1016/j.wneu.2021.10.140

Abstract

Background: Management of vestibular schwannoma (VS) is a complex process aimed at identifying a clinical indication for fractionated stereotactic radiotherapy (sRT) or radiosurgery, microsurgical resection, or wait and scan (WS). We describe the experience of our VS multidisciplinary team (MDT) at a tertiary university referral center created for diagnosis, treatment, and follow-up of VS patients.

Methods: We conducted a retrospective study on 132 consecutive patients referred to the MDT and managed by observation (WS), microsurgery, or fractionated sRT. The analysis included patient age, tumor size, hearing level, facial nerve function, tumor control, complications, and quality of life questionnaires.

Results: Among the patients, 21% were subjected to microsurgery, 10% to sRT, and 69% to WS. The median follow-up time was 30 months. Outcomes based on different management modalities are described. Statistically significant differences among groups were detected in terms of quality of life (physical domain).

Conclusions: MDT may provide the best individualized therapy for VS patients compared with a single gold-standard strategy.

Keywords: Management; Multidisciplinary; Vestibular schwannoma.

MeSH terms

Aged
Aged, 80 and over
Clinical Decision-Making / methods*
Female
Follow-Up Studies
Humans
Male
Microsurgery / methods*
Middle Aged
Neuroma, Acoustic / diagnostic imaging*
Neuroma, Acoustic / surgery*
Patient Care Team*
Retrospective Studies