Treatment Options and Surgical Indications

The goal of modern management of vestibular schwannoma is to improve the quality of life and to preserve the neurological functions while maintaining mortality and morbidity rates as low as possible. Tumor size and growth pattern as well as patient’s age, symptoms, and comorbidities determine the treatment of choice among three main options: conservative therapy with watchful waiting, radiation therapy, and surgery. Watchful waiting mainly applies to incidentally diagnose vestibular schwannomas with small size (≤2 cm) and low growth rate (≤2 mm/year) at diagnosis in patients with nonfunctional hearing (AAO-HNS class C/D). Radiation therapy is indicated in case of small tumor size (≤2 cm), high tumor growth rate (≥3 mm/year), nonfunctional hearing (AAO-HNS class C/D), and poor clinical conditions contraindicating surgical intervention (ASA ≥ 4). Surgical resection is the sole treatment modality that—if total—guarantees tumor eradication and is indicated in case of large tumor size (>2 cm), high tumor growth rate (>2 mm/year), and/or presence of socially useful hearing (AAO-HNS class A/B) and/or cystic degeneration of tumor on MRI.