ANA Discussion Forum
Watch and Wait => For those in the 'watch and wait' status => Topic started by: arizonajack on March 28, 2013, 04:54:40 pm
-
The following article is in pdf form so you can save it to your computer for future reference.
http://thejns.org/doi/pdf/10.3171/2012.6.FOCUS12192
Summary:
The newly diagnosed vestibular schwannoma: radiosurgery, resection, or observation?
Object. Management recommendations for patients with smaller-volume or newly diagnosed vestibular schwannomas (< 4 cm3) need to be based on an understanding of the anticipated natural history of the tumor and the side effects it produces. The natural history can then be compared with the risks and benefits of therapeutic intervention using a minimally invasive strategy such as stereotactic radiosurgery (SRS).
Methods. The authors reviewed the emerging literature stemming from recent recommendations to “wait and scan” (observation) and compared this strategy with published outcomes after early intervention using SRS or results from matched cohort studies of resection and SRS.
Results. Various retrospective studies indicate that vestibular schwannomas grow at a rate of 0–3.9 mm per year and double in volume between 1.65 and 4.4 years. Stereotactic radiosurgery arrests growth in up to 98% of patients when studied at intervals of 10–15 years. Most patients who select “wait and scan” note gradually decreasing hearing function leading to the loss of useful hearing by 5 years. In contrast, current studies indicate that 3–5 years after Gamma Knife surgery, 61%–80% of patients maintain useful hearing (speech discrimination score > 50%, pure tone
average < 50).
Conclusions. Based on published data on both volume and hearing preservation for both strategies, the authors devised a management recommendation for patients with small vestibular schwannomas. When resection is not chosen by the patient, the authors believe that early SRS intervention, in contrast to observation, results in long-term tumor control and improved rates of hearing preservation.
Please don't rely on just the summary. There's a lot of great information in the full article.
-
I can attest to the facts presented. I was WW for 1.5 yrs. Sometime at the end of the last year my tumor doubled in size. (based on my increased symptoms during the last 2 mos of the year). The scheduled MRI showed the remarkable growth spurt. I lost my hearing sometime after the MRI, unsteadiness increased, and plugged ear feeling became more pronounced. To those on the WW, read the new literature and proceed with caution. I did all the research and consulted with numerous Doctors and did what I felt was the best for me. In the end, I lost. The good thing was that I went through a successful 30 day Proton Therapy treatment and came out almost good as new. Except for the hearing. But then again I get to play with my new toy, the Cross hearing aid. So in the end life is good and maybe my experiences will help some one else.
-
Going into my 6th year W+W. My AN is stable and hearing + tinnitus all relitively a lil better. Overall I do feel better healthwise. I`m very healthconsious and would be happy to go on like this and take this little bugger along with the other unwanted lumps and bumps with me. Just want to get older gracefully... Best wishes, Mickey