OTOLOGY Management of growing vestibular schwannomas Gian Gaetano Ferri • Antonio Pirodda • Alberto Rinaldi Ceroni • Antonio Fioravanti • Fabio Calbucci • Giovanni Carlo Modugno Received: 17 July 2012 / Accepted: 25 October 2012 / Published online: 8 November 2012 Ó Springer-Verlag Berlin Heidelberg 2012 Abstract Conservative management of small vestibular schwannomas is frequently proposed as most tumours do not grow. Anyway, tumour growth is reported in 30–40 % of the cases, so that surgery is consequently generally proposed. We primarily observed 161 patients affected by unilateral vestibular schwannomas. All patients were examined by means of gadolinium-enhanced magnetic resonance imaging scans. Tumour growth was recorded in 58 cases (35.8 %) and these subjects set up the group of study. Twenty-two (37.9 %) patients were surgically trea- ted; tumour was always completely removed, all patients had normal facial function after surgery and only one patient suffered from a major complication (cerebellar haematoma). Fourteen patients (24.1 %) were submitted to radiotherapy, while one patient was lost at follow-up and another one died because of other medical reasons. Finally, 20 (34.5 %) subjects continued to be observed for different reasons. The mean follow-up period after identification of growth was 6.1 years. Nine tumours continued to grow, nine tumours stopped growing, one tumour grew and then regressed in size and one tumour decreased. Sixty percent of patients with useful hearing at diagnosis preserved it during the entire observation period. In conclusion, most of VS do not grow; in case of tumour growth, a surgical procedure may be suggested and the outcomes are not negatively influenced by the delay of the procedure. But in some cases, patients can still follow the ‘‘wait and scan’’ policy. In fact, only less than half of the growing tumours continued to grow. Moreover, most of the patients con- tinued to retain a useful hearing. Keywords Vestibular schwannoma Á Growth rate Á Hearing function Á Imaging Introduction The management of unilateral vestibular schwannoma (VS) has definitively changed in the last two decades. Once most of these tumours were surgically treated, aiming to completely remove the tumour and possibly preserving facial nerve integrity and sometimes hearing function. Many technical improvements, such as anaesthesiological assistance, refinement of surgical techniques, cranial nerves monitoring and the cumulated experience of the surgeons have remarkably contributed to the achievement of better outcomes. Nevertheless, this kind of benign tumour does not often cause significant symptoms for the patient, as the quality of life (QoL) of a patient submitted to VS removal is strongly negatively affected [1] and in most of the cases (i.e. [ 50 %) is worse after surgery [2, 3]. Moreover, early reports [4–6] evidenced that these benign tumours often do not grow. Therefore, a conservative management of VS is today more frequently proposed as primary therapeutic option and many studies have docu- mented that the percentage of not growing tumours is clearly over 50 % [7–14]. Presented at the Sixth International Conference on Acoustic Neuroma. Hyatt Regency Century Plaza Hotel and Spa. Los Angeles, CA, USA, June 28–July 1, 2011. G. G. Ferri (&) Á A. Pirodda Á A. R. Ceroni Á G. C. Modugno Department of Specialist Surgical and Anesthesiological Sciences, S. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy e-mail: giangaetano.ferri@unibo.it A. Fioravanti Á F. Calbucci Department of Neurosurgery, Bellaria Hospital, Bologna, Italy 123 Eur Arch Otorhinolaryngol (2013) 270:2013–2019 DOI 10.1007/s00405-012-2248-4