2025 Proffered Presentations
S179: VESTIBULAR SCHWANNOMA MANAGEMENT IN THE 21ST CENTUTRY - EMOTIONAL AND OTHER INVESTMENTS IN DECISION MAKING?
Shakeel Saeed, Professor; University College London Ear Institute
Purpose: The primary purpose of this paper is to evidence how the management of patients presenting with a vestibular schwannoma has evolved in the last 25 years and to evidence how there remain diverse opinions and management strategies despite accrued evidence. The author then asks the question as to whether emotional investment (a recognised phenomenon in patient management generally) or other investments in decision making play a role.
Methods: Presentation of some historic context, the author's prospectively accrued dataset of over 1000 cases and aspects of the UK British Skullbase VS Audit which comprises over 18,000 cases with datasets
Results: Of 1141 patients seen by the author and his skullbase team between 1999 and 2023, 59% of patients were managed conservatively with one third converting to intervention during the observation period.
Of 18,610 VS cases accrued prospectively in the UK national database since 2013, 17,137 datasets were analysed. 35% were intracanalicular tumours at presentation, 37% <15mm in the CPA, 22% 15 -30mm and 6% > 30mm. The primary management and subsequent growth outcomes are presented for the groups.
Conclusion: Conservative management of intracanalicular and small tumours at presentation forms the basis of the management at diagnosis for the majority of patients both for the author and the UK skullbase units as a whole. This is not necessarily the case in centres in other parts of the world and the author explores the possible reasons for the divergent management pardigms.