Natural History of Sporadic Vestibular Schwannoma: A Volumetric Study of Tumor Growth

Katherine A. Lees, Nicole M. Tombers, Michael J. Link, Colin L. Driscoll, Brian A. Neff, Jamie J. Van Gompel, John I. Lane, Christine M. Lohse, Matthew L. Carlson

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Objective: (1) Assess 3-dimensional volumetric growth of untreated sporadic vestibular schwannomas (VSs) in a large cohort of patients treated with conservative observation. (2) Compare volumetric and conventional linear diameter measurements for detecting tumor growth. Study Design: Case series with chart review. Setting: Tertiary skull base referral center. Subjects and Methods: Patients with sporadic VS who elected initial conservative treatment with at least 2 serial magnetic resonance imaging (MRI) scans were included. Tumor volume was determined with 3-dimensional segmentation of MRI sequences. The volumetric threshold for tumor growth was an increase ≥20% from baseline tumor volume. Tumor size based on linear diameter was assessed with the 1995 American Academy of Otolaryngology—Head and Neck Surgery Foundation guidelines for VS outcome reporting, with growth defined as an increase ≥2 mm. Results: A total of 361 patients were included with a median radiologic follow-up of 4.1 years (interquartile range [IQR], 2.5-6.8). At diagnosis, 232 VSs (64%) were purely intracanalicular, and 129 (36%) extended into the cerebellopontine angle. The median baseline tumor volume was 0.161 cm3 (IQR, 0.054-0.418). Overall, 69% of tumors demonstrated volumetric growth at a median of 1.1 years (IQR, 0.6-2.1) after initial MRI. In contrast, based on linear measurement assessment, 48% of tumors demonstrated growth at a median of 1.8 years (IQR, 0.8-3.1) from first MRI scan. Disequilibrium, facial hypoesthesia, aural fullness, initial tumor size, and nonincidental diagnosis were associated with tumor growth. Conclusion: Three-dimensional volumetric assessment of VS provides a more sensitive measure of tumor growth when compared with linear diameter assessment. Through volumetric analysis, the current study revealed that a significant proportion of VSs demonstrate growth during observation.

Original languageEnglish (US)
Pages (from-to)535-542
Number of pages8
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number3
StatePublished - Sep 1 2018
Externally publishedYes


  • acoustic neuroma
  • natural history
  • neurotology
  • skull base
  • vestibular schwannoma
  • volumetric

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


Dive into the research topics of 'Natural History of Sporadic Vestibular Schwannoma: A Volumetric Study of Tumor Growth'. Together they form a unique fingerprint.

Cite this