VESTIBULAR SCHWANNOMA MANAGEMENT IN THE NEXT CENTURY - A RADIOSURGICAL PERSPECTIVE

PURPOSE: To discuss how the evolution of vestibular schwannoma radiosu rgery, changes in health care delivery, and patient accessibility to m edical information will affect the management of vestibular schwannoma s in the future. CONCEPT: In comparison with microsurgical resection o f vestibular schwannomas, radiosurgery has a lower morbidity rate, a s imilar risk of requiring further surgery, and higher patient satisfact ion. As this information becomes more widely available to patients and third-party payors, radiosurgery may replace surgical resection as th e preferred management strategy for patients with small to medium size d vestibular schwannomas in the United States. RATIONALE: It is estima ted that 2500 patients are diagnosed with vestibular schwannomas each year in the United States. Assuming that 80% undergo surgery, 2000 ope rations are performed annually for newly diagnosed vestibular schwanno mas. Data available since 1987 regarding the number of cases for which gamma knife radiosurgery was performed were used to predict the numbe r of patients who will undergo vestibular schwannoma radiosurgery in t he future. if the current trend continues, an equal number of patients will undergo surgical resection and radiosurgery to treat their vesti bular schwannomas (similar to 1000/yr) sometime between 2005 and 2010. Moreover, it is predicted that by 2020, two-thirds of the patients wh o are newly diagnosed with vestibular schwannomas will undergo radiosu rgery, with surgical resection being reserved for patients with large tumors associated with symptomatic brain stem compression. DISCUSSION: Early data regarding vestibular schwannoma radiosurgery predicted an exponential growth curve. Although it is premature to assume that the current trend will continue, it is likely that an ever increasing perc entage of patients wilt undergo radiosurgery as accessibility to this alternative increases, and more data are published regarding long-term tumor growth control rates. If the mathematical model proves to be ac curate, then stereotactic radiosurgery will replace surgical resection as the preferred management strategy for the majority of patients wit h vestibular schwannomas.