{"title":"Decision-making in sporadic vestibular schwannoma.","authors":"Cathal John Hannan, Andrew King","doi":"10.1016/B978-0-12-824534-7.00010-X","DOIUrl":null,"url":null,"abstract":"<p><p>Over the last 20 years, there has been a marked shift from active intervention to radiologic observation in the management of vestibular schwannomas, prompted by our understanding that a substantial proportion of these tumors do not demonstrate significant growth following diagnosis. In parallel with this, when active intervention does take place, our outcome measures are increasingly focused on preserving neurologic function, rather than on complete tumor removal at any cost. These principles of management are now widely accepted in most major skull-base centers throughout the world, but a number of areas of controversy in the management of these tumors remain. The chapter aims to provide an overview of such topics including intervention for hearing preservation, radiosurgery vs surgery, choice of surgical approach, and the management of residual tumor following surgical resection. Ultimately, our intention was not to add yet another voice to the debate as to which are the \"right\" approaches, but to prompt the reader to consider the evidence surrounding these areas of contention when coming to a shared decision with their patients as to which management strategies to adopt.</p>","PeriodicalId":12907,"journal":{"name":"Handbook of clinical neurology","volume":"212 ","pages":"303-313"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Handbook of clinical neurology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/B978-0-12-824534-7.00010-X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Over the last 20 years, there has been a marked shift from active intervention to radiologic observation in the management of vestibular schwannomas, prompted by our understanding that a substantial proportion of these tumors do not demonstrate significant growth following diagnosis. In parallel with this, when active intervention does take place, our outcome measures are increasingly focused on preserving neurologic function, rather than on complete tumor removal at any cost. These principles of management are now widely accepted in most major skull-base centers throughout the world, but a number of areas of controversy in the management of these tumors remain. The chapter aims to provide an overview of such topics including intervention for hearing preservation, radiosurgery vs surgery, choice of surgical approach, and the management of residual tumor following surgical resection. Ultimately, our intention was not to add yet another voice to the debate as to which are the "right" approaches, but to prompt the reader to consider the evidence surrounding these areas of contention when coming to a shared decision with their patients as to which management strategies to adopt.
期刊介绍：
The Handbook of Clinical Neurology (HCN) was originally conceived and edited by Pierre Vinken and George Bruyn as a prestigious, multivolume reference work that would cover all the disorders encountered by clinicians and researchers engaged in neurology and allied fields. The first series of the Handbook (Volumes 1-44) was published between 1968 and 1982 and was followed by a second series (Volumes 45-78), guided by the same editors, which concluded in 2002. By that time, the Handbook had come to represent one of the largest scientific works ever published. In 2002, Professors Michael J. Aminoff, François Boller, and Dick F. Swaab took on the responsibility of supervising the third (current) series, the first volumes of which published in 2003. They have designed this series to encompass both clinical neurology and also the basic and clinical neurosciences that are its underpinning. Given the enormity and complexity of the accumulating literature, it is almost impossible to keep abreast of developments in the field, thus providing the raison d''être for the series. The series will thus appeal to clinicians and investigators alike, providing to each an added dimension. Now, more than 140 volumes after it began, the Handbook of Clinical Neurology series has an unparalleled reputation for providing the latest information on fundamental research on the operation of the nervous system in health and disease, comprehensive clinical information on neurological and related disorders, and up-to-date treatment protocols.
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