Brain Tumor Res Treat.  2024 Apr;12(2):125-131. 10.14791/btrt.2024.0008.

Spontaneous Regression of a Large Vestibular Schwannoma: Is Nonoperative Management Reasonable?

• Teo KAC
• Agrwal R
• Kei PL
• Lim SL
• Sun SI
• Low SW

• KMID: 2555872
• DOI: http://doi.org/10.14791/btrt.2024.0008

Abstract

Vestibular schwannomas (VSs) are the most common cerebellopontine tumors. The natural history of smaller-sized VSs (<30 mm) has been well-studied, leading to the recommendation of a “watch and wait” approach. However, large VSs (>30 mm) have not been extensively studied, mainly because of their rarity. As such, most patients are conventionally offered surgery which carries a significant risk of neurological morbidity. Here, we report a case of a giant VS (>40 mm) in a 30-year-old man who regressed spontaneously. He was lost to follow-up for 18 years and, upon re-presentation, the symptomatology drastically improved and repeat imaging demonstrated a marked reduction in tumor size. Referring to similar cases in other studies, we postulate that most large and giant VSs undergo a phase of growth and stasis, followed by regression due to shifts in the balance between tumorigenic and regressive factors. Taken together with emerging molecular data, further studies are required to better understand the history of large and giant VSs to shape more personalized treatment options. This potentially includes non-operative management as a tenable option.

Keyword

Acoustic neuroma; Conservative; Cerebellopontine angle tumors; Remission

Figure

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  Fig. 1 Giant vestibular schwannomas (VS) diagnosed at 30 years of age. A: Axial T2 MRI of giant VS. B: Axial T1 MRI of giant VS. C: Coronal T1 MRI of giant VS.

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  Fig. 2 Marked reduction in tumor volume at 48 years of age. A: Axial T2 MRI of giant VS. B: Axial T2 FLAIR MRI of giant VS. C: Coronal T1 MRI of giant VS. FLAIR, fluid attenuated inversion recovery; VS, vestibular schwannoma.

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  Fig. 3 Postulated balance between regressive and tumorigenic factors influencing vestibular schwannomas growth.

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