[Vestibular schwannoma (acoustic neurinoma). Natural history and quality of life].

Management of patients with vestibular shwannomas has gradually improved with the development of stereotaxic radiotherapy, our better understanding of these tumours' natural history, and the increasing accent placed on quality of life. The aim of this study was two-fold:--to evaluate the natural history and tumor growth in a series of 386 patients presenting with small- or medium-sized tumors amenable to conservative management; and ii) to compare quality of life in 356 patients undergoing surgery (n = 198), radiosurgery (n = 23) or conservative management (n = 135). The annual tumor growth rate was < 1 mm in 58.6% of patients, 1-3 mm in 29.2%, and > 3 mm in 12.2%. The overall growth rate did not differ significantly between intrameatal and extrameatal tumors (1.02 +/- 1.8 and 1.40 +/- 3.1 mm/y, respectively). The tumor growth rate was not related to sex, age, initial hearing status or initial tumor grade. Late diagnosis was the only factor significantly associated with the tumor growth rate. All three treatment modalities had a negative impact on QOL, but surgery led to a significant deterioration. This study supports a conservative "wait-and-scan" policy for patients with small tumours, most of which are slow-growing. Long-term radiological controls are needed even for non growing tumours. Surgery significantly degrades quality of life.