Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Emerging Therapies for the Treatment of Patients With Vestibular Schwannomas

    loading  Checking for direct PDF access through Ovid

Abstract

MEDICAL THERAPY

Target Population: Adults with histologically proven or suspected vestibular schwannomas with neurofibromatosis type 2 (NF2).

MEDICAL THERAPY

Question: What is the role of bevacizumab in the treatment of patients with vestibular schwannomas?

MEDICAL THERAPY

Recommendations: Level 3: It is recommended that bevacizumab be administered in order to radiographically reduce the size or prolong tumor stability in patients with NF2 without surgical options.

MEDICAL THERAPY

Level 3: It is recommended that bevacizumab be administered to improve hearing or prolong time to hearing loss in patients with NF2 without surgical options.

MEDICAL THERAPY

Question: Is there a role for lapatinib, erlotinib, or everolimus in the treatment of patients with vestibular schwannomas?

MEDICAL THERAPY

Recommendations: Level 3: Lapatinib may be considered for use in reducing vestibular schwannoma size and improvement in hearing in NF2.

MEDICAL THERAPY

Level 3: Erlotinib is not recommended for use in reducing vestibular schwannoma size or improvement in hearing in patients with NF2.

MEDICAL THERAPY

Level 3: Everolimus is not recommended for use in reducing vestibular schwannoma size or improvement in hearing in NF2.

MEDICAL THERAPY

Question: What is the role of aspirin, to augment inflammatory response, in the treatment of patients with vestibular schwannomas?

MEDICAL THERAPY

Target Population: Any patient with a vestibular schwannoma undergoing observation.

MEDICAL THERAPY

Recommendation: Level 3: It is recommended that aspirin administration may be considered for use in patients undergoing observation of their vestibular schwannomas.

MEDICAL THERAPY

Question: Is there a role for treatment of vasospasm, ie, nimodipine or hydroxyethyl starch, perioperatively to improve facial nerve outcomes in patients with vestibular schwannomas?

MEDICAL THERAPY

Target Population: Adults with histologically proven or suspected vestibular schwannomas.

MEDICAL THERAPY

Recommendation: Level 3: Perioperative treatment with nimodipine (or with the addition of hydroxyethyl starch) should be considered to improve postoperative facial nerve outcomes and may improve hearing outcomes.

PREHABILITATION

Question: Is there a role for preoperative vestibular rehab or vestibular ablation with gentamicin for patients surgically treated for vestibular schwannomas?

PREHABILITATION

Target Population: Adults with histologically proven or suspected vestibular schwannomas.

PREHABILITATION

Recommendations: Level 3: Preoperative vestibular rehabilitation is recommended to aid in postoperative mobility after vestibular schwannoma surgery.

PREHABILITATION

Level 3: Preoperative gentamicin ablation of the vestibular apparatus should be considered to improve postoperative mobility after vestibular schwannoma surgery.

SURGICAL THERAPY

Question: Does endoscopic assistance make a difference in resection or outcomes in patients with vestibular schwannomas?

SURGICAL THERAPY

Target Population: Vestibular schwannoma patients, who are surgical candidates. Inclusion in this analysis required resection utilizing the endoscope, either as the primary operative visualization or microscopic assistance with more than 20 patients treated.

SURGICAL THERAPY

Recommendation: Level 3: Endoscopic assistance is a surgical technique that the surgeon may choose to use in order to aid in visualization.

SURGICAL THERAPY

The full guideline can be found at: https://www.cns.org/guidelines/guidelines-management-patients-vestibular-schwannoma/chapter_9.

Related Topics

    loading  Loading Related Articles