Prognosis

Due to the potential slow-growing nature of benign vestibular schwannomas, many patients will have no intervention: "patients live undisturbed by their tumours, ultimately dying with them but not because of them".[78]​ If treated with current techniques, patients have a very good prognosis with minimal complications. Between 40% and 60% of small tumours may not require treatment.[33][34][35]​ Tumours treated with focused radiation have a control rate of >90%.[60][61]​ One meta-analysis of 37 studies found an overall disease stabilisation rate (after adjustment for significant publication bias) of 91.1% with stereotactic radiosurgery.[79] Following surgery, patients have a recurrence rate of <5%.[80][81][82]​ In experienced hands, repeat surgery for recurrences (in patients who have had previous surgery and/or radiation) is possible and has an acceptable outcome.[83] In experienced treatment centres, patients experience very good (equal) quality of life whether treatment is observation, radiation, or surgery.[84]

Long-term sequelae

If baseline hearing is near normal, 40% to 80% of hearing is preserved with radiation in the first 5-10 years of follow-up and about 30% to 80% of hearing is preserved with surgery, depending on anatomy, size of tumour, and surgical approach.[1][63][65][66][70][85] One analysis of 49 studies reported an overall hearing preservation rate of 52% with surgery.[86] Facial nerve preservation rates are very high with radiation and with surgery. However, outcomes are very dependent on tumour size and centre experience.[1][63][65][66][70][85]​​​​ Vestibular symptoms are not uncommon before and after treatment of vestibular schwannomas.[87][88]

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