A large vestibular schwannoma that did not grow for 18 years

Treatment strategies for vestibular schwannoma include microsurgery, stereotactic radiotherapy and conservative management (wait and scan). To avoid neurological complications or even death, surgery is the preferred treatment for large tumours with an extrameatal diameter > 3.0 cm. We present the case history of a man with a large vestibular schwannoma who had refused treatment and was seen again eighteen years later. This patient had not developed symptoms other than the initial hearing loss. Repeated imaging showed that the tumour had not grown and the brainstem compression had not progressed. This case history illustrates the unpredictable growth pattern of vestibular schwannomas. Apparently, even large tumours in close proximity to the brainstem may remain stable for many years. However, there still are no valid arguments to refrain from therapy in patients with a large vestibular schwannoma, since reliable growth predictors are not available.