Distinct Spontaneous Shrinkage Of A Sporadic Vestibular Schwannoma.
Huang, X., Caye-Thomasen, P., & Stangerup, S. E. (2013). Distinct spontaneous shrinkage of a sporadic vestibular schwannoma. Auris, nasus, larynx, 40(2), 243–246. https://doi.org/10.1016/j.anl.2012.01.011
View Original Source →Abstract
We present a case with outspoken spontaneous vestibular schwannoma shrinkage and review the related literature. The patient was initially diagnosed with a left-sided, intrameatal vestibular schwannoma, which subsequently grew into the cerebello-pontine angle (CPA), followed by total shrinkage of the CPA component without any intervention over a 12-year observation period. The literature on spontaneous tumor shrinkage was retrieved by searching the subject terms "vestibular schwannoma, conservative management" in PubMed/MEDLINE database, without a time limit. Of the published data, the articles on "shrinkage" or "negative growth" or "regression" or "involution" of the tumor were selected, and the contents on the rate, extent and mechanism of spontaneous tumor shrinkage were extracted and reviewed. The reported rate of spontaneous shrinkage of vestibular schwannoma is 5-10% of patients managed conservatively. Extreme shrinkage of the tumor may occur spontaneously.
Case Details
Disease Location
Left intrameatal vestibular schwannoma
Personal Characteristics
68-year-old female
Clinical Characteristics
Presented with left side sensorineural hearing loss and tinnitus, symptom onset in june 1998 CT at that time was normal. Hearing loss progressed and MRI done in april 99 showed 10mm intrameatal vestibular schwannoma. Patient followed under wait and watch protocol. MRI in july 2000 showed increased size with growth into cpa and largest extrameatal diameter 7mm. By 2001, patient was completely deaf on the left side but was reluctant to undergo surgery. Tumor continued to grow with peak size in 2004 to 13-14mm but no corresponding worsening of symptoms. Following this, there was spontaneous slow shrinkage of the tumor up to 2007 after which spotaneous shrinkage accelerated and extrameatal part had completely cleared by feb 2011.
Remission Characteristics
After cont growth of the tumor from 1998- 2004, there was spontaneous slow shrinkage of the tumor up to 2007 after which spotaneous shrinkage accelerated and extrameatal part had completely cleared by feb 2011.
Treatment & Mechanisms
Proposed Remission Mechanisms
Possible vascular - ischemic necrosis vs immunological