Paradoxical trends in the management of vestibular schwannoma in the United States

Clinical article

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Recent natural history studies of vestibular schwannomas (VSs) suggest that most of these tumors do not grow. The impact of these new data on management trends in the US is currently unknown. The aim in the present study was to evaluate current trends in the treatment of VS in the US by analyzing a national cancer database.


The Surveillance, Epidemiology, and End Results Program is a national database maintained by the National Cancer Institute representing 26% of the US population. Data from the database were downloaded using provided software. Cases were isolated based on histology codes and the site code. Data from 2004 to 2007 were included in the analysis. The number of patients undergoing resection was compared with the number treated with beam radiation and observation, based on tumor size.


Three thousand six hundred fifty cases were identified in the database. Over the study period, management choices for VSs showed a significant change only for tumors with a diameter < 2 cm. In this tumor category, a decrease in resection and an increase in radiation were observed, with observation showing a modest increase but remaining low at an average of 25%.


Study data demonstrated a shift in the management of small VSs in the US between 2004 and 2007, with microsurgical removal giving way to radiation treatment and the overall rate for observation remaining low and stable. With recent literature suggesting that the majority of small tumors do not grow, the authors assert that VSs are being overtreated in the US.

Abbreviations used in this paper:SEER = Surveillance, Epidemiology, and End Results; VS = vestibular schwannoma.

Article Information

Address correspondence to: Siviero Agazzi, M.D., Department of Neurosurgery and Brain Repair, College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, Florida 33606. email:

Please include this information when citing this paper: published online June 22, 2012; DOI: 10.3171/2012.5.JNS111858.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Graph showing management trend for VSs with a diameter smaller than 2 cm. From 2004 to 2007, there was a significant decrease in the percentage of patients undergoing surgery (triangles) from 52% to 42%, while the percentage of patients undergoing radiation (squares) increased from 27% to 32% (overall p = 0.004). Diamonds indicate observation.

  • View in gallery

    Graph showing management trend for all VSs from 2004 to 2007. Note the significant decrease in the percentage of patients undergoing surgery (squares) from 61% to 51%, while the percentage of patients undergoing radiation (diamonds) increased from 23% to 28% (p = 0.004). The overall trend for treatment versus nontreatment remained nonsignificant (p = 0.129). Triangles indicate observation.



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