Treatment of Small Vestibular Schwannomas

Vestibular schwannomas (VS) are benign neoplasms that arise from the Schwann cells enveloping the vestibular division of the eighth cranial nerve. These tumors typically exhibit indolent growth and commonly cause audiovestibular dysfunction. If allowed to grow large enough, VS can cause brainstem compression and become fatal. Treatment options include observation with serial imaging, radiotherapy, and microsurgical resection. This review will summarize the literature regarding treatment outcomes for patients with small VS. Advances in diagnostic imaging have allowed for earlier and more frequent detection of small VS. Management of small VS remains controversial and is influenced by physician preference. Recent studies have summarized outcomes in small VS in conservative, radiosurgery, and microsurgery cohorts. Additional data on quality of life, volumetry, and morphometry allow for more informed decision-making in the treatment of small VS. In this article, we review contemporary literature describing outcomes of each treatment modality, with emphasis on tumor control, facial nerve function, hearing preservation, and quality of life.