A 59-year-old has a 14 mm intracanalicular vestibular schwannoma, serviceable hearing and two MRI scans showing 1 mm apparent change over one year. What is the most defensible next step?
A single very small apparent change may reflect technique or measurement variability; management should integrate reproducible growth, symptoms, hearing and preferences.
A. Immediate translabyrinthine excision: This sacrifices residual hearing and is disproportionate without confirmed progression or another compelling indication.
B. Stereotactic radiotherapy solely because any growth is seen: Treatment should not be triggered by an unverified millimetric difference alone.
C. Continue protocolled surveillance after checking measurement comparability and patient priorities: A single very small apparent change may reflect technique or measurement variability; management should integrate reproducible growth, symptoms, hearing and preferences.
D. Discharge from follow-up: A known tumour requires longitudinal surveillance even when initially stable.
E. Annual CT instead of MRI: CT is inferior for serial soft-tissue assessment and adds ionising radiation.
If serial comparable scans showed sustained growth with declining hearing, active treatment discussion would become more appropriate.
Independent Clinora preparation material; not official JCIE content, an accredited programme or a substitute for local policy and specialist judgement.
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