FRCS (ORL-HNS) · SECTION 1 SBA

Vestibular schwannoma observation

A 73-year-old has a 7-mm intracanalicular vestibular schwannoma, mild stable asymmetry, no disabling imbalance and significant comorbidity. What is the most defensible initial plan?

CHOOSE ONE ANSWER

Best of five

  1. A. Individualised surveillance with serial MRI and audiometry
  2. B. Mandatory microsurgery
  3. C. Immediate radiotherapy without discussion
  4. D. Discharge without follow-up
  5. E. Annual CT instead of MRI
ANSWER AND REASONING

A. Individualised surveillance with serial MRI and audiometry

Small minimally symptomatic tumours in older or comorbid patients may be observed. Management weighs growth, hearing, symptoms, age, preference and treatment morbidity; no single modality is automatic.

Why every option is right or wrong

A. Individualised surveillance with serial MRI and audiometry: Small minimally symptomatic tumours in older or comorbid patients may be observed. Management weighs growth, hearing, symptoms, age, preference and treatment morbidity; no single modality is automatic.

B. Mandatory microsurgery: The morbidity may exceed benefit for a small stable lesion.

C. Immediate radiotherapy without discussion: Stereotactic treatment is an option, not an obligation.

D. Discharge without follow-up: Growth and hearing change still require surveillance.

E. Annual CT instead of MRI: MRI is the preferred modality for soft-tissue surveillance and avoids radiation.

What if the scenario changed?

If serial imaging demonstrated meaningful growth or symptoms progressed, active treatment would be reconsidered.

EDUCATIONAL USE

Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.

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