The Natural History of Vestibular Schwannoma and When to Intervene

Purpose of Review: To review and summarize current updates in the epidemiology, natural history, and treatment strategies of vestibular schwannoma (VS). Recent Findings: The incidence of VS has increased in recent decades, which may be due in part to improved detection but may also be an actual biological shift. Based on our improving understanding of VS’s natural history, treatment strategy has shifted toward primary observation. Based on several large studies, we can predict which VS are at the greatest risk of growth and which patients are at risk of losing serviceable hearing. Measurement of tumor volume is a new tool that is more sensitive than linear axial measurements, although the clinical implications are still under investigation. Summary: Advances in our understanding of VS’s natural history improve our ability to counsel patients on when to pursue intervention and which modality is most appropriate on an individual basis.