Emerging Therapies For The Treatment Of Patients With Vestibular Schwannomas

Publication Date: February 1, 2018

Recommendations

MEDICAL THERAPY

It is recommended that bevacizumab be administered in order to radiographically reduce the size or prolong tumor stability in patients with neurofibromatosis type 2 (NF2) without surgical options. (Level III)
318512
It is recommended that bevacizumab be administered to improve hearing or prolong time to hearing loss in patients with NF2 without surgical options. (Level III)
318512
Lapatinib may be considered for use in reducing vestibular schwannoma size and improvement in hearing in NF2. (Level III)
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Erlotinib is not recommended for use in reducing vestibular schwannoma size or improvement in hearing in patients with NF2. (Level III)
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Everolimus is not recommended for use in reducing vestibular schwannoma size or improvement in hearing in NF2. (Level III)
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It is recommended that aspirin administration may be considered for use in patients undergoing observation of their vestibular schwannomas. (Level III)
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Perioperative treatmentwith nimodipine (or with the addition of hydroxyethyl starch) should be considered to improve postoperative facial nerve outcomes and may improve hearing outcomes. (Level III)
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PREHABILITATION

Preoperative vestibular rehabilitation is recommended to aid in postoperative mobility after vestibular schwannoma surgery. (Level III)
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Preoperative gentamicin ablation of the vestibular apparatus should be considered to improve postoperative mobility after vestibular schwannoma surgery. (Level III)
318512

SURGICAL THERAPY

Endoscopic assistance is a surgical technique that the surgeon may choose to use in order to aid in visualization. (Level III)
318512

Recommendation Grading

Disclaimer

Overview

Title

Emerging Therapies For The Treatment Of Patients With Vestibular Schwannomas

Authoring Organization

Publication Month/Year

February 1, 2018

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Vestibular schwannomas (VS) are commonly managed well with observation, surgery, and radiation. However, treating physicians continue to investigate new and emerging therapies for treatment-resistant cases as well as to aid in improved patient outcomes.

Target Patient Population

Adults with histologically proven or suspected vestibular schwannomas

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospice, Hospital, Long term care, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D015837 - Vestibular Diseases, D000911 - Antibodies, Monoclonal, D061067 - Antibodies, Monoclonal, Humanized, D000068258 - Bevacizumab, D000077341 - Lapatinib, D001241 - Aspirin

Keywords

aspirin, vestibular schwannomas, monoclonal antibodies

Source Citation

Neurosurgery, Volume 82, Issue 2, February 2018, Pages E52–E54, https://doi.org/10.1093/neuros/nyx516

Supplemental Methodology Resources

Methodology Supplement