A patient with a vestibular schwannoma (acoustic neuroma) of 2 cm is found on gadolinium-enhanced MRI. He is 65 years old with mild imbalance and unilateral high-frequency hearing loss. The most appropriate management strategy is:

• A Immediate microsurgical excision via translabyrinthine approach
• B Active surveillance (MRI monitoring at 6 months, then annually) ✓
• C Stereotactic radiosurgery (Gamma Knife) as first-line treatment
• D Middle fossa approach surgery to preserve hearing

Explanation

For small to medium vestibular schwannomas in older patients, active surveillance ("watch and wait") with serial MRI monitoring is a validated first-line strategy. Up to 50-70% of vestibular schwannomas are slow-growing or quiescent. Treatment is recommended if growth exceeds 2-3 mm/year, tumor grows to >3 cm, or symptoms significantly progress. Radiosurgery (option C) is appropriate for tumors up to 3 cm, especially in elderly or poor surgical candidates, but is not mandated immediately. Middle fossa approach preserves hearing only in small tumors with serviceable hearing.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.