A patient with a 1.5 cm acoustic neuroma (vestibular schwannoma) extending into the cerebellopontine angle with serviceable hearing is being evaluated. The patient is 55 years old and otherwise healthy. Which management option is currently considered appropriate according to standard guidelines?

• A Observation with serial MRI only, regardless of tumor size
• B Stereotactic radiosurgery (Gamma Knife) as primary treatment
• C Systemic chemotherapy with bevacizumab
• D Surgical excision via a hearing-preservation approach or stereotactic radiosurgery are both reasonable options ✓

Explanation

For a small to medium vestibular schwannoma (1.5 to 2.5 cm) with serviceable hearing in a healthy patient, both microsurgical excision (via middle fossa or retrosigmoid approach) and stereotactic radiosurgery are accepted management options. Observation is preferred for small tumors in elderly or poor-surgical candidates. Bevacizumab is reserved for progressive neurofibromatosis type 2-associated tumors, not sporadic schwannomas.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.