A 40-year-old woman with neurofibromatosis type 2 (NF2) is found on surveillance MRI to have bilateral vestibular schwannomas. Her right-sided tumor is 2.5 cm with mild sensorineural hearing loss and no brainstem compression. The management strategy that best balances hearing preservation with tumor control is:
- A Urgent surgical excision via translabyrinthine approach to prevent deafness
- B Bevacizumab (VEGF inhibitor) therapy for NF2-associated schwannomas
- C Bilateral simultaneous microsurgical excision to remove all tumor tissue
- D Stereotactic radiosurgery (Gamma Knife) to control growth while preserving residual hearing ✓
Explanation
In NF2 patients with bilateral vestibular schwannomas, hearing preservation is a paramount concern because deafness in both ears is profoundly disabling. For small-to-medium tumors (<3 cm) with serviceable hearing, stereotactic radiosurgery (Gamma Knife) achieves 90-95% tumor control rates while preserving useful hearing in 60-70% of cases, superior to surgical hearing preservation rates. Microsurgery is reserved for large tumors causing brainstem compression. Bevacizumab has evidence for NF2-associated schwannomas as a systemic option but is not first-line for focal unilateral disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.