The Natural History and Management of Vestibular Schwannomas

Over the past decade (2000-), the management of vestibular schwannomas has been in a state of flux. An increasing availability of magnetic resonance imaging has allowed clinicians to monitor tumour progression and increasingly, it has become recognised that once diagnosed, a significant proportion of lesions do not continue to grow. As a result, a number of neurotological centres have advocated conservative management as appropriate for small-medium sized tumours. Birmingham has been one of these centres, and this thesis presents data gathered over the past fifteen years that reflects this change in management, drawing upon the Birmingham Vestibular Schwannoma Database maintained by the author. The thesis addresses issues pertinent to conservative management: growth rates among observed tumours, risk factors for growth, the evolution of hearing while under observation and proposes a radiological surveillance protocol. More broadly, the thesis examines other themes important in the management of patients with vestibular schwannomas: the role of functional surgery and the possibility of rehabilitation in single-sided deafness. A number of chapters from the thesis have been published in peer-reviewed journals and are presented here in updated or amended form.