Postoperative MRI Surveillance of Vestibular Schwannomas: Is There a Standard of Care?

OBJECTIVE: To examine current practices for postoperative imaging surveillance following vestibular schwannoma resection. STUDY DESIGN: Cross-sectional survey of practicing neurotologists. SETTING: Tertiary referral centers. PATIENTS: Not applicable. INTERVENTION: Two hundred seventy-six members of the American Neurotology Society were invited to participate. Using a web-based format, respondents self-reported demographic and practice details. Case scenarios were presented. For each scenario, both quantitative and qualitative data were recorded. MAIN OUTCOME MEASURES: Timing, frequency, duration, and modality of postoperative imaging. RESULTS: For all scenarios, responses were widely disparate with respect to timing, frequency, number, and duration of follow-up imaging. Following gross total resection, respondents most commonly (46.5%) obtain the first magnetic resonance imaging 1 year after surgery, with the most common endpoint to discontinue surveillance imaging at 10 years (34.9%). Tumor beds with postoperative enhancement were generally followed longer than those without enhancement, but with wide variability in practice patterns. The majority of neurotologists do not change surveillance patterns regarding tumor size or completeness of initial resection. Lower volume surgeons appear to be more aggressive with initial surveillance postoperatively than higher volume surgeons. CONCLUSION: Wide variability exists amongst neurotologists concerning postsurgical tumor surveillance imaging. Despite recent data to suggest more standardized protocols, disparate practice patterns persist. Additional research is needed to this end, as the subsequent establishment of such evidence-based protocols could obviate substantial medical, medico-legal, and economic burdens concerning this patient population.