Postoperative imaging and follow-up of vestibular schwannomas

Objective: No standards exist regarding patient follow-up after complete vestibular schwannoma resection. We surveyed neurotologists and neurosurgeons to determine practice patterns. Study Design: A nonrandomized sample of American Neurotology Society and North American Skull Base Society members was surveyed. Questions concerned years in practice, experience with vestibular schwannoma surgery, and postoperative follow-up algorithms given the scenario of complete gross tumor removal. Data were collected, tallied, and statistically analyzed. Setting: Academic and private practice neurotologists and neurosurgeons. Subjects: Nonrandom sample of American Neurotology Society and North American Skull Base Society members. Main Outcome Measures: Number of postoperative magnetic resonance imaging scans, timing of magnetic resonance imaging scans, timing of final magnetic resonance imaging scan, timing of final visit, and variability between specialties. Results: Four hundred ninety-eight surveys were sent and 135 were returned (27.1%). The average number of postoperative magnetic resonance imaging scans was 3.6 for neurotologists (range, 1-11) and 5.6 for neurosurgeons (range, 1-13). This was statistically significant (p > 0.001). There was no correlation between number of magnetic resonance imaging scans and either years in practice or tumor experience. Average length of follow-up varied greatly (1 year to lifetime) but was most commonly 5 years. Eight percent of neurotologists varied their postoperative routine on the basis of surgical approach, whereas none of the neurosurgeons did. Conclusion: There remains no standard postoperative imaging algorithm for patients after complete vestibular schwannoma resection.