Vestibular Schwannoma (Acoustic Neuroma) · Observe vs SRS vs Surgery

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Size + growth/symptoms + hearing
   Tumor size? Growing/symptomatic? Hearing?
   • Small, asymptomatic/non-growing → Small asymptomatic → observe
   • Small-medium, growing or symptomatic, wants minimally invasive → Small-medium growing → radiosurgery
   • Large (>2.5–3 cm)/brainstem compression/cystic → Large/brainstem compression → microsurgery
2. [End] Small asymptomatic → observe
   Small, asymptomatic, non-growing → observe (serial MRI + hearing); most grow slowly; intervene once growth is confirmed.
3. [End] Small-medium growing → radiosurgery
   Small-medium (generally <2.5–3 cm), growing or symptomatic → stereotactic radiosurgery (gamma knife); high tumor control rate, good facial nerve preservation.
4. [End] Large/brainstem compression → microsurgery
   Large (>2.5–3 cm)/brainstem compression/cystic → microsurgical resection (retrosigmoid/translabyrinthine/middle fossa approach); balance facial nerve and hearing preservation.

Source guidelines & references

• Vestibular schwannoma management (observation/radiosurgery/microsurgery)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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