What follow-up protocols should be in place for patients diagnosed with acoustic neuroma after initial treatment?

For patients diagnosed with acoustic neuroma (vestibular schwannoma) following initial treatment, follow-up protocols should focus on regular clinical review and surveillance for potential late-onset side effects NICE NG99.

• Individualised Assessment: It is crucial to assess each person's individual risk of developing late effects when they finish treatment NICE NG99. These risks should be recorded in their written treatment summary and explained to the person, and their relatives and carers as appropriate NICE NG99.
• Regular Clinical Review: Patients should be offered regular clinical review to assess changes in their physical, psychological, and cognitive wellbeing NICE NG99. The timing of these reviews and any follow-up imaging should be based on factors such as any residual tumour, life expectancy, the person's preferences, treatments used, treatment options available, and tumour subtype NICE NG99. Regular clinical review involves outpatient assessment at planned intervals to evaluate symptoms and care needs, provide support and treatment, and perform imaging when appropriate NICE NG99.
• Imaging: Standard structural MRI (T2 weighted, FLAIR, DWI series, and T1 pre- and post-contrast volume) should be considered as part of regular clinical review to assess for progression or recurrence, unless MRI is contraindicated NICE NG99. A baseline MRI scan within 72 hours of surgical resection should be considered for all types of glioma, and a baseline MRI scan 3 months after the completion of radiotherapy should also be considered NICE NG99. It is important to explain that imaging can be difficult to interpret and results can be of uncertain significance, and to be aware that routine imaging and waiting for results may cause anxiety NICE NG99.
• Surveillance for Late-Onset Side Effects: Be aware that people with brain tumours can develop side effects months or years after treatment NICE NG99. These can include, but are not limited to, hearing loss, visual impairment, cognitive decline, hypopituitarism, and stroke NICE NG99. Specific considerations include:
  • Hearing Loss: Consider referring people at risk of hearing loss to audiology for a hearing test NICE NG99.
  • Visual Impairment: Consider referring people at risk of visual impairment for an ophthalmological assessment NICE NG99.
  • Cognitive Decline: Consider ongoing neuropsychology assessment for people at risk of cognitive decline NICE NG99.
  • Endocrine Function: If a person has had a radiotherapy dose that might affect pituitary function, consider checking their endocrine function regularly after the end of treatment NICE NG99.
  • Stroke Risk: For people at risk of stroke, consider checking their blood pressure, HbA1c level, and cholesterol profile regularly NICE NG99. Encourage a healthy lifestyle, including exercise, a healthy diet, and stopping smoking, to decrease stroke risk NICE NG99. If an MRI during active monitoring identifies asymptomatic ischaemic stroke, consider referring the person to stroke services NICE NG99.

While the provided literature discusses initial management strategies for newly diagnosed vestibular schwannomas, such as upfront stereotactic radiosurgery versus watchful waiting Vasconcellos et al. 2024, it does not detail specific post-treatment follow-up protocols.