{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:19:24Z","timestamp":1787631564827,"version":"build-2736575974"},"reference-count":18,"publisher":"Royal College of Surgeons of England","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p> Conservative management of patients with a stable vestibular schwannoma (VS) places a significant burden on National Health Service (NHS) resources and yet patients\u2019 surveillance management is often inconsistent. Our unit has developed a standardised pathway to guide surveillance imaging of patients with stable VS. In this article, we provide the basis for our imaging protocol by reviewing the measurement, natural history and growth patterns of VS, and we present a cost analysis of implementing the pathway both regionally and nationally. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> Patients with an extrameatal VS measuring \u226420mm in maximal diameter receive magnetic resonance imaging (MRI) six months after their index imaging, followed by three annual MRI scans, two two-year interval MRI scans, a single three-year interval MRI scan and then five-yearly MRI scans to be continued lifelong. Patients with purely intrameatal tumours follow the same protocol but the initial six-month imaging is omitted. A cost analysis of the new pathway was modelled on our unit\u2019s retrospective data for 2015 and extrapolated to reflect the cost of VS surveillance nationally. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Based on an estimation that imaging surveillance would last approximately 25 years (+\/- 10 years), the cost of implementing our regional surveillance programme would be \u00a3151,011 per year (for 99 new referrals per year) and it would cost the NHS \u00a31,982,968 per year if implemented nationally. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> A standardised surveillance pathway promotes safe practice in the conservative management of VS. The estimated cost of a national surveillance programme compares favourably with other tumour surveillance initiatives, and would enable the NHS to provide a safe and economical service to patients with VS. <\/jats:p><\/jats:sec>","DOI":"10.1308\/rcsann.2017.0217","type":"journal-article","created":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T15:04:21Z","timestamp":1519916661000},"page":"216-220","source":"Crossref","is-referenced-by-count":26,"title":["A standardised pathway for the surveillance of stable vestibular schwannoma"],"prefix":"10.1308","volume":"100","author":[{"given":"J","family":"Shapey","sequence":"first","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, UK, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Barkas","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, UK, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Connor","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, UK, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Hitchings","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, UK, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Cheetham","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, UK, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Thomson","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, UK, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JM","family":"U-King-Im","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, UK, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Beaney","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, UK, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Jiang","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, UK, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Barazi","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, UK, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Obholzer","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, UK, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"NWM","family":"Thomas","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust, UK, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"171","reference":[{"key":"bib1","doi-asserted-by":"publisher","DOI":"10.1097\/00129492-200501000-00016"},{"key":"bib2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2273.1995.tb00018.x"},{"key":"bib3","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e3181f22660"},{"key":"bib4","doi-asserted-by":"publisher","DOI":"10.1017\/S0317167100047685"},{"key":"bib5","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2011.12.008"},{"key":"bib6","doi-asserted-by":"publisher","DOI":"10.1097\/00129492-200307000-00019"},{"key":"bib7","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1097\/00129492-200606000-00018","volume":"27","author":"Stangerup SE","year":"2006","journal-title":"Otol Neurotol"},{"key":"bib8","doi-asserted-by":"publisher","DOI":"10.3171\/2011.12.JNS111662"},{"key":"bib9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2016.05.003"},{"key":"bib10","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0b013e3182040d9f"},{"key":"bib11","first-page":"722","volume":"21","author":"Tschudi DC","year":"2000","journal-title":"Am J Otol"},{"key":"bib12","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215109992362"},{"key":"bib13","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0b013e31819a8df6"},{"key":"bib14","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215114001315"},{"key":"bib15","volume-title":"National Life Tables, UK: 2014 to 2016","author":"Office for National Statistics","year":"2017"},{"key":"bib16","volume-title":"Population Estimates for UK, England and Wales, Scotland and Northern Ireland: Mid-2016","author":"Office for National Statistics","year":"2017"},{"key":"bib17","volume-title":"Prostate Cancer: Diagnosis and Management","author":"National Institute for Health and Care Excellence","year":"2014"},{"key":"bib18","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26688"}],"container-title":["The Annals of The Royal College of Surgeons of England"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/pdf\/10.1308\/rcsann.2017.0217","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T10:44:23Z","timestamp":1684147463000},"score":1,"resource":{"primary":{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/10.1308\/rcsann.2017.0217"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3]]},"references-count":18,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,3]]}},"alternative-id":["10.1308\/rcsann.2017.0217"],"URL":"https:\/\/doi.org\/10.1308\/rcsann.2017.0217","relation":{},"ISSN":["0035-8843","1478-7083"],"issn-type":[{"value":"0035-8843","type":"print"},{"value":"1478-7083","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3]]}}}