Role Of Bevacizumab As A Prophylactic And Rehabilitative Treatment Modality In Cases Of Sporadic And Syndromic Vestibular Schwannoma: Fifty Shades Of Grey!

Abstract Background Detection of vestibular schwannoma in young patient demands specific attention by looking at the relatively aggressive course and natural history of the disease. Patients with syndromic variants such as NF2 suffer from multiple tumors including bilateral vestibular schwannoma, meningioma, ependymomas and peripheral nerve sheath tumors. Such patients may suffer from unprecedented complications following radio surgical treatment such as poor tumor control and functional outcome. Material and methods Authors describe their own experience with Bevacizumab as a preventive and rehabilitative treatment option in two such patients who suffered from complications of radiosurgery in the immediate post-procedure period. Literature is reviewed for the indications, dosage, safety profile, and complications profile on short and long-term of Bevacizumab in vestibular schwannomas. Results One middle-aged patient of sporadic vestibular schwannoma suffered rapid onset facial paresis within one month of GKRS. After a failed attempt with steroids, the patient regained partial improvement following Bevacizumab treatment. Another young female of phenotypic NF2 syndrome suffered rapid onset hearing deficit within two weeks of GKRS, which improved to pre GKRS level with the early introduction of Bevacizumab. Bevacizumab has shown its efficacy both as a prophylactic and rehabilitative treatment modality for syndromic patients of VS. Conclusion Though not a wonder drug, Bevacizumab is a valuable adjunct in crossroad situations. It has a proven role as a prophylactic treatment option to retard the growth of VS and spinal ependymomas with no role on meningiomas. As a rehabilitative treatment option, Bevacizumab may be used in steroid-resistant cases to prevent radiosurgery-induced complications. Long-term studies are warranted to confirm the dosing schedules, regimens, and complication profile.