Small vestibular schwannomas in the elderly: a management dilemma

Small vestibular schwannomas were diagnosed in two elderly patients and, for different reasons, a policy of watch and wait was instituted. One was reliable in attending for follow-up and lived for over 20 years without surgical intervention. The other was unreliable in follow-up, there was an unexpected and undetected acceleration of the growth rate and urgent surgery became imperative at the age of 77 years. This proved to be unsuccessful. A watch and wait policy is acceptable in the elderly but only if the patient can be relied upon to co-operate in follow-up attendance and imaging.