With advances in imaging and radiation technologies, small, slowly growing vestibular schwannomas (VS) are treated primarily with either observation or stereotactic radiosurgery (SRS). Routine magnetic resonance (MRI) scans with gadolinium are obtained six months and one year after SRS in the majority of the centres managing VS, although there is no defined guideline for the interval at which imaging is to be performed. This retrospective study reviewed 10-year data of VS patients with more than one year of post-treatment follow-up. Six-month routine post-SRS imaging was obtained in 76% of the screened cohort. Nine patients were imaged prior to six months as they were symptomatic.
Based on an independent third party developed financial model, the authors calculated that if the MRI scan at six months post-SRS was eliminated in stable patients, the total annual healthcare expenditure saved will be approximately $1,611,504. So, they recommend that the six-month post-SRS MRI be eliminated in asymptomatic patients as it does not offer any additional information.
The authors suggest that an MRI scan one-year post-SRS be obtained instead. In the face of rising health costs, the author’s recommendation of eliminating a six-month post-SRS MRI in asymptomatic patients versus the impact on patient safety is worth debating.