Box 1 Description of the vestibular schwannoma care pathway in the LUMC

Vestibular schwannomas are benign intracranial tumors, with a heterogeneous clinical presentation: it may present as a small, slow growing, and asymptomatic tumor, but also as large, faster growing, and potentially fatal disease. Patients typically present with symptoms of hearing loss, loss of balance and vertigo, but may also suffer from facial numbness, facial paralysis, or elevated intracranial pressure. In non-progressive tumors, active surveillance with MRI is usually the management option of choice. In progressive tumors, surgery or radiotherapy is performed to prevent future complications. After an active intervention, prolonged active surveillance ensues in these patients too, in order to identify possible recurrences. The LUMC is an expert referral center for vestibular schwannoma in the Netherlands. The care is organized in an integrated practice unit including all specialties involved in the diagnosis and treatment (i.e., neurosurgery, otorhinolaryngology, radiology and radiation oncology).