The recommendations are mostly based on established consensus guidelines.r
MRI is recommended even in asymptomatic individuals as NF2 associated tumours and interval tumour growth may occur without any change in symptoms.r
The type, timing and degree of surgery (if any) should be carefully considered by a multidisciplinary team with experience in managing NF2, the lifelong implications of the condition, its treatments and the complications that may result from treatment. The cornerstone of care is in minimal interference, conservation of function and maintenance of quality of life.r Factors that should be considered in surgical decision making include tumour impact on the patient (such as degree of brain stem compression), size, location, growth rate, number of lesions, patient’s comorbidities (such as degree of hearing loss in each ear), suitability for auditory rehabilitation (using a cochlear implant or auditory brain stem implant) or other treatment (e.g. stereotactic radiosurgery), and the possible complications that may arise from the surgery, such as loss of cochlear, vestibular, bulbar and facial nerve function.rrr
Anti-angiogenic agents (including bevacizumab) have demonstrated disease stabilisation, tumour reduction and improved hearing in bilateral vestibular schwannoma.rr Bevacizumab was listed on the Pharmaceutical Benefits Scheme (PBS) in Australia on 1st June 2021 as an unrestricted benefit, including for use in NF2-related tumours. Prescription of bevacizumab should only occur with input from a multidisciplinary team including individuals with experience in its use.