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Finally, the middle cranial fossa approach is utilized primarily for smaller ([http://www.selleckchem.com/products/BKM-120.html BKM120 supplier] facial nerve function after resection in a large [http://www.selleckchem.com/products/pexidartinib-plx3397.html Pexidartinib in vitro] series [Grey et al., 1996]. Although size is an important factor, the consensus is that facial nerve outcome is not as good overall in NF2 patients versus patients with idiopathic VS even in the most experienced hands [Evans et al., 2005; Samii et al., 2008]. VS tumors less than 3?cm in diameter may be monitored for growth and hearing loss, or may be surgically excised [Thomsen et al., 1994; Bennett and Haynes, 2007]. There is no consensus about when to pursue surgery for smaller tumors in patients with NF2 (e.g., following hearing loss only; following tumor growth only; or both). A detailed discussion of the risks and benefits is required to help the patient choose the optimal approach for each situation. Observation of VS without surgical intervention is often the approach taken for a period of time. The natural history of NF2 associated VS was assessed via a consortium of VS expert centers [Slattery et al., 2004; Fisher et al., 2009]. They evaluated 540 patients with NF2 and showed a roughly 7-year delay from the time of symptom onset to diagnosis and that roughly 1/3 of patients had surgery within 2 years of their diagnosis. In this study, the average age at diagnosis was 27 years and there was an average of 1?mm/year rate of tumor growth with a high rate of variability. Importantly, the growth rates of the right and [http://en.wikipedia.org/wiki/GUCY1B3 GUCY1B3] left VS were independent, and rate of growth was not correlated with rate of hearing loss. This variability suggests that a tailored approach must be taken for each patient with multidisciplinary assessment from otolaryngology/neuro-otology, neurosurgery, genetics, and neurology in planning the timing of surgical interventions. When surgery is planned for NF2 VS less than 1.5?cm in diameter, a common strategy is r""Thus far, the phenotype of tetrasomy 18p has been primarily delineated by published case series and reports.