Multimodal biomarker landscape in vestibular schwannoma.

[PURPOSE OF REVIEW] This review provides an update on recent advances in molecular and imaging biomarker discovery for the diagnosis and prognosis of vestibular schwannoma (VS), with the goal of accelerating their validation and clinical adoption.

[RECENT FINDINGS] A panel of nine circulating plasma biomarkers - TNF-R2/MIF/CD30/MCP-3/IL-2R/BLC/TWEAK/eotaxin/S100B - shows strong discriminatory power between patients with VS and healthy controls, with MCP-3 and S100B correlating with hearing loss and tumor size, respectively. A ~40-fold elevation of CFHR2 levels in the perilymph of patients with severe VS-induced hearing loss implicates complement activation in cochlear inflammation. Tumor-secreted TNF-α and TWEAK reach the inner ear and exhibit synergistic ototoxicity. Tissue profiling identified two distinct biomarker panels: one comprising ANGPTL1/IL17RC/LTBR/OLR1/TGFBR1, which associates with tumor cell proliferation and migration; and another including MMP-2/MMP-14/CD80/CD163/CD45, which accurately predicts peritumoral adhesion. Several tumor-derived miRNAs, including miR-431-5p, miR-7, miR-142-3p/5p, miR-155, and hypoxamiRs, are associated with hearing outcomes and tumor growth. MRI biomarkers from dynamic contrast-enhanced and diffusion-weighted imaging, as well as perilymph signal intensity ratio correlate with tumor growth, surgical outcomes, and auditory decline, respectively.

[SUMMARY] This review outlines emerging circulating, tissue-derived and imaging biomarker candidates in VS that may complement MRI and support more precise diagnosis, monitoring, and individualized management.