■ OBJECTIVE: Vestibular schwannomas consider to causemorbidity and occasional mortality. The current treatment options of microsurgical removal or stereotactic radiation are not ideal for all patients with these tumors. The potential for medical treatment of vestibular schwannomas could revolutionize the current treatment protocols. The objective of this study is to review the currently understood molecular pathways of vestibular schwannomas and to discuss potential routes of medical intervention to restore or compensate for the cascade of events which begins with a mutation in merlin.

■ METHODS: Review of the literature and results of in vitro and in vivo testing of agents active in the merlin pathways.

■ RESULTS: Small molecule inhibitors of receptors on the schwannoma membrane, inhibitors of proliferation such as Akt inhibitors and Ras inhibitors, and cell cycle regulators have all been offered as possible routes of intervention. Likewise viral vectors with replacement wild type merlin in schwannomas have shown some promise in the murine model.

■ CONCLUSION: Understanding the underlying pathophysiology of the vestibular schwannomas is leading to potential human trials with new directed agents.