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Comparative Study
. 2025 Jan 1;96(1):41-49.
doi: 10.1227/neu.0000000000003215. Epub 2024 Nov 6.

Vestibular Schwannoma Koos Grade I International Study of Active Surveillance Versus Stereotactic Radiosurgery: The VISAS-K1 Study

Othman Bin-Alamer  1 , Hussam Abou-Al-Shaar  1 , Selcuk Peker  2 , Yavuz Samanci  2 , Isabelle Pelcher  3 , Sabrina Begley  3 , Anuj Goenka  4 , Michael Schulder  3 , Jean-Nicolas Tourigny  5 , David Mathieu  5 , Andréanne Hamel  5 , Robert G Briggs  6 , Cheng Yu  6 , Gabriel Zada  6 , Steven L Giannotta  6 , Herwin Speckter  7 , Sarai Palque  7 , Manjul Tripathi  8 , Saurabh Kumar  8 , Rupinder Kaur  8 , Narendra Kumar  8 , Brandon Rogowski  9 , Matthew J Shepard  10 , Bryan A Johnson  11 , Daniel M Trifiletti  11 , Ronald E Warnick  12 , Samantha Dayawansa  13 , Elad Mashiach  14 , Fernando De Nigris Vasconcellos  14 , Kenneth Bernstein  15 , Zane Schnurman  14 , Juan Alzate  14 , Douglas Kondziolka  14 , Jason P Sheehan  13
Affiliations
Comparative Study

Vestibular Schwannoma Koos Grade I International Study of Active Surveillance Versus Stereotactic Radiosurgery: The VISAS-K1 Study

Othman Bin-Alamer et al. Neurosurgery. .

Abstract

Background and objective: This investigation evaluates the safety and efficacy of stereotactic radiosurgery (SRS) vs observation for Koos grade I vestibular schwannomas (VS).

Methods: In a multicenter study, we retrospectively analyzed data of patients with Koos grade I VS who underwent SRS (SRS group) or were observed (observation group). Propensity score matching was used to equilibrate demographics, tumor size, and audiometric data across groups. The outcome analyzed included tumor control, preservation of serviceable hearing, and neurological function.

Results: The study matched 142 patients, providing a median follow-up period of 36 months. SRS significantly enhanced tumor control compared with observation, with a 100% control rate at both 5- and 8-year marks in the SRS group vs 48.6% and 29.5% in the observation group at the same time intervals, respectively ( P < .001). Preservation of serviceable hearing outcomes between groups showed no significant difference at 5 and 8 years, ensuring a comparable quality of auditory function (SRS 70.1% vs observation 53.4% at 5 years; P = .33). Furthermore, SRS was associated with a reduced likelihood of tinnitus (odds ratio [OR] = 0.46, P = .04), vestibular dysfunction (OR = 0.17, P = .002), and overall cranial nerve dysfunction (OR = 0.49, P = .03) at last follow-up.

Conclusion: SRS management of patients with Koos grade I VS was associated with superior tumor control and reduced odds for cranial nerve dysfunction, while not compromising hearing preservation compared with observation. These findings support the safety and efficacy of SRS as a primary care approach for this patient population.

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