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. 2025 Sep 16.
doi: 10.1227/neu.0000000000003734. Online ahead of print.

Stereotactic Radiosurgery Versus Observation in Small- and Medium-Sized Vestibular Schwannoma Patients With Normal Hearing: A Retrospective International Multicenter Study

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

Stereotactic Radiosurgery Versus Observation in Small- and Medium-Sized Vestibular Schwannoma Patients With Normal Hearing: A Retrospective International Multicenter Study

Bardia Hajikarimloo et al. Neurosurgery. .

Abstract

Background and objectives: The therapeutic approach for small- and medium-sized vestibular schwannoma (VS) with normal hearing function remains controversial, with limited comparative data regarding hearing outcomes after stereotactic radiosurgery (SRS) or observation (OBS). We evaluated the serviceable hearing preservation, loss of American Academy of Otolaryngology-Head and Neck Surgery class A hearing, and tumor control (TC) across individuals with Koos grade I and II VSs and normal hearing at presentation who underwent SRS or OBS.

Methods: In this multicenter international study, we retrospectively analyzed the hearing, radiological, and neurological outcomes of patients who underwent SRS (SRS group) or OBS (OBS group). The cohorts were matched using propensity scores based on age, sex, tumor volume, pure-tone average, and speech discrimination score at a 1:1 ratio without replacement.

Results: After matching, each group comprised 57 patients. The median follow-up was 49 and 37 months for the SRS and the OBS groups, respectively (P = .3). The 5- and 9-year serviceable hearing preservation rates in the SRS group were 76.2% and 42.4% vs 56.1% and 16.8% in the OBS group (P = .17). Class A preservation occurred in 57.9% (33/57) of the SRS and 52.6% (30/57) of the OBS cohorts (P = .70). Regarding the TC rates, SRS was associated with significantly higher TC rates (P < .0001).

Conclusion: We found that SRS is significantly superior regarding TC and provided noninferior hearing outcomes compared with OBS in VS patients with American Academy of Otolaryngology-Head and Neck Surgery class A hearing at presentation. Therefore, we suggest performing SRS in individuals with VS and normal hearing function.

Keywords: Acoustic neuroma; Gamma Knife; Observation; Stereotactic radiosurgery; Surveillance; Vestibular schwannoma.

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References

    1. Bin-Alamer O, Abou-Al-Shaar H, Peker S, et al. Vestibular schwannoma international study of active surveillance versus stereotactic radiosurgery: the VISAS study. Int J Radiat Oncol Biol Phys. 2024;120(2):454-464.
    1. Bin-Alamer O, Faramand A, Alarifi NA, et al. Stereotactic radiosurgery for vestibular schwannoma in neurofibromatosis type 2: an international multicenter case series of response and malignant transformation risk. Neurosurgery. 2023;92(5):934-944.
    1. Hajikarimloo B, Mohammadzadeh I, Nazari MA, et al. Prediction of facial nerve outcomes after surgery for vestibular schwannoma using machine learning-based models: a systematic review and meta-analysis. Neurosurg Rev. 2025;48(1):79.
    1. Coughlin AR, Willman TJ, Gubbels SP. Systematic review of hearing preservation after radiotherapy for vestibular schwannoma. Otol Neurotol 2018;39(3):273-283.
    1. Daloiso A, Cazzador D, Concheri S, Tealdo G, Zanoletti E. Long-term hearing outcome for vestibular schwannomas after microsurgery and radiotherapy: a systematic review and Meta-analysis. Otolaryngol Head Neck Surg. 2024;171(6):1670-1681.

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