• Othman Bin-Alamer, Hussam Abou-Al-Shaar, Selcuk Peker, Yavuz Samanci, Isabelle Pelcher, Sabrina Begley, Anuj Goenka, Michael Schulder, Jean-Nicolas Tourigny, David Mathieu, Andréanne Hamel, Robert G Briggs, Cheng Yu, Gabriel Zada, Steven L Giannotta, Herwin Speckter, Sarai Palque, Manjul Tripathi, Saurabh Kumar, Rupinder Kaur, Narendra Kumar, Brandon Rogowski, Matthew J Shepard, Bryan A Johnson, Daniel M Trifiletti, Ronald E Warnick, Samantha Dayawansa, Elad Mashiach, VasconcellosFernando De NigrisFNDepartment of Neurosurgery, NYU Langone, Manhattan , New York , USA., Kenneth Bernstein, Zane Schnurman, Juan Alzate, Douglas Kondziolka, and Jason P Sheehan.
• Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA.
• Neurosurgery. 2025 Jan 1; 96 (1): 505850-58.

Background And ObjectivesThis study assessed the efficacy and safety of stereotactic radiosurgery (SRS) in comparison with watchful waiting for managing Koos grade II vestibular schwannomas (VS).MethodsA retrospective, multicentric analysis was conducted, focusing on patients with Koos grade II VS who either received SRS (SRS group) or were observed (observation group). To ensure comparability between groups, propensity score matching was used, including factors such as demographic characteristics, tumor dimensions, and hearing assessments. The primary end points examined were tumor control, maintenance of serviceable hearing, and neurological outcomes.ResultsA total of 92 patients were equally matched across both cohorts, with a median follow-up of 37 months for the SRS group and 27.5 months for those observed. The SRS cohort exhibited superior tumor control over observation across 3, 5, and 8 years, achieving a 100% control rate vs 47.9%, 40.1%, and 34.3% for the observation group at these time intervals, respectively ( P < .001). Serviceable hearing preservation rates were comparable between the 2 groups throughout 3, 5, and 7 years (72.9% for SRS vs 65.4% for observation at 3 years; P = .86). Moreover, SRS management correlated with a lower incidence of vestibular symptoms (odds ratio = 0.11, P = .002), with no significant disparity in the deterioration of cranial nerve (CN) V or CN VII functions. Notably, the likelihood of experiencing any CN impairment was significantly diminished in the SRS cohort (odds ratio = 0.47, P = .04).ConclusionFor patients with Koos grade II VS, SRS offers superior tumor control rate and a lower risk of CN dysfunction without sacrificing hearing preservation.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

28 keywords...

hide…