• Prabhuraj A R, Ujwal Yeole, Arivazhagan Arimappamagan, Rao K V L Narasinga KVLN Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India., Dhananjaya I Bhat, Srinivas Dwarakanath, Bhanumathi Govindswamy, and Sampath Somanna.
• Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India. Electronic address: drprabhuraj@yahoo.co.in.
• World Neurosurg. 2019 Jul 1; 127: e114-e123.

ObjectiveGamma Knife radiosurgery (GKRS) is an established treatment modality for vestibular schwannomas (VSs). The tumor control and hearing preservation rates suggest that GKRS is a good alternative treatment for small- and medium-size VS. Data are lacking from India regarding GKRS for VSs. Our aim was to find the hearing preservation and tumor control rates and the factors contributing to these.MethodsIn a retrospective 9-year study period, 87 patients had undergone GKRS for unilateral VS with Gardner-Robertson (GR) class I or II serviceable hearing. All 87 had been evaluated with magnetic resonance imaging and audiometry before GKRS and during follow-up to assess for the factors influencing tumor control and hearing preservation.ResultsOf the 87 patients, 77 with a minimum follow-up of 2 years and magnetic resonance imaging and audiometry evaluations available were included in the present study. The median follow-up period was 30 months. The tumor control rate and hearing preservation rate was 96.1% and 79.2%, respectively. Hearing preservation was not affected by the tumor volume. However, age >40 years, pre-GKRS pure tone average <30 decibels, speech discrimination score >85%, pre-GKRS Gardner-Robertson grade I hearing, mean cochlear dose <4 Gy, and pre-GKRS Ohata class of laterality C, D, E were significant on univariate analysis. The multivariate analysis revealed that age >40 years (P = 0.017), pre-GKRS pure tone average <30 decibels (P = 0.002), and Gardner-Robertson class I (P = 0.001) were significant factors. No patient developed cranial nerve dysfunction, hydrocephalus, or malignant degeneration.ConclusionFor most patients with small VSs, GKRS will be an effective alternative treatment to microsurgery with retained serviceable hearing and good tumor control.Copyright © 2019 Elsevier Inc. All rights reserved.

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