{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T14:10:44Z","timestamp":1780063844395,"version":"3.54.0"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Limited evidence guides the optimal timing of treatment after the detection of tumor growth during the observation of sporadic vestibular schwannoma (VS). The current work aimed to inform the timing of radiosurgical intervention based on an analysis of patient outcomes among those who ultimately failed stereotactic radiosurgery (SRS) and underwent salvage microsurgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>A historical cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Seven centers across the United States and Norway.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adults with sporadic VS who underwent salvage microsurgery following failed primary SRS were included. The primary outcome of interest was the association between tumor size <jats:italic>at the time of primary SRS<\/jats:italic> and the ability to achieve gross total resection (GTR) and maintain postoperative House\u2013Brackmann (HB) facial nerve grade I at the last follow\u2010up <jats:italic>after salvage microsurgery<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 96 patients, the median (interquartile range [IQR]) cerebellopontine angle (CPA) tumor size at primary SRS was 14.5\u2009mm (10.0\u201019.0). Each 1\u2010mm increase in CPA tumor size at the time of primary SRS was associated with a 13% increased likelihood of near\u2010total\/subtotal resection or most recent postoperative HB grade &gt;I (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.05\u20101.21, <jats:italic>P<\/jats:italic>\u2009=\u2009.001), with an optimal tumor size threshold to distinguish this outcome of 12\u2009mm of CPA extension (c\u2010index 0.73). Similarly, for each 1\u2010mm increase in CPA tumor size at the time of primary SRS, a 9% increase in any postoperative complication with salvage microsurgery was observed (OR 1.09, 95% CI 1.02\u20101.15, <jats:italic>P<\/jats:italic>\u2009=\u2009.009).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Corroborated by size threshold surveillance data informing the timing of primary microsurgical resection, the current study suggests that VS outcomes are optimized when primary radiosurgical intervention is undertaken on growing tumors when they harbor 10\u201315 mm of cerebellopontine angle extension or less.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.1161","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T01:36:27Z","timestamp":1739237787000},"page":"1717-1724","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Optimal Timing of Primary Radiosurgical Treatment of Growing Vestibular Schwannoma: Insights From Salvage Microsurgery Outcomes"],"prefix":"10.1002","volume":"172","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2350-8942","authenticated-orcid":false,"given":"John P.","family":"Marinelli","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans A.","family":"Herberg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Bergen University Hospital Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay S.","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Stanford University Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen L.","family":"Yancey","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery UT Southwestern Medical Center Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Kay\u2010Rivest","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery NYU Langone Health New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett G.","family":"Casale","sequence":"additional","affiliation":[{"name":"Department of Neurotology Michigan Ear Institute Farmington Hills Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Durham","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl R.","family":"Khandalavala","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"Lund\u2010Johansen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Bergen University Hospital Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikitha","family":"Kosaraju","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Stanford University Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"Lohse","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil S.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard K.","family":"Gurgel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seilesh C.","family":"Babu","sequence":"additional","affiliation":[{"name":"Department of Neurotology Michigan Ear Institute Farmington Hills Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.","family":"Golfinos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery NYU Langone Medical Center New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Thomas","family":"Roland","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery NYU Langone Health New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob B.","family":"Hunter","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery UT Southwestern Medical Center Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Walter","family":"Kutz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery UT Southwestern Medical Center Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter L.","family":"Santa Maria","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Stanford University Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Link","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Mayo Clinic Rochester Minnesota USA"},{"name":"Department of Neurologic Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8ystein V.","family":"Tveiten","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Bergen University Hospital Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew L.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Mayo Clinic Rochester Minnesota USA"},{"name":"Department of Neurologic Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"key":"e_1_2_8_2_1","article-title":"Global incidence of sporadic vestibular schwannoma: a systematic review","volume":"167","author":"Marinelli JP","year":"2021","journal-title":"Otolaryngol Head Neck Surg"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S218670"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2020394"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000002110"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599818770629"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000003224"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000004275"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noab303"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2023.1427"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.3171\/2021.4.JNS21465"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2023.4474"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599812458401"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599812437156"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.22411"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-5998(95)70101-X"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2023.02.019"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.3171\/2022.1.FOCUS21708"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2023.02.006"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000004189"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.1161","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:31:19Z","timestamp":1760956279000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ohn.1161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,10]]},"references-count":19,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/ohn.1161"],"URL":"https:\/\/doi.org\/10.1002\/ohn.1161","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,10]]},"assertion":[{"value":"2024-09-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}