{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:36:21Z","timestamp":1787240181125,"version":"build-2736575974"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NEUROSURGERY","NEUROS"],"published-print":{"date-parts":[[2018,2]]},"abstract":"Abstract<\/jats:title>\n \n RADIOSURGERY VS OBSERVATION<\/jats:title>\n <\/jats:sec>\n \n Question<\/jats:title>\n What are the indications for stereotactic radiosurgery (SRS) treatment vs observation for patients with intracanalicular vestibular schwannomas without evidence of radiographic progression?<\/jats:p>\n <\/jats:sec>\n \n Recommendation<\/jats:title>\n Level 3: If tinnitus is not observed at presentation, it is recommended that intracanalicular vestibular schwannomas and small tumors (<2 cm) without tinnitus be observed as observation does not have a negative impact on tumor growth or hearing preservation compared to treatment.<\/jats:p>\n <\/jats:sec>\n \n RADIOSURGERY TECHNOLOGY<\/jats:title>\n <\/jats:sec>\n \n Question<\/jats:title>\n Is there a difference in outcome based on radiosurgery equipment used: Gamma Knife (Elekta, Stockholm, Sweden) vs linear accelerator-based radiosurgery vs proton beam?<\/jats:p>\n <\/jats:sec>\n \n Recommendation<\/jats:title>\n There are no studies that compare 2 or all 3 modalities. Thus, recommendations on outcome based on modality cannot be made.<\/jats:p>\n <\/jats:sec>\n \n RADIOSURGERY TECHNIQUE<\/jats:title>\n <\/jats:sec>\n \n Question<\/jats:title>\n Is there a difference in outcome based on the dose delivered?<\/jats:p>\n <\/jats:sec>\n \n Recommendation<\/jats:title>\n Level 3: As there is no difference in radiographic control using different doses, it is recommended that for single fraction SRS doses, <13 Gy be used to facilitate hearing preservation and minimize new onset or worsening of preexisting cranial nerve deficits.<\/jats:p>\n <\/jats:sec>\n \n Question<\/jats:title>\n Is there a difference in outcome based on the number of fractions?<\/jats:p>\n <\/jats:sec>\n \n Recommendation<\/jats:title>\n As there is no difference in radiographic control and clinical outcome using single or multiple fractions, no recommendations can be given.<\/jats:p>\n <\/jats:sec>\n \n RADIOGRAPHIC FOLLOW-UP, RETREATMENT, AND TUMORIGENESIS AFTER RADIOSURGERY<\/jats:title>\n <\/jats:sec>\n \n Question<\/jats:title>\n What is the best time sequence for follow-up images after SRS?<\/jats:p>\n <\/jats:sec>\n \n Recommendation<\/jats:title>\n Level 3: Follow-up imaging should be obtained at intervals after SRS based on clinical indications, a patient's personal circumstances, or institutional protocols. Long-term follow-up with serial magnetic resonance imagings to evaluate for recurrence is recommended. No recommendations can be given regarding the interval of these studies.<\/jats:p>\n <\/jats:sec>\n \n Question<\/jats:title>\n Is there a role for retreatment?<\/jats:p>\n <\/jats:sec>\n \n Recommendation<\/jats:title>\n Level 3: When there has been progression of tumor after SRS, SRS can be safely and effectively performed as a retreatment.<\/jats:p>\n <\/jats:sec>\n \n Question<\/jats:title>\n What is the risk of radiation-induced malignant transformation of vestibular schwannomas treated with SRS?<\/jats:p>\n <\/jats:sec>\n \n Recommendation<\/jats:title>\n Level 3: Patients should be informed that there is minimal risk of malignant transformation of vestibular schwannomas after SRS.<\/jats:p>\n <\/jats:sec>\n \n NEUROFIBROMATOSIS TYPE 2<\/jats:title>\n <\/jats:sec>\n \n Question<\/jats:title>\n What are the indications for SRS in patients with neurofibromatosis type 2?<\/jats:p>\n <\/jats:sec>\n \n Recommendation<\/jats:title>\n Level 3: Radiosurgery is a treatment option for patients with neurofibromatosis type 2 whose vestibular schwannomas are enlarging and\/or causing hearing loss.<\/jats:p>\n \u2003The full guideline can be found at: https:\/\/www.cns.org\/guidelines\/guidelines-management-patients-vestibular-schwannoma\/chapter_7.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/neuros\/nyx515","type":"journal-article","created":{"date-parts":[[2017,10,27]],"date-time":"2017-10-27T15:11:30Z","timestamp":1509117090000},"page":"E49-E51","source":"Crossref","is-referenced-by-count":74,"title":["Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Radiosurgery and Radiation Therapy in the Management of Patients With Vestibular Schwannomas"],"prefix":"10.1227","volume":"82","author":[{"given":"Isabelle M","family":"Germano","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnathan","family":"Parish","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Spine, Carolinas Medical Center, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Atkins","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Spine, Carolinas Medical Center, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Asher","sequence":"additional","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantinos G","family":"Hadjipanayis","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart H","family":"Burri","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Levine Cancer Institute, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheryl","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J","family":"Olson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,2]]},"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00006123-201802000-00028","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:49:55Z","timestamp":1786121395000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00006123-201802000-00028"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,20]]},"references-count":0,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyx515","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,20]]}}}