{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:57:31Z","timestamp":1792036651176,"version":"4.4.0"},"reference-count":64,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2019,7,4]],"date-time":"2019-07-04T00:00:00Z","timestamp":1562198400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/ mailto:journals.permissions@oup.com"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Gamma Knife radiosurgery (GKRS; Elekta AB) remains a well-established treatment modality for vestibular schwannomas. Despite highly effective tumor control, further research is needed toward optimizing long-term functional outcomes. Whereas dose-rate effects may impact post-treatment toxicities given tissue dose-response relationships, potential effects remain largely unexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To evaluate treatment outcomes and potential dose-rate effects following definitive GKRS for vestibular schwannomas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We retrospectively reviewed 419 patients treated at our institution between 1998 and 2015, characterizing baseline demographics, pretreatment symptoms, and GKRS parameters. The cohort was divided into 2 dose-rate groups based on the median value (2.675 Gy\/min). Outcomes included clinical tumor control, radiographic progression-free survival, serviceable hearing preservation, hearing loss, and facial nerve dysfunction (FND). Prognostic factors were assessed using Cox regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      The study cohort included 227 patients with available follow-up. Following GKRS 2-yr and 4-yr clinical tumor control rates were 98% (95% CI: 95.6%-100%) and 96% (95% CI: 91.4%-99.6%), respectively. Among 177 patients with available radiographic follow-up, 2-yr and 4-yr radiographic progression-free survival rates were 97% (95% CI: 94.0%-100.0%) and 88% (95% CI: 81.2%-95.0%). The serviceable hearing preservation rate was 72.2% among patients with baseline Gardner-Robertson class I\/II hearing and post-treatment audiological evaluations. Most patients experienced effective relief from prior headaches (94.7%), tinnitus (83.7%), balance issues (62.7%), FND (90.0%), and trigeminal nerve dysfunction (79.2%), but not hearing loss (1.0%). Whereas GKRS provided effective tumor control independently of dose rate, GKRS patients exposed to lower dose rates experienced significantly better freedom from post-treatment hearing loss and FND (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.044).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Whereas GKRS provides excellent tumor control and effective symptomatic relief for vestibular schwannomas, dose-rate effects may impact post-treatment functional outcomes. Further research remains warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyz229","type":"journal-article","created":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T23:17:15Z","timestamp":1558048635000},"page":"E1084-E1094","source":"Crossref","is-referenced-by-count":50,"title":["Treatment Outcomes and Dose Rate Effects Following Gamma Knife Stereotactic Radiosurgery for Vestibular Schwannomas"],"prefix":"10.1227","volume":"85","author":[{"given":"Deborah Ruth","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heva Jasmine","family":"Saadatmand","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Chia","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J","family":"Black","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Ruh","family":"Wuu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeraldine","family":"Lesser","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryellen","family":"Horan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven R","family":"Isaacson","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony J C","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York"},{"name":"Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York"},{"name":"Herbert Irving Comprehensive Cancer Center, NewYork-Presbyterian\/Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B","family":"Sisti","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York"},{"name":"Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York"},{"name":"Herbert Irving Comprehensive Cancer Center, NewYork-Presbyterian\/Columbia University Irving Medical Center, New York, New York"},{"name":"Department of Otolaryngology: Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,12]]},"reference":[{"issue":"May","key":"bib1-20231011","first-page":"1265","article-title":"CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 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