{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:22:28Z","timestamp":1794324148973,"version":"4.9.0"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"Special_Supplement","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2010,12]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>The roles of the wait-and-see strategy and proactive Gamma Knife surgery (GKS) in the treatment paradigm for small intracanalicular vestibular schwannomas (VSs) is still a matter of debate, especially when patients present with functional hearing. The authors compare these 2 methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Forty-seven patients (22 men and 25 women) harboring an intracanalicular VS were followed prospectively. The mean age of the patients at the time of inclusion was 54.4 years (range 20\u201371 years). The mean follow-up period was 43.8 \u00b1 40 months (range 9\u2013222 months). Failure was defined as significant tumor growth and\/or hearing deterioration that required microsurgical or radiosurgical treatment. This population was compared with a control group of 34 patients harboring a unilateral intracanalicular VS who were consecutively treated by GKS and had functional hearing at the time of radiosurgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 47 patients in the wait-and-see group, treatment failure (tumor growth requiring treatment) was observed in 35 patients (74%), although conservative treatment is still ongoing for 12 patients. Treatment failure in the control (GKS) group occurred in only 1 (3%) of 34 patients. In the wait-and-see group, there was no change in tumor size in 10 patients (21%), tumor growth in 36 patients (77%), and a mild decrease in tumor size in 1 patient (2%). Forty patients in the wait-and-see group were available for a hearing level study, which demonstrated no change in Gardner-Robertson hearing class for 24 patients (60%). Fifteen patients (38%) experienced more than 10 db of hearing loss and 2 of them became deaf. At 3, 4, and 5 years, the useful hearing preservation rates were 75%, 52%, and 41% in the wait-and-see group and 77%, 70%, and 64% in the control group, respectively. Thus, the chances of maintaining functional hearing and avoiding further intervention were much higher in cases treated by GKS (79% and 60% at 2 and 5 years, respectively) than in cases managed by the wait-and-see strategy (43% and 14% at 2 and 5 years, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These data indicate that the wait-and-see policy exposes the patient to elevated risks of tumor growth and degradation of hearing. Both events may occur independently in the mid-term period. This information must be presented to the patient. A careful sequential follow-up may be adopted when the wait-and-see strategy is chosen, but proactive GKS is recommended when hearing is still useful at the time of diagnosis. This recommendation may be a main paradigm shift in the practice of treating intracanalicular VSs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2010.8.gks101058","type":"journal-article","created":{"date-parts":[[2018,11,15]],"date-time":"2018-11-15T20:11:01Z","timestamp":1542312661000},"page":"105-111","source":"Crossref","is-referenced-by-count":109,"title":["Wait-and-see strategy compared with proactive Gamma Knife surgery in patients with intracanalicular vestibular schwannomas"],"prefix":"10.3171","volume":"113","author":[{"given":"Jean","family":"R\u00e9gis","sequence":"first","affiliation":[{"name":"Service de Neurochirurgie St\u00e9r\u00e9otaxique et Fonctionnelle, Centre Hospitalier Universitaire (C. H. U.) la Timone;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Carron","sequence":"additional","affiliation":[{"name":"Service de Neurochirurgie St\u00e9r\u00e9otaxique et Fonctionnelle, Centre Hospitalier Universitaire (C. H. U.) la Timone;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Park","sequence":"additional","affiliation":[{"name":"Service de Neurochirurgie St\u00e9r\u00e9otaxique et Fonctionnelle, Centre Hospitalier Universitaire (C. H. U.) la Timone;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Outouma","family":"Soumare","sequence":"additional","affiliation":[{"name":"Service de Neurochirurgie, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Delsanti","sequence":"additional","affiliation":[{"name":"Service de Neurochirurgie St\u00e9r\u00e9otaxique et Fonctionnelle, Centre Hospitalier Universitaire (C. H. U.) la Timone;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Marc","family":"Thomassin","sequence":"additional","affiliation":[{"name":"F\u00e9d\u00e9ration d'Oto-Rhino-Laryngologie, C. H. U. la Timone, AP-HM, Assistance Publique des H\u00f4pitaux de Marseille, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre-Hugues","family":"Roche","sequence":"additional","affiliation":[{"name":"Service de Neurochirurgie, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-1130105","series-title":"Acta Otolaryngol","first-page":"1063","article-title":"Conservative management versus surgery for small vestibular schwannomas","volume":"125","author":"Bozorg Grayeli","year":"2005"},{"key":"b2-1130105","series-title":"Neurosurgery","first-page":"260","article-title":"Conservative management of acoustic neuroma: an outcome study","volume":"39","author":"Deen","year":"1996"},{"key":"b3-1130105","series-title":"Prog Neurol Surg","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1159\/000156712","article-title":"Morphological changes of vestibular schwannomas after radiosurgical treatment: pitfalls and diagnosis of failure","volume":"21","author":"Delsanti","year":"2008"},{"key":"b4-1130105","series-title":"Prog Neurol Surg","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1159\/000156709","article-title":"Management of large vestibular schwannomas by combined surgical resection and gamma knife radiosurgery","volume":"21","author":"Fuentes","year":"2008"},{"key":"b5-1130105","series-title":"Surg Neurol","first-page":"283","article-title":"Surgery combined with radiosurgery of large acoustic neuromas","volume":"59","author":"Iwai","year":"2003"},{"key":"b6-1130105","series-title":"J Neurosurg","first-page":"28","article-title":"Acoustic neurilemmoma. 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