{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T12:09:39Z","timestamp":1791374979945,"version":"4.3.1"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,3]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Stereotactic radiosurgery (SRS) is an important management option for patients with small- and medium-sized vestibular schwannomas. To assess the potential role of SRS in larger tumors, the authors reviewed their recent experience.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Between 1994 and 2008, 65 patients with vestibular schwannomas between 3 and 4 cm in one extracanalicular maximum diameter (median tumor volume 9 ml) underwent Gamma Knife surgery. Seventeen patients (26%) had previously undergone resection.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The median follow-up duration was 36 months (range 1\u2013146 months). At the first planned imaging follow-up at 6 months, 5 tumors (8%) were slightly expanded, 53 (82%) were stable in size, and 7 (11%) were smaller. Two patients (3%) underwent resection within 6 months due to progressive symptoms. Two years later, with 63 tumors overall after the 2 post-SRS resections, 16 tumors (25%) had a volume reduction of more than 50%, 22 (35%) tumors had a volume reduction of 10\u201350%, 18 (29%) were stable in volume (volume change &lt; 10%), and 7 (11%) had larger volumes (5 of the 7 patients underwent resection and 1 of the 7 underwent repeat SRS). Eighteen (82%) of 22 patients with serviceable hearing before SRS still had serviceable hearing after SRS more than 2 years later. Three patients (5%) developed symptomatic hydrocephalus and underwent placement of a ventriculoperitoneal shunt. In 4 patients (6%) trigeminal sensory dysfunction developed, and in 1 patient (2%) mild facial weakness (House-Brackmann Grade II) developed after SRS. In univariate analysis, patients who had a previous resection (p = 0.010), those with a tumor volume exceeding 10 ml (p = 0.05), and those with Koos Grade 4 tumors (p = 0.02) had less likelihood of tumor control after SRS.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Although microsurgical resection remains the primary management choice in patients with low comorbidities, most vestibular schwannomas with a maximum diameter less than 4 cm and without significant mass effect can be managed satisfactorily with Gamma Knife radiosurgery.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.8.jns10674","type":"journal-article","created":{"date-parts":[[2010,8,27]],"date-time":"2010-08-27T13:59:29Z","timestamp":1282917569000},"page":"801-807","source":"Crossref","is-referenced-by-count":71,"title":["Gamma Knife radiosurgery for larger-volume vestibular schwannomas"],"prefix":"10.3171","volume":"114","author":[{"given":"Huai-che","family":"Yang","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Kano","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasir Raza","family":"Awan","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Dade","family":"Lunsford","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Niranjan","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Flickinger","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Radiation Oncology, and the"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Novotny","sequence":"additional","affiliation":[{"name":"Radiation Oncology, and the"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jagdish P.","family":"Bhatnagar","sequence":"additional","affiliation":[{"name":"Radiation Oncology, and the"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Kondziolka","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"Suppl","key":"b1-jns10674","series-title":"J Neurosurg","first-page":"87","article-title":"Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases","volume":"102","author":"Chung","year":"2005"},{"key":"b2-jns10674","series-title":"Md Med J","first-page":"1128","article-title":"Acoustic neuroma: summary of the NIH consensus","volume":"41","author":"Cohen","year":"1992"},{"key":"b3-jns10674","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1341","article-title":"Long-term outcome of stereotactic radiosurgery (SRS) in patients with acoustic neuromas","volume":"64","author":"Combs","year":"2006"},{"key":"b4-jns10674","series-title":"J Neurosurg","first-page":"1","article-title":"Results of acoustic neuroma radiosurgery: an analysis of 5 years' experience using current methods","volume":"94","author":"Flickinger","year":"2001"},{"key":"b5-jns10674","series-title":"Int J Radiat Oncol Biol Phys","first-page":"225","article-title":"Acoustic neuroma radiosurgery with marginal tumor doses of 12 to 13 Gy","volume":"60","author":"Flickinger","year":"2004"},{"key":"b6-jns10674","series-title":"Ann Otol Rhinol Laryngol","first-page":"55","article-title":"Hearing preservation in unilateral acoustic neuroma surgery","volume":"97","author":"Gardner","year":"1988"},{"key":"b7-jns10674","series-title":"Otol Neurotol","first-page":"629","article-title":"Surgery for large vestibular schwannoma: residual tumor and outcome","volume":"30","author":"Godefroy","year":"2009"},{"key":"b8-jns10674","series-title":"Neurosurgery","first-page":"50","article-title":"Acoustic neuromas: results of current surgical management","volume":"41","author":"Gormley","year":"1997"},{"key":"b9-jns10674","series-title":"J Neurosurg","first-page":"10","article-title":"Long-term outcomes in patients with vestibular schwannomas treated using gamma knife surgery: 10-year follow up","volume":"102","author":"Hasegawa","year":"2005"},{"key":"b10-jns10674","series-title":"Otolaryngol Head Neck Surg","first-page":"146","article-title":"Facial nerve grading system","volume":"93","author":"House","year":"1985"},{"issue":"Suppl","key":"b11-jns10674","series-title":"J Neurosurg","first-page":"111","article-title":"Low-dose radiosurgery for large vestibular schwannomas: long-term results of functional preservation","volume":"102","author":"Inoue","year":"2005"},{"key":"b12-jns10674","series-title":"Surg Neurol","first-page":"370","article-title":"Current surgical results of retrosigmoid approach in extralarge vestibular schwannomas","volume":"53","author":"Jung","year":"2000"},{"key":"b13-jns10674","series-title":"J Neurosurg","first-page":"863","article-title":"Predictors of hearing preservation after stereotactic radiosurgery for acoustic neuroma. 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