{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:11:11Z","timestamp":1784693471848,"version":"3.55.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,3]]},"abstract":"\nObject<\/jats:title>\nGamma Knife surgery (GKS) for vestibular schwannoma (VS) is an accepted treatment for small- to medium-sized tumors, generally smaller than 2.5 cm in the maximum posterior fossa dimension. The purpose of this study was to evaluate the efficacy and toxicity of GKS for larger tumors.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nProspectively collected data were analyzed for 22 patients who had undergone GKS for VSs larger than 2.5 cm in the posterior fossa diameter between 1997 and 2006. No patient had symptomatic brainstem compression at the time of GKS. The median treated tumor volume was 9.4 cm3<\/jats:sup> (range 5.3\u201319.1 cm3<\/jats:sup>). The median maximum posterior fossa diameter was 2.8 cm (range 2.5\u20133.8 cm). The median tumor margin dose was 12 Gy (range 12\u201314 Gy). Serial imaging, audiometry (10 patients with serviceable hearing pre-GKS), and clinical follow-up were available for a median of 66 months (range 26\u2013121 months). Tumor control failure was defined as either a progressive increase in tumor diameter of at least 2 mm in any dimension or a later resection.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nFour patients met the criteria for GKS failure, including 1 patient who demonstrated sarcomatous degeneration more than 7 years after GKS and died 3 months after microsurgical debulking. An enlarging cystic component was the surgical indication in 1 of the 2 patients who required resection, although 27% of tumors (6 lesions) were cystic before GKS. The 3-year actuarial rate of tumor control, freedom from new facial neuropathy, and preservation of functional hearing were 86%, 92%, and 47%, respectively. At 5 years post-GKS, these rates decreased to 82%, 85%, and 28%, respectively. At the most recent follow-up, 91% of tumors were smaller than at the time of GKS and the median maximum posterior fossa diameter reduction was 26%. On multivariate analysis, none of the following factors was associated with GKS failure, new facial weakness, new trigeminal neuropathy, or loss of serviceable hearing: patient age, tumor volume, tumor margin dose, and preoperative cranial nerve dysfunction.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nSingle-session radiosurgery is a successful treatment for the majority of patients with larger VSs. Although tumor control rates are lower than those for smaller VSs managed with GKS, the cranial nerve morbidity of GKS is significantly lower than that typically achieved via resection of larger VSs.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.11.jns11811","type":"journal-article","created":{"date-parts":[[2011,12,16]],"date-time":"2011-12-16T15:05:00Z","timestamp":1324047900000},"page":"598-604","source":"Crossref","is-referenced-by-count":88,"title":["Long-term tumor control and cranial nerve outcomes following Gamma Knife surgery for larger-volume vestibular schwannomas"],"prefix":"10.3171","volume":"116","author":[{"given":"Brian D.","family":"Milligan","sequence":"first","affiliation":[{"name":"Departments of Neurologic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce E.","family":"Pollock","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery,"},{"name":"Radiation Oncology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Foote","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Link","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery,"},{"name":"Otorhinolaryngology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns11811","series-title":"J Neurosurg","first-page":"643","article-title":"Resection of large vestibular schwannomas: facial nerve preservation in the context of surgical approach and patient-assessed outcome","volume":"102","author":"Anderson","year":"2005"},{"key":"b2-jns11811","series-title":"Otolaryngol Head Neck Surg","first-page":"179","article-title":"Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). 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