{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:03:39Z","timestamp":1783775019668,"version":"3.55.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Stereotactic radiosurgery (SRS) is an important alternative management option for patients with small- and medium-sized vestibular schwannomas (VSs). Its use in the treatment of large tumors, however, is still being debated. The authors reviewed their recent experience to assess the potential role of SRS in larger-sized VSs.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Between 2000 and 2014, 35 patients with large VSs, defined as having both a single dimension &gt; 3 cm and a volume &gt; 10 cm<jats:sup>3<\/jats:sup>, underwent Gamma Knife radiosurgery (GKRS). Nine patients (25.7%) had previously undergone resection. The median total volume covered in this group of patients was 14.8 cm<jats:sup>3<\/jats:sup> (range 10.3\u201324.5 cm<jats:sup>3<\/jats:sup>). The median tumor margin dose was 11 Gy (range 10\u201312 Gy).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The median follow-up duration was 48 months (range 6\u2013156 months). All 35 patients had regular MRI follow-up examinations. Twenty tumors (57.1%) had a volume reduction of greater than 50%, 5 (14.3%) had a volume reduction of 15%\u201350%, 5 (14.3%) were stable in size (volume change &lt; 15%), and 5 (14.3%) had larger volumes (all of these lesions were eventually resected). Four patients (11.4%) underwent resection within 9 months to 6 years because of progressive symptoms. One patient (2.9%) had open surgery for new-onset intractable trigeminal neuralgia at 48 months after GKRS. Two patients (5.7%) who developed a symptomatic cyst underwent placement of a cystoperitoneal shunt. Eight (66%) of 12 patients with pre-GKRS trigeminal sensory dysfunction had hypoesthesia relief. One hemifacial spasm completely resolved 3 years after treatment. Seven patients with facial weakness experienced no deterioration after GKRS. Two of 3 patients with serviceable hearing before GKRS deteriorated while 1 patient retained the same level of hearing. Two patients improved from severe hearing loss to pure tone audiometry less than 50 dB.<\/jats:p><jats:p>The authors found borderline statistical significance for post-GKRS tumor enlargement for later resection (p = 0.05, HR 9.97, CI 0.99\u2013100.00). A tumor volume \u2265 15 cm<jats:sup>3<\/jats:sup> was a significant factor predictive of GKRS failure (p = 0.005). No difference in outcome was observed based on indication for GKRS (p = 0.0761).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Although microsurgical resection remains the primary management choice in patients with VSs, most VSs that are defined as having both a single dimension &gt; 3 cm and a volume &gt; 10 cm<jats:sup>3<\/jats:sup> and tolerable mass effect can be managed satisfactorily with GKRS. Tumor volume \u2265 15 cm<jats:sup>3<\/jats:sup> is a significant factor predicting poor tumor control following GKRS.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.12.jns161530","type":"journal-article","created":{"date-parts":[[2017,7,14]],"date-time":"2017-07-14T13:58:47Z","timestamp":1500040727000},"page":"1380-1387","source":"Crossref","is-referenced-by-count":59,"title":["Gamma Knife radiosurgery for large vestibular schwannomas greater than 3 cm in diameter"],"prefix":"10.3171","volume":"128","author":[{"given":"Cheng-Wei","family":"Huang","sequence":"first","affiliation":[{"name":"Gamma Knife Center, Chang Bing Show Chwan Memorial Hospital;"},{"name":"Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsien-Tang","family":"Tu","sequence":"additional","affiliation":[{"name":"Gamma Knife Center, Chang Bing Show Chwan Memorial Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Yi","family":"Chuang","sequence":"additional","affiliation":[{"name":"School of Medicine, Chung-Shan Medical University, Taichung, Taiwan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Siu","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chung-Shan Medical University Hospital;"},{"name":"School of Medicine, Chung-Shan Medical University, Taichung, Taiwan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsi-Hsien","family":"Chou","sequence":"additional","affiliation":[{"name":"School of Medicine, Chung-Shan Medical University, Taichung, Taiwan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Tsung","family":"Lee","sequence":"additional","affiliation":[{"name":"Gamma Knife Center, Chang Bing Show Chwan Memorial Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuan-Fu","family":"Huang","sequence":"additional","affiliation":[{"name":"Gamma Knife Center, Chang Bing Show Chwan Memorial Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurol Surg B Skull Base","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1055\/s-0034-1371525","article-title":"Long-term outcome of Gamma Knife radiosurgery for vestibular schwannoma","volume":"75","author":"Bir SC","year":"2014","unstructured":"Bir SC, Ambekar S, Bollam P, Nanda A: Long-term outcome of Gamma Knife radiosurgery for vestibular schwannoma. 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