{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:15:18Z","timestamp":1785413718204,"version":"3.56.0"},"reference-count":90,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Wait-and-scan surveillance is now commonly employed for initial management of small- and medium-sized vestibular schwannomas. Although small differences in tumor size are unlikely to impact outcomes significantly, treatment with either radiosurgery or microsurgery is usually recommended following radiological detection of tumor growth. The objective of the current study was to identify potential inflection points in vestibular schwannoma tumor size, where the risks of treatment with single-fraction stereotactic radiosurgery (SRS) accelerate to inform timing of intervention.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Adult (\u2265 18 years old) patients with sporadic vestibular schwannoma who underwent SRS from 2000 through 2022 were included.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 749 patients with a median age at SRS of 62 years were studied, the majority (n = 566 [76%]) of whom had tumors extending into the cerebellopontine angle (CPA) at SRS. The optimal tumor size cut point to predict SRS failure and need for salvage treatment was 4 mm or more of CPA extension (c-index 0.59, HR 3.60, p = 0.01). The optimal tumor size cut point to predict the outcome of facial nerve paresis was 13 mm or more of CPA extension, resulting in a c-index of 0.63 (HR 2.88, p = 0.01). Among patients with at least 3 months of surveillance before SRS, those with a tumor growth rate \u2265 2.5 mm\/year were more likely to undergo salvage treatment than those with a growth rate < 2.5 mm\/year, although this difference did not achieve statistical significance (HR 1.82, p = 0.18).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The risk of SRS failure requiring salvage treatment and the risk of post-SRS facial nerve paralysis increase at sizes of approximately 4 and 13 mm extension into the CPA, respectively, providing a size threshold anchor to help guide treatment decision-making regarding timing of SRS. Furthermore, rapid tumor growth during the initial wait-and-scan period may be associated with an increased risk of radiosurgical failure, which may influence choice of treatment.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.8.jns25830","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:22Z","timestamp":1769083222000},"page":"955-964","source":"Crossref","is-referenced-by-count":2,"title":["Defining clinically significant tumor size in sporadic vestibular schwannoma to inform timing of radiosurgery during wait-and-scan management: further evidence supporting size threshold surveillance"],"prefix":"10.3171","volume":"144","author":[{"given":"Matthew L.","family":"Carlson","sequence":"first","affiliation":[{"name":"Departments of Otolaryngology-Head and Neck Surgery,"},{"name":"Neurologic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Marinelli","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head and Neck Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric E.","family":"Babajanian","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head and Neck Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghazal S.","family":"Daher","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head and Neck Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James R.","family":"Dornhoffer","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head and Neck Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl R.","family":"Khandalavala","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head and Neck Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"Lohse","sequence":"additional","affiliation":[{"name":"Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie J.","family":"Van Gompel","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head and Neck Surgery,"},{"name":"Neurologic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Peris Celda","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head and Neck Surgery,"},{"name":"Neurologic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian A.","family":"Neff","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head and Neck Surgery,"},{"name":"Neurologic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin L. W.","family":"Driscoll","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head and Neck Surgery,"},{"name":"Neurologic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Link","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head and Neck Surgery,"},{"name":"Neurologic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"14","key":"b1","series-title":"N Engl J Med","first-page":"1335","article-title":"Vestibular schwannomas","volume":"384","author":"Carlson ML","year":"2021","unstructured":"Carlson ML, Link MJ. Vestibular schwannomas. 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Otolaryngol Head Neck Surg. 2018;159(4):717\u2013723."},{"issue":"3","key":"b4","series-title":"Otol Neurotol","first-page":"384","article-title":"Prevalence of sporadic vestibular schwannoma: reconciling temporal bone, radiologic, and population-based studies","volume":"40","author":"Marinelli JP","year":"2019","unstructured":"Marinelli JP, Grossardt BR, Lohse CM, Carlson ML. Prevalence of sporadic vestibular schwannoma: reconciling temporal bone, radiologic, and population-based studies. Otol Neurotol. 2019;40(3):384\u2013390."},{"key":"b5","series-title":"Clin Epidemiol","first-page":"981","article-title":"Epidemiology of vestibular schwannomas - prospective 40-year data from an unselected national cohort","volume":"11","author":"Reznitsky M","year":"2019","unstructured":"Reznitsky M, Petersen M, West N, Stangerup SE, Caye-Thomasen P. Epidemiology of vestibular schwannomas - prospective 40-year data from an unselected national cohort. 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