Beyond tumor control: symptom trajectories and hearing outcomes after contemporary Gamma Knife radiosurgery for vestibular schwannoma.

Authors

Jheremy S Reyes, Constantinos G Hadjipanayis, L Dade Lunsford, Ajay Niranjan

Published in

Journal of neuro-oncology. Volume 178. Issue 3. Jun 23, 2026. Epub Jun 23, 2026.

Abstract

Gamma Knife radiosurgery (GKRS) is an established treatment for vestibular schwannoma, but contemporary cohort-level data integrating long-term tumor control with clinical symptom trajectories and hearing-related correlates remain valuable.
We performed a retrospective cohort study of 286 patients with vestibular schwannoma (VS) treated with GKRS (2014-2024). The primary endpoint was local control. Secondary outcomes included overall survival and changes in hearing loss, imbalance, vertigo, dizziness, and tinnitus. Kaplan-Meier analysis was used to estimate local control and overall survival. Paired symptom changes were assessed using McNemar testing.
The Median follow-up was 52.3 months (IQR 27.4-80.3). Progressive radiographic enlargement occurred in 5 patients, yielding a crude local control rate of 98.3%. The actuarial local control was 98.5% at 5 years and 96.5% at 10 years. Imbalance, vertigo, dizziness, and tinnitus improved significantly after GKRS, whereas hearing loss remained stable overall (59.4% vs. 57.3%, p = 0.441). Mean symptom burden declined from 1.74 to 1.20 symptoms per patient (p < 0.001). Post-radiosurgery hearing loss was more frequent in Koos IV tumors and increased stepwise across quartiles of cochlear mean dose: 38.7% for ≤ 2.9 Gy, 53.3% for > 2.9-3.6 Gy, 66.2% for > 3.6-4.5 Gy, and 73.8% for > 4.5 Gy (p = 0.00012). Baseline hearing loss remained the strongest predictor in multivariable modeling.
At a median of four years GKRS provided tumor control in > 95% of VS patients and was associated with reduced overall symptom burden and improvement in vestibular symptoms. Hearing outcomes were related to baseline auditory status, Koos grade, and cochlear dosimetry.
Not applicable.

PMID:
42334723
Bibliographic data and abstract were imported from PubMed on 23 Jun 2026.

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