Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in young patients: a multi-institutional study

Chloe Dumot, Stylianos Pikis, Georgios Mantziaris, Zhiyuan Xu, Rithika Kormath Anand, Ahmed M. Nabeel, Darrah Sheehan, Kimball Sheehan, Wael A. Reda, Sameh R. Tawadros, Khaled Abdel Karim, Amr M.N. El-Shehaby, Reem M. Emad Eldin, Selcuk Peker, Yavuz Samanci, Tehila Kaisman-Elbaz, Herwin Speckter, Wenceslao Hernández, Julio Isidor, Manjul TripathiRenu Madan, Brad E. Zacharia, Lekhaj C. Daggubati, Nuria Martínez Moreno, Roberto Martínez Álvarez, Anne Marie Langlois, David Mathieu, Christopher P. Deibert, Vivek R. Sudhakar, Christopher P. Cifarelli, Denisse Arteaga Icaza, Daniel T. Cifarelli, Zhishuo Wei, Ajay Niranjan, Gene H. Barnett, L. Dade Lunsford, Greg N. Bowden, Jason P. Sheehan

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Purpose: Surgery is the treatment of choice for large vestibular schwannomas (VS). Stereotactic radiosurgery (SRS) has been suggested as an alternative to resection in selected patients. However, the safety and efficacy of SRS in Koos grade IV patients ≤ 45 years old has not been evaluated. The aim of this study is to describe the clinical and radiological outcomes of Koos grade IV in young patient managed with a single-session SRS. Methods: This retrospective, multicenter analysis included SRS-treated patients, ≤ 45 years old presenting with non-life threatening or incapacitating symptoms due to a Koos Grade IV VS and with follow-up ≥ 12 months. Tumor control and neurological outcomes were evaluated. Results: 176 patients [median age of 36.0 (IQR 9) and median tumor volume of 9.3 cm3 (IQR 4.7)] were included. The median prescription dose was 12 Gy (IQR 0.5). Median follow-up period was 37.5 (IQR 53.5) months. The 5- and 10-year progression-free survival was 90.9% and 86.7%. Early tumor enlargement occurred in 10.9% of cases and was associated with tumor progression at the last follow-up. The probability of serviceable hearing preservation at 5- and 10-years was 56.8% and 45.2%, respectively. The probability of improvement or preservation of facial nerve function was 95.7% at 5 and 10-years. Adverse radiation effects were noted in 19.9%. New-onset hydrocephalus occurred in 4.0%. Conclusion: Single-session SRS is a safe and effective alternative to surgical resection in selected patients ≤ 45 years old particularly those with medical co-morbidities and those who decline resection. Longer term follow up is warranted.

Original languageEnglish
Pages (from-to)201-208
Number of pages8
JournalJournal of Neuro-Oncology
Issue number1
StatePublished - 1 Oct 2022
Externally publishedYes


  • Koos grade IV
  • Stereotactic radiosurgery
  • Vestibular schwannoma
  • Young age

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Oncology
  • Cancer Research


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