2025 Proffered Presentations
S266: VESTIBULAR SCHWANNOMA KOOS GRADE I INTERNATIONAL STUDY OF ACTIVE SURVEILLANCE VERSUS STEREOTACTIC RADIOSURGERY: THE VISAS-K1 STUDY
Hussam Abou-Al-Shaar, MD1; Othman Bin-Alamer, MBBS1; Selcuk Peker, MD2; Yavuz Samanci, MD2; Isabelle Pelcher, BA3; Sabrina Begley, BA3; Anuj Goenka, MD3; Michael Schulder, MD3; Jean-Nicolas Tourigny, MD, MS4; David Mathieu, MD4; Andréanne Hamel, BSc4; Robert G Briggs, MD5; Cheng Yu, PhD5; Gabriel Zada, MD5; Steven L Giannotta, MD5; Herwin Speckter, MD, MSc6; Sarai Palque, MD6; Manjul Tripathi, MCh7; Saurabh Kumar, MS7; Rupinder Kaur, BSc7; Narendra Kumar, MD7; Brandon Rogowski, MD8; Matthew J Shepard, MD9; Bryan A Johnson, MD, MBA10; Daniel M Trifiletti, MD10; Ronald E Warnick, MD11; Samantha Dayawansa, MD, PhD12; Elad Mashiach, MS13; Fernando De Nigris Vasconcellos, MD13; Kenneth Bernstein, MD13; Zane Schnurman, MD13; Juan Alzate, MD13; Douglas Kondziolka, MD, MSc13; Jason P Sheehan, MD, PhD12; 1University of Pittsburgh Medical Center; 2Koc University School of Medicine; 3Donald & Barbara Zucker School of Medicine at Hofstra/Northwell; 4Université de Sherbrooke; 5University of Southern California; 6Dominican Gamma Knife Center; 7Post Graduate Institute of Medical Education and Research; 8Drexel University School of Medicine; 9Allegheny Health Network; 10Mayo Clinic; 11Mayfield Clinic; 12University of Virginia; 13NYU Langone
Objectives: The appropriate management of Koos grade I vestibular schwannomas (VS) remains controversial. This study evaluates the safety and efficacy of stereotactic radiosurgery (SRS) versus observation for Koos grade I VS.
Methods: In a multicenter study, this report gathered and analyzed data retrospectively on Koos grade I VS patients who underwent SRS (SRS group) or were observed (observation group). Propensity score matching was utilized to equilibrate demographics, tumor size, and audiometric data across groups. The outcome analyzed included tumor control, preservation of serviceable hearing (SHP), and neurological function.
Results: The study matched 142 patients, providing a median follow-up period of 36 months. SRS significantly enhanced tumor control compared to observation, with a 100% control rate at both 5- and 8-year marks in the SRS group versus 49.7% and 33% in the observation group at the same time intervals, respectively (P<0.001; Figure 1). SHP outcomes between groups showed no significant difference at 5 and 8 years, ensuring a comparable quality of auditory function (SRS 70.1% vs. observation 53.4% at 5 years; P=0.33; Figure 2). Furthermore, SRS was associated with a reduced likelihood of tinnitus (OR=0.46, P=0.04), vestibular dysfunction (OR=0.17, P=0.002), and overall cranial nerve dysfunction (OR=0.49, P=0.03) at last follow up.
Conclusion: SRS management of Koos grade I VS patients was associated with superior tumor control and reduced odds for dysfunction of various cranial nerves, while not compromising hearing preservation compared to observation. These findings support the safety and efficacy of SRS as a potential management modality for this patient population.
