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Conservative Management or Gamma Knife Radiosurgery for Vestibular Schwannoma: Tumor Growth, Symptoms, and Quality of Life

Breivik, Cathrine Nansdal MD*; Nilsen, Roy Miodini PhD; Myrseth, Erling MD, PhD*; Pedersen, Paal Henning MD, PhD*,§; Varughese, Jobin K. MD, PhD§; Chaudhry, Aqeel Asghar MD*; Lund-Johansen, Morten MD, PhD*,§

doi: 10.1227/01.neu.0000429862.50018.b9
Research-Human-Clinical Studies

BACKGROUND: There are few reports about the course of vestibular schwannoma (VS) patients following gamma knife radiosurgery (GKRS) compared with the course following conservative management (CM). In this study, we present prospectively collected data of 237 patients with unilateral VS extending outside the internal acoustic canal who received either GKRS (113) or CM (124).

OBJECTIVE: The aim was to measure the effect of GKRS compared with the natural course on tumor growth rate and hearing loss. Secondary end points were postinclusion additional treatment, quality of life (QoL), and symptom development.

METHODS: The patients underwent magnetic resonance imaging scans, clinical examination, and QoL assessment by SF-36 questionnaire. Statistics were performed by using Spearman correlation coefficient, Kaplan-Meier plot, Poisson regression model, mixed linear regression models, and mixed logistic regression models.

RESULTS: Mean follow-up time was 55.0 months (26.1 standard deviation, range 10-132). Thirteen patients were lost to follow-up. Serviceable hearing was lost in 54 of 71 (76%) (CM) and 34 of 53 (64%) (GKRS) patients during the study period (not significant, log-rank test). There was a significant reduction in tumor volume over time in the GKRS group. The need for treatment following initial GKRS or CM differed at highly significant levels (log-rank test, P < .001). Symptom and QoL development did not differ significantly between the groups.

CONCLUSION: In VS patients, GKRS reduces the tumor growth rate and thereby the incidence rate of new treatment about tenfold. Hearing is lost at similar rates in both groups. Symptoms and QoL seem not to be significantly affected by GKRS.

ABBREVIATIONS: CM, conservative management

CPA, cerebellopontine angle

GKRS, gamma knife radiosurgery

IAC, internal acoustic canal

GR, Gardner-Robertson

KM, Kaplan-Meier

MS, microsurgery

QoL, quality of life

RS, radiosurgery

SD, standard deviation

SF-36, 36-item short-form health survey

VAS, visual analog scale

VS, vestibular schwannoma

*Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway;

Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway;

§Institute of Surgical Sciences, University of Bergen, Norway

Correspondence: Cathrine Nansdal Breivik, MD, Department of Neurosurgery, Haukeland University Hospital, Jonas Liesgt 51, 5021 Bergen. E-mail: or

Received August 15, 2012

Accepted February 26, 2013

Copyright © by the Congress of Neurological Surgeons