Early Gamma Knife Radiosurgery for Hearing Preservation in Vestibular Schwannoma

Purpose of Review: To examine and summarize the existing literature surrounding early stereotactic radiosurgery for hearing preservation in the treatment of vestibular schwannoma. Recent Findings: There is no universally accepted definition of “early” stereotactic radiosurgery or “hearing preservation” within the vestibular schwannoma literature. Most recent studies originate from the University of Pittsburgh, where upfront stereotactic radiosurgery is routinely pursued in patients of all tumor sizes and hearing capabilities. The preliminary data suggests that short-term hearing preservation may be improved when radiating patients with smaller tumors and better hearing when compared to radiating those who present “later” in their disease course. Unfortunately, the existing literature suffers from significant limitations in study design such that proper conclusions about long-term hearing outcomes of “early” stereotactic radiosurgery and its comparison to observation or microsurgery cannot be drawn. Summary: There is insufficient evidence in the current literature to support early stereotactic radiosurgery for hearing preservation in the treatment of vestibular schwannoma.