neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2024-26-1-110-122neurosurgery-1506Research ArticleЛЕКЦИЯLECTUREСтереотаксическая радиохирургия вестибулярных шванном: эволюция философии леченияStereotactic radiosurgery for vestibular schwannomas: evolution of the philosophy of treatmenthttps://orcid.org/0000-0002-1572-5798ИльяловС. Р.IlyalovS. R.

Сергей Рустамович Ильялов 

249036 Обнинск, ул. Королева, 4

Sergey Rustamovich Ilyalov 

4 Koroleva St., Obninsk 249036

sergeyilyalov@gmail.comhttps://orcid.org/0000-0002-0976-4547ГолановА. В.GolanovA. V.

отделение радиотерапии и радиохирургии 

125047 Москва, ул. 4-я Тверская-Ямская, 16

Radiotherapy and Radiosurgery Department

16 4th Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0002-6510-7883БановС. М.BanovS. M. 

отделение радиотерапии и радиохирургии 

125047 Москва, ул. 4-я Тверская-Ямская, 16

Radiotherapy and Radiosurgery Department

16 4th Tverskaya-Yamskaya St., Moscow 125047

ООО «Гамма Медтехнологии»Россия“Gamma Medtechnology” LtdRussian FederationФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. акад. Н. Н. Бурденко» Минздрава РоссииРоссияN. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of RussiaRussian Federation202405042024261110‑122Copyright © Ильялов С.Р., Голанов А.В., Банов С.М., 20242024Ильялов С.Р., Голанов А.В., Банов С.М.Ilyalov S.R., Golanov A.V., Banov S.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1506

Вестибулярные шванномы – наиболее частая разновидность опухолей области мостомозжечкового угла. Стереотаксическая радиохирургия входит в арсенал методов лечения данных опухолей наравне с традиционным хирургическим подходом. В России с учетом заболеваемости, превышающей 15 радиохирургических случаев на 1 млн населения в год, ожидаемая потребность в стереотаксической радиохирургиии при вестибулярных шванномах составляет более 2 тыс. вмешательств ежегодно.

Стереотаксическая радиохирургия находится на стыке нескольких клинических специальностей: нейрорадиологии, нейрохирургии и радиационной терапии, каждая из которых внесла серьезный вклад в развитие данного метода лечения. Наиболее часто в клинической практике используется кобальтовый аппарат «Гамма‑нож», специально предназначенный для воздействия на интракраниальные новообразования. Также применяются современные линейные ускорители электронов и протонные ускорители, обеспечивающие высокую точность и конформность облучения. Опыт применения, накопленный с момента первого применения данного метода в лечении вестибулярных шванном, позволил не только оптимизировать дозы облучения для воздействия на опухоль и прилежащие критические структуры (ствол мозга, внутреннее ухо), но и изучить особенности постлучевых микро‑ и макроизменений, их влияние на клиническое течение, а также разработать рекомендации по радиохирургии шванном различного размера. Все это способствует высокому уровню контроля роста опухоли и низкой частоте функциональных нарушений, что наряду с хорошей переносимостью и минимальными сроками госпитализации определяет более низкую себестоимость лечения по сравнению с традиционной хирургией и значительный социально‑экономический эффект.

Представленная лекция предназначена для нейрохирургов и радиационных терапевтов и посвящена наиболее значимым факторам, повлиявшим на развитие, продвижение и активное применение стереотаксической радиохирургии вестибулярных шванном в клинической практике.

Vestibular schwannomas are the most common tumors in the cerebellopontine angle. Stereotactic radiosurgery is included in the armamentarium of methods for treating these tumors along with surgical treatment. Given the annual incidence of more than 15 radiosurgical cases of vestibular schwannomas per 1 million population, the expected need for stereotactic radiosurgery of these tumors in Russia is more than 2000 cases annually.

Stereotactic radiosurgery is located at the intersection of several clinical specialties: neuroradiology, neurosurgery and radiation therapy, each of which has made a significant contribution to the development of this treatment method. The most commonly used for this is the cobalt‑based Leksell Gamma Knife, specifically intended for the treatment of intracranial neoplasms. Treatment is also possible with modern linear accelerators and proton accelerators, which provide high accuracy and conformity of irradiation. The experience gained since the first application of this method in the treatment of vestibular schwannomas has made it possible not only to optimize the radiation doses to the tumor and adjacent critical structures (brain stem, inner ear), but also to study the features of post‑radiation micro‑ and macro‑ changes, their impact on the clinical course, to develop recommendations for radiosurgery with schwannomas of various sizes. All this contributes to high control of tumor growth and a low level of functional disorders, which, along with easy tolerability and minimal hospitalization time, determines lower cost of this treatment compared to the traditional surgical approach and significant social and economic effect.

This lecture is intended for neurosurgeons and radiation therapists and focuses on the most significant factors that influenced the development, promotion and active use of stereotactic radiosurgery of vestibular schwannomas in cli nical practice.

стереотаксическая радиохирургия«Гамма‑нож»вестибулярная шванномапсевдопрогрессиялицевой нервнарушения слухаstereotactic radiosurgeryGamma Knifevestibular schwannomapseudoprogressionfacial nervehearing impairmentReferencesCaye-Thomasen P., Stangerup S.-E. Epidemiology of vestibular schwannoma. In: Comprehensive management of vestibular schwannoma. Ed. by M.L. Carlson. NY: Thieme, 2019. Pp. 14–17. DOI: 10.1055/b-0039-169179Caye-Thomasen P., Stangerup S.-E. Epidemiology of vestibular schwannoma. In: Comprehensive management of vestibular schwannoma. Ed. by M.L. Carlson. NY: Thieme, 2019. Pp. 14–17. DOI: 10.1055/b-0039-169179Stangerup S.-E., Caye-Thomasen P. Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin N Am 2012;45(2):257–68, vii. DOI: 10.1016/j.otc.2011.12.008Stangerup S.-E., Caye-Thomasen P. Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin N Am 2012;45(2):257–68, vii. DOI: 10.1016/j.otc.2011.12.008Leksell L. A note on the treatment of acoustic tumors. Acta Chir Scand 1971;137(8):763–5.Leksell L. A note on the treatment of acoustic tumors. Acta Chir Scand 1971;137(8):763–5.Faramand A., Lunsford L.D., Regis J., Liscak R. Gamma Knife radiosurgery: a review of epidemiology and practice. 2020. Available at: https://www.elekta.com/medical-affairs/bibliographies/LGKS%20Review%20of%20epidemiology.pdf.Faramand A., Lunsford L.D., Regis J., Liscak R. Gamma Knife radiosurgery: a review of epidemiology and practice. 2020. Available at: https://www.elekta.com/medical-affairs/bibliographies/LGKS%20Review%20of%20epidemiology.pdf.Lindquist C. Gamma Knife surgery: evolution and long-term results. In: Radiosurgery 1999. Ed. by D. Kondziolka, S. Karger. Vol. 3. Basel: Karger, 2000. Pp. 1–12.Lindquist C. Gamma Knife surgery: evolution and long-term results. In: Radiosurgery 1999. Ed. by D. Kondziolka, S. Karger. Vol. 3. Basel: Karger, 2000. Pp. 1–12.Костюченко В.В. История стереотаксиса и радиохирургии. В кн.: Нейрорадиохирургия на Гамма-ноже. Под ред. В.В. Костюченко, А.В. Голанова. М.: Т.А. Алексеева, 2018. С. 41–173.Kostuchenko V.V. History of stereotaxy and radiosurgery. In: Neuroradiosurgery with Gamma knife. Ed. by V.V. Kostjuchenko, A.V. Golanov. Moscow: T.A. Aleskeeva, 2018. Pp. 41–173. (In Russ.).Annual treatment statistics. Leksell Gamma Knife Society. Available at: https://www.lgksociety.com/fileadmin/groups/1/Documents/Treatment_Statistics/2020/1968-2020_Treatment_Report.pdfAnnual treatment statistics. Leksell Gamma Knife Society. Available at: https://www.lgksociety.com/fileadmin/groups/1/Documents/Treatment_Statistics/2020/1968-2020_Treatment_Report.pdfLinskey M.E., Martinez A.J., Kondziolka D. et al. The radiobiology of human acoustic schwannoma xenografts after stereotactic radiosurgery evaluated in the subrenal capsule of athymic mice. J Neurosurg 1993;78(4):645–53. DOI: 10.3171/jns.1993.78.4.0645Linskey M.E., Martinez A.J., Kondziolka D. et al. The radiobiology of human acoustic schwannoma xenografts after stereotactic radiosurgery evaluated in the subrenal capsule of athymic mice. J Neurosurg 1993;78(4):645–53. DOI: 10.3171/jns.1993.78.4.0645Szeifert G.T., Figarella-Branger D., Roche P.-H., Régis J. Histopathological observations on vestibular schwannomas after Gamma Knife radiosurgery: the Marseille experience. Neurochirurgie 2004;50(2–3 Pt 2):327–37.Szeifert G.T., Figarella-Branger D., Roche P.-H., Régis J. Histopathological observations on vestibular schwannomas after Gamma Knife radiosurgery: the Marseille experience. Neurochirurgie 2004;50(2–3 Pt 2):327–37.Lee D.J., Westra W.H., Staecker H. et al. Clinical and histopathologic features of recurrent vestibular schwannoma (acoustic neuroma) after stereotactic radiosurgery. Otol Neurotol 2003;24(4):650–60; discussion 660. DOI: 10.1097/00129492-200307000-00020Lee D.J., Westra W.H., Staecker H. et al. Clinical and histopathologic features of recurrent vestibular schwannoma (acoustic neuroma) after stereotactic radiosurgery. Otol Neurotol 2003;24(4):650–60; discussion 660. DOI: 10.1097/00129492-200307000-00020Шиманский В.Н., Одаманов Д.А., Рыжова М.В. и др. Морфологические изменения в невриномах слухового нерва после радиологического лечения: опыт ФГАУ «НМИЦ нейрохирургии им. акад. Н.Н. Бурденко». Вестник Российского научного центра рентгенорадиологии 2018;18(2):1–20.Shimanskiy V.N., Odamanov D.A., Ryzhova M.V. et al. Morphological changes in acoustic neuromas after radiological treatment: experience of the N.N. Burdenko National Medical Center of Neurosurgery. Vestnik Rossiyskogo naucnogo tsentra rentgenoradiologii = Bulletin of the Russian Scientific Center of Roentgenoradiology 2018;18(2):1–20. (In Russ.).Link M.J., Pollock B.E., Carlson M.L., Foote M.R. Gamma knife radiosurgery for treatment of sporadic vestibular schwannoma. In: Comprehensive management of vestibular schwannoma. Ed. by M.L. Carlson. NY: Thieme, 2019. Рр. 91–101. DOI: 10.1055/b-0039-169179Link M.J., Pollock B.E., Carlson M.L., Foote M.R. Gamma knife radiosurgery for treatment of sporadic vestibular schwannoma. In: Comprehensive management of vestibular schwannoma. Ed. by M.L. Carlson. NY: Thieme, 2019. Рр. 91–101. DOI: 10.1055/b-0039-169179Kubicky C.D., Chan L.W., Tsuji S.Y. Central Nervous System. In: Handbook of Evidence-Based Radiation Oncology. Ed. by E.K. Hansen, M. Roach. NY: Springer, 2010. Pp. 29–75. DOI: 10.1007/978-0-387-92988-0Kubicky C.D., Chan L.W., Tsuji S.Y. Central Nervous System. In: Handbook of Evidence-Based Radiation Oncology. Ed. by E.K. Hansen, M. Roach. NY: Springer, 2010. Pp. 29–75. DOI: 10.1007/978-0-387-92988-0Голанов А.В., Банов С.В., Ветлова Е.Р. и др. Опухоли центральной нервной системы. В кн.: Терапевтическая радиология. Под ред. А.Д. Каприна, Ю.С. Мардынского. М.: ГЭОТАР-Медиа, 2018. Доступно по: https://www.rosmedlib.ru/book/ISBN9785970446584.htmlGolanov A.V., Banov S.M., Vetlova E.R. et al. Central nervous system tumors. In: Therapeutic radiology. Ed. by A.D. Kaprin, Yu.S. Mardynskiy. Moscow: GEOTAR-Media, 2018. (In Russ.). Available at: https://www.rosmedlib.ru/book/ISBN9785970446584.htmlRaleigh D.R., Barani I.J., Sneed P. Intracranial tumors. In: Handbook of evidence-based stereotactic radiosurgery and stereotactic body radiotherapy. Ed. by R.A. Sethi, I.J. Barani, D.A. Larson, M. Roach 3rd. Springer, 2016. Рр. 41–79. DOI: 10.1007/978-3-319-21897-7Raleigh D.R., Barani I.J., Sneed P. Intracranial tumors. In: Handbook of evidence-based stereotactic radiosurgery and stereotactic body radiotherapy. Ed. by R.A. Sethi, I.J. Barani, D.A. Larson, M. Roach 3rd. Springer, 2016. Рр. 41–79. DOI: 10.1007/978-3-319-21897-7Myrseth E., Møller P., Pedersen P.-H., Lund-Johansen M. Vestibular schwannoma: surgery or gamma knife radiosurgery? A prospective, nonrandomized study. Neurosurgery 2009;64(4):654–61; discussion 661–3. DOI: 10.1227/01.NEU.0000340684.60443.55Myrseth E., Møller P., Pedersen P.-H., Lund-Johansen M. Vestibular schwannoma: surgery or gamma knife radiosurgery? A prospective, nonrandomized study. Neurosurgery 2009;64(4):654–61; discussion 661–3. DOI: 10.1227/01.NEU.0000340684.60443.55Костюченко В.В. Дозиметрическое планирование РХГН. В кн.: Нейрорадиохирургия на Гамма-ноже. Под ред. В.В. Костюченко, А.В. Голанова М., 2018. С. 351–434.Костюченко В.В. Дозиметрическое планирование РХГН. В кн.: Нейрорадиохирургия на Гамма-ноже. Под ред. В.В. Костюченко, А.В. Голанова М., 2018. С. 351–434. Kostuchenko V.V. GKRS dosimetric planning. In: Neuroradiosurgery with Gamma knife. Ed. by V.V. Kostjuchenko, A.V. Golanov. Moscow, 2018. Pp. 351–434. (In Russ.).Pollock B.E. Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 year experience. Neurosurgery 2006;58(2):241–8; discussion 241–8. DOI: 10.1227/01.NEU.0000194833.66593.8BPollock B.E. Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 year experience. Neurosurgery 2006;58(2):241–8; discussion 241–8. DOI: 10.1227/01.NEU.0000194833.66593.8BKondziolka D., Lunsford L.D., McLaughlin M.R., Flickinger J.C. Long-term outcomes after radiosurgery for acoustic neuromas. New Engl J Med 1998;339(20):1426–33. DOI: 10.1056/nejm199811123392003Kondziolka D., Lunsford L.D., McLaughlin M.R., Flickinger J.C. Long-term outcomes after radiosurgery for acoustic neuromas. New Engl J Med 1998;339(20):1426–33. DOI: 10.1056/nejm199811123392003Delsanti C., Roche P.-H., Thomassin J.-M., Régis J. Morphological changes of vestibular schwannomas after radiosurgical treatment: pitfalls and diagnosis of failure. Prog Neurol Surg 2008;21:93–7. DOI: 10.1159/000156712Delsanti C., Roche P.-H., Thomassin J.-M., Régis J. Morphological changes of vestibular schwannomas after radiosurgical treatment: pitfalls and diagnosis of failure. Prog Neurol Surg 2008;21:93–7. DOI: 10.1159/000156712Шиманский В.Н., Одаманов Д.А., Рыжова М.В. и др. Хирургическая тактика при удалении вестибулярных шванном после стереотаксического радиологического лечения. Результаты операций и морфологические изменения в опухолях после облучения. Вопросы нейрохирургии им. Н.Н. Бурденко 2018;82(6):38–52. DOI: 10.17116/neiro20188206138Shimanskiy V.N., Odamanov D.A., Ryzhova M.V. et al. Surgical approach to resection of vestibular schwannomas following stereotactic radiological treatment. Surgical outcomes and morphological changes in tumors after radiotherapy. Zhurnal Voprosy neirokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2018;82(6):38–52. (In Russ.). DOI: 10.17116/neiro20188206138Lee H.-J., Kim M.J., Koh S.H. et al. Comparing outcomes following salvage microsurgery in vestibular schwannoma patients failing Gamma-knife radiosurgery or microsurgery. Otol Neurotol 2017;38(9):1339–44. DOI: 10.1097/MAO.0000000000001536Lee H.-J., Kim M.J., Koh S.H. et al. Comparing outcomes following salvage microsurgery in vestibular schwannoma patients failing Gamma-knife radiosurgery or microsurgery. Otol Neurotol 2017;38(9):1339–44. DOI: 10.1097/MAO.0000000000001536Régis J., Delsanti C., Roche P.-H. Editorial: Vestibular schwannoma radiosurgery: progression or pseudoprogression? J Neurosurg 2017;127(2):374–9. DOI: 10.3171/2016.7.JNS161236Régis J., Delsanti C., Roche P.-H. Editorial: Vestibular schwannoma radiosurgery: progression or pseudoprogression? J Neurosurg 2017;127(2):374–9. DOI: 10.3171/2016.7.JNS161236Breshears J.D., Chang J., Molinaro A.M. et al. Temporal dynamics of pseudoprogression after Gamma Knife radiosurgery for vestibular schwannomas – a retrospective volumetric study. Neurosurgery 2019;84(1):123–31. DOI: 10.1093/neuros/nyy019Breshears J.D., Chang J., Molinaro A.M. et al. Temporal dynamics of pseudoprogression after Gamma Knife radiosurgery for vestibular schwannomas – a retrospective volumetric study. Neurosurgery 2019;84(1):123–31. DOI: 10.1093/neuros/nyy019Ильялов С.Р., Банов С.М., Голанов А.В., Усачев Д.Ю. Радиохирургия вестибулярных шванном: динамика ближайших и отдаленных постлучевых изменений и контроль опухолевого роста. Журнал «Вопросы нейрохирургии им. Н.Н. Бурденко» 2022;86(2):55–63. DOI: 10.17116/neiro20228602155Ilyalov S.R., Banov S.M., Golanov A.V., Usachev D.Yu. Stereotactic radiosurgery for vestibular schwannoma: early and long-term radiation-induced changes and tumor growth control. Zhurnal Voprosy neyrokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2022;86(2):55–63. (In Russ.). DOI: 10.17116/neiro20228602155Frisch C.D., Jacob J.T., Carlson M.L. et al. Stereotactic radiosurgery for cystic vestibular schwannomas. Neurosurgery 2017;80(1):112–8. DOI: 10.1227/NEU.0000000000001376Frisch C.D., Jacob J.T., Carlson M.L. et al. Stereotactic radiosurgery for cystic vestibular schwannomas. Neurosurgery 2017;80(1):112–8. DOI: 10.1227/NEU.0000000000001376Klijn S., Verheul J.B., Beute G.N. et al. Gamma Knife radiosurgery for vestibular schwannomas: evaluation of tumor control and its predictors in a large patient cohort in The Netherlands. J Neurosurg 2016;124(6):1619–26. DOI: 10.3171/2015.4.JNS142415Klijn S., Verheul J.B., Beute G.N. et al. Gamma Knife radiosurgery for vestibular schwannomas: evaluation of tumor control and its predictors in a large patient cohort in The Netherlands. J Neurosurg 2016;124(6):1619–26. DOI: 10.3171/2015.4.JNS142415Goldbrunner R., Weller M., Regis J. et al. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro Oncol 2020;22(1):31–45. DOI: 10.1093/neuonc/noz153Goldbrunner R., Weller M., Regis J. et al. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro Oncol 2020;22(1):31–45. DOI: 10.1093/neuonc/noz153Breivik C.N., Nilsen R.M., Myrseth E. et al. Conservative management or gamma knife radiosurgery for vestibular schwannoma: tumor growth, symptoms, and quality of life. Neurosurgery 2013;73(1):48–56; discussion 56–7. DOI: 10.1227/01.neu.0000429862.50018.b9Breivik C.N., Nilsen R.M., Myrseth E. et al. Conservative management or gamma knife radiosurgery for vestibular schwannoma: tumor growth, symptoms, and quality of life. Neurosurgery 2013;73(1):48–56; discussion 56–7. DOI: 10.1227/01.neu.0000429862.50018.b9Régis J., Carron R., Park M.C. et al. Wait-and-see strategy compared with proactive Gamma Knife surgery in patients with intracanalicular vestibular schwannomas. J Neurosurg 2010;113 Suppl:105–11. DOI: 10.3171/2010.8.gks101058Régis J., Carron R., Park M.C. et al. Wait-and-see strategy compared with proactive Gamma Knife surgery in patients with intracanalicular vestibular schwannomas. J Neurosurg 2010;113 Suppl:105–11. DOI: 10.3171/2010.8.gks101058Han J.H., Kim D.G., Chung H.-T. et al. Hearing outcomes after stereotactic radiosurgery for vestibular schwannomas: mechanism of hearing loss and how to preserve hearing. Adv Tech Stand Neurosurg 2016;43:3–36. DOI: 10.1007/978-3-319-21359-0_1Han J.H., Kim D.G., Chung H.-T. et al. Hearing outcomes after stereotactic radiosurgery for vestibular schwannomas: mechanism of hearing loss and how to preserve hearing. Adv Tech Stand Neurosurg 2016;43:3–36. DOI: 10.1007/978-3-319-21359-0_1Baschnagel A.M., Chen P.Y., Bojrab D. et al. Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery. J Neurosurg 2013;118(3):571–8. DOI: 10.3171/2012.10.JNS12880Baschnagel A.M., Chen P.Y., Bojrab D. et al. Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery. J Neurosurg 2013;118(3):571–8. DOI: 10.3171/2012.10.JNS12880Hasegawa T., Kida Y., Kato T. et al. Factors associated with hearing preservation after Gamma Knife surgery for vestibular schwannomas in patients who retain serviceable hearing. J Neurosurg 2011;115(6):1078–86. DOI: 10.3171/2011.7.JNS11749Hasegawa T., Kida Y., Kato T. et al. Factors associated with hearing preservation after Gamma Knife surgery for vestibular schwannomas in patients who retain serviceable hearing. J Neurosurg 2011;115(6):1078–86. DOI: 10.3171/2011.7.JNS11749Kano H., Kondziolka D., Khan A. et al. Predictors of hearing preservation after stereotactic radiosurgery for acoustic neuroma. J Neurosurg 2009;111(4):863–73. DOI: 10.3171/2008.12.JNS08611Kano H., Kondziolka D., Khan A. et al. Predictors of hearing preservation after stereotactic radiosurgery for acoustic neuroma. J Neurosurg 2009;111(4):863–73. DOI: 10.3171/2008.12.JNS08611Hasegawa T., Kida Y., Kato T. et al. Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery. J Neurosurg 2013;118(3):557–65. DOI: 10.3171/2012.10.JNS12523Hasegawa T., Kida Y., Kato T. et al. Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery. J Neurosurg 2013;118(3):557–65. DOI: 10.3171/2012.10.JNS12523Sughrue M.E., Kaur R., Rutkowski M.J. et al. A critical evaluation of vestibular schwannoma surgery for patients younger than 40 years of age. Neurosurgery 2010;67(6):1646–53; discussion 1653–4. DOI: 10.1227/NEU.0b013e3181f8d3d3Sughrue M.E., Kaur R., Rutkowski M.J. et al. A critical evaluation of vestibular schwannoma surgery for patients younger than 40 years of age. Neurosurgery 2010;67(6):1646–53; discussion 1653–4. DOI: 10.1227/NEU.0b013e3181f8d3d3Chung W.-Y., Liu K.-D., Shiau C.-Y. et al. Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases. J Neurosurg 2005;102 Suppl:87–96. PMID: 15662787.Chung W.-Y., Liu K.-D., Shiau C.-Y. et al. Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases. J Neurosurg 2005;102 Suppl:87–96. PMID: 15662787.Lunsford L.D., Niranjan A., Flickinger J.C. et al. Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 2005;102 Suppl:195–9.Lunsford L.D., Niranjan A., Flickinger J.C. et al. Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 2005;102 Suppl:195–9.Régis J., Carron R., Delsanti C. et al. Radiosurgery for vestibular schwannomas. Neurosurg Clin N Am 2013;24(4):521–30. DOI: 10.1016/j.nec.2013.06.002Régis J., Carron R., Delsanti C. et al. Radiosurgery for vestibular schwannomas. Neurosurg Clin N Am 2013;24(4):521–30. DOI: 10.1016/j.nec.2013.06.002Watanabe S., Yamamoto M., Kawabe T. et al. Stereotactic radiosurgery for vestibular schwannomas: average 10-year follow-up results focusing on long-term hearing preservation. J Neurosurg 2016;125(Suppl 1):64–72. DOI: 10.3171/2016.7.GKS161494Watanabe S., Yamamoto M., Kawabe T. et al. Stereotactic radiosurgery for vestibular schwannomas: average 10-year follow-up results focusing on long-term hearing preservation. J Neurosurg 2016;125(Suppl 1):64–72. DOI: 10.3171/2016.7.GKS161494Anselmo P., Casale M., Arcidiacono F. et al. Twelve-year results of LINAC-based radiosurgery for vestibular schwannomas. Strahlenther Onkol 2020;196(1):40–7. DOI: 10.1007/s00066-019-01498-7Anselmo P., Casale M., Arcidiacono F. et al. Twelve-year results of LINAC-based radiosurgery for vestibular schwannomas. Strahlenther Onkol 2020;196(1):40–7. DOI: 10.1007/s00066-019-01498-7Carlson M.L., Vivas E.X., McCracken D.J. et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Hearing Preservation Outcomes in Patients with Sporadic Vestibular Schwannomas. Neurosurgery 2018;82(2):E35–9. DOI: 10.1093/neuros/nyx511Carlson M.L., Vivas E.X., McCracken D.J. et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Hearing Preservation Outcomes in Patients with Sporadic Vestibular Schwannomas. Neurosurgery 2018;82(2):E35–9. DOI: 10.1093/neuros/nyx511MacDonald B.V., Ren Y., Shahrvini B. et al. Delayed facial nerve palsy following resection of vestibular schwannoma: clinical and surgical characteristics. Otol Neurotol 2022;43(2):244–50. DOI: 10.1097/MAO.0000000000003392MacDonald B.V., Ren Y., Shahrvini B. et al. Delayed facial nerve palsy following resection of vestibular schwannoma: clinical and surgical characteristics. Otol Neurotol 2022;43(2):244–50. DOI: 10.1097/MAO.0000000000003392Perkins E.L., Manzoor N.F., Totten D.J. et al. The influence of extent of resection and tumor morphology on facial nerve outcomes following vestibular schwannoma surgery. Otol Neurotol 2021;42(9):e1346–52. DOI: 10.1097/MAO.0000000000003253Perkins E.L., Manzoor N.F., Totten D.J. et al. The influence of extent of resection and tumor morphology on facial nerve outcomes following vestibular schwannoma surgery. Otol Neurotol 2021;42(9):e1346–52. DOI: 10.1097/MAO.0000000000003253Tawfik K.O., Alexander T.H., Saliba J. et al. Predicting long-term facial nerve outcomes after resection of vestibular schwannoma. Otol Neurotol 2020;41(10):e1328–32. DOI: 10.1097/MAO.0000000000002883Tawfik K.O., Alexander T.H., Saliba J. et al. Predicting long-term facial nerve outcomes after resection of vestibular schwannoma. Otol Neurotol 2020;41(10):e1328–32. DOI: 10.1097/MAO.0000000000002883Nakatomi H., Jacob J.T., Carlson M.L. et al. Long-term risk of recurrence and regrowth after gross-total and subtotal resection of sporadic vestibular schwannoma. J Neurosurg 2017:1–7. DOI: 10.3171/2016.11.JNS16498Nakatomi H., Jacob J.T., Carlson M.L. et al. Long-term risk of recurrence and regrowth after gross-total and subtotal resection of sporadic vestibular schwannoma. J Neurosurg 2017:1–7. DOI: 10.3171/2016.11.JNS16498Iwai Y., Ishibashi K., Watanabe Y. et al. Functional preservation after planned partial resection followed by Gamma Knife radiosurgery for large vestibular schwannoma. World Neurosurg 2015;84(2):292–300. DOI: 10.1016/j.wneu.2015.03.012Iwai Y., Ishibashi K., Watanabe Y. et al. Functional preservation after planned partial resection followed by Gamma Knife radiosurgery for large vestibular schwannoma. World Neurosurg 2015;84(2):292–300. DOI: 10.1016/j.wneu.2015.03.012Chung W.-Y., Pan D. H.-C., Lee C.-C. et al. Large vestibular schwannomas treated by Gamma Knife surgery: long-term outcomes. J Neurosurg 2010;113 Suppl:112–21. DOI: 10.3171/2010.8.gks10954Chung W.-Y., Pan D. H.-C., Lee C.-C. et al. Large vestibular schwannomas treated by Gamma Knife surgery: long-term outcomes. J Neurosurg 2010;113 Suppl:112–21. DOI: 10.3171/2010.8.gks10954Van de Langenberg R., Hanssens P.E.J., Verheul J.B. et al. Management of large vestibular schwannoma. Part II. Primary Gamma Knife surgery: radiological and clinical aspect. J Neurosurg 2011;115(5):885–93. DOI: 10.3171/2011.6.JNS101963Van de Langenberg R., Hanssens P.E.J., Verheul J.B. et al. Management of large vestibular schwannoma. Part II. Primary Gamma Knife surgery: radiological and clinical aspect. J Neurosurg 2011;115(5):885–93. DOI: 10.3171/2011.6.JNS101963Bailo M., Boari N., Franzin A. et al. Gamma Knife radiosurgery as primary treatment for large vestibular schwannomas: clinical results at long-term follow-up in a series of 59 patients. World Neurosurg 2016;95:487–501. DOI: 10.1016/j.wneu.2016.07.117Bailo M., Boari N., Franzin A. et al. Gamma Knife radiosurgery as primary treatment for large vestibular schwannomas: clinical results at long-term follow-up in a series of 59 patients. World Neurosurg 2016;95:487–501. DOI: 10.1016/j.wneu.2016.07.117Lefranc M., Da Roz L.M., Balossier A. et al. Place of Gamma Knife stereotactic radiosurgery in grade 4 vestibular schwannoma based on case series of 86 patients with long-term follow-up. World Neurosurg 2018;114:e1192–8. DOI: 10.1016/j.wneu.2018.03.175Lefranc M., Da Roz L.M., Balossier A. et al. Place of Gamma Knife stereotactic radiosurgery in grade 4 vestibular schwannoma based on case series of 86 patients with long-term follow-up. World Neurosurg 2018;114:e1192–8. DOI: 10.1016/j.wneu.2018.03.175Watanabe S., Yamamoto M., Kawabe T. et al. Long-term follow-up results of stereotactic radiosurgery for vestibular schwannomas larger than 8 cc. Actа Neurochirurg 2019;161(7):1457–65. DOI: 10.1007/s00701-019-03951-zWatanabe S., Yamamoto M., Kawabe T. et al. Long-term follow-up results of stereotactic radiosurgery for vestibular schwannomas larger than 8 cc. Actа Neurochirurg 2019;161(7):1457–65. DOI: 10.1007/s00701-019-03951-zStastna D., Urgosik D., Chytka T., Liscak R. Large vestibular schwannomas: long-term outcomes after stereotactic radiosurgery. Neuro Endocrinol Lett 2021;41(6):329–38.Stastna D., Urgosik D., Chytka T., Liscak R. Large vestibular schwannomas: long-term outcomes after stereotactic radiosurgery. Neuro Endocrinol Lett 2021;41(6):329–38.Iwai Y., Yamanaka K., Yamagata K., Yasui T. Surgery after radiosurgery for acoustic neuromas: surgical strategy and histological findings. Neurosurgery 2007;60(2 Suppl 1):75–82; discussion 82. DOI: 10.1227/01.NEU.0000249251.78794.45Iwai Y., Yamanaka K., Yamagata K., Yasui T. Surgery after radiosurgery for acoustic neuromas: surgical strategy and histological findings. Neurosurgery 2007;60(2 Suppl 1):75–82; discussion 82. DOI: 10.1227/01.NEU.0000249251.78794.45Troude L., Boucekine M., Balossier A. et al. Is salvage surgery for large vestibular schwannomas after failed gamma knife radiosurgery more challenging? Neurosurg Rev 2022;45(1):751–61. DOI: 10.1007/s10143-021-01604-3Troude L., Boucekine M., Balossier A. et al. Is salvage surgery for large vestibular schwannomas after failed gamma knife radiosurgery more challenging? Neurosurg Rev 2022;45(1):751–61. DOI: 10.1007/s10143-021-01604-3Whitmeyer M., Brahimaj B.C., Beer-Furlan A. et al. Resection of vestibular schwannomas after stereotactic radiosurgery: a systematic review. J Neurosurg 2020;135(3):881–9. DOI: 10.3171/2020.7.JNS2044Whitmeyer M., Brahimaj B.C., Beer-Furlan A. et al. Resection of vestibular schwannomas after stereotactic radiosurgery: a systematic review. J Neurosurg 2020;135(3):881–9. DOI: 10.3171/2020.7.JNS2044Hadjipanayis C.G., Carlson M.L., Link M.J. et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Surgical Resection for the Treatment of Patients with Vestibular Schwannomas. Neurosurgery 2018;82(2):E40–3. DOI: 10.1093/neuros/nyx512Hadjipanayis C.G., Carlson M.L., Link M.J. et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Surgical Resection for the Treatment of Patients with Vestibular Schwannomas. Neurosurgery 2018;82(2):E40–3. DOI: 10.1093/neuros/nyx512Li L.-F., Yu C.-P., Tsang A.C.-O. et al. Near-complete regression 19 years after Gamma Knife radiosurgery of vestibular schwannoma with massive pseudoprogression: case report. J Neurosurg 2020;134(5):1455–8. DOI: 10.3171/2020.3.JNS20389Li L.-F., Yu C.-P., Tsang A.C.-O. et al. Near-complete regression 19 years after Gamma Knife radiosurgery of vestibular schwannoma with massive pseudoprogression: case report. J Neurosurg 2020;134(5):1455–8. DOI: 10.3171/2020.3.JNS20389Régis J., Pellet W., Delsanti C. et al. Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 2002;97(5):1091–100. DOI: 10.3171/jns.2002.97.5.1091Régis J., Pellet W., Delsanti C. et al. Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 2002;97(5):1091–100. DOI: 10.3171/jns.2002.97.5.1091Berkowitz O., Han Y.-Y., Talbott E.O. et al. Gamma Knife radiosurgery for vestibular schwannomas and quality of life evaluation. Stereotact Funct Neurosurg 2017;95(3):166–73. DOI: 10.1159/000472156Berkowitz O., Han Y.-Y., Talbott E.O. et al. Gamma Knife radiosurgery for vestibular schwannomas and quality of life evaluation. Stereotact Funct Neurosurg 2017;95(3):166–73. DOI: 10.1159/000472156Caruso J.P., Moosa S., Fezeu F. et al. A cost comparative study of Gamma Knife radiosurgery versus open surgery for intracranial pathology. J Clin Neurosci 2015;22(1):184–8. DOI: 10.1016/j.jocn.2014.08.012Caruso J.P., Moosa S., Fezeu F. et al. A cost comparative study of Gamma Knife radiosurgery versus open surgery for intracranial pathology. J Clin Neurosci 2015;22(1):184–8. DOI: 10.1016/j.jocn.2014.08.012

The authors declare that there are no conflicts of interest present.