Pseudoprogression in Koos grade 4 vestibular schwannomas following stereotactic radiosurgery: temporal dynamics and radiological predictors

To gain insight into the volumetric temporal response dynamics following primary stereotactic radiosurgery (SRS) and to evaluate possible MRI-derived predictors at time of treatment for pseudoprogression in sporadic Koos grade 4 vestibular schwannomas (VS).

Clinicians managing large vestibular schwannomas post-radiosurgery should be aware of pseudoprogression patterns and MRI predictors identified here before escalating treatment; however, the study's observational design means findings should be validated before changing surveillance protocols.

Misinterpreting post-radiosurgery pseudoprogression as true tumor growth can lead to unnecessary salvage surgery; identifying reliable radiological predictors could prevent avoidable interventions in a complex patient population.

1. 01Study characterizes volumetric temporal dynamics of pseudoprogression in Koos grade 4 vestibular schwannomas after radiosurgery.
2. 02MRI-derived features were analyzed as potential predictors of pseudoprogression versus true progression.
3. 03Pseudoprogression, if misidentified, can lead to unnecessary and risky salvage surgery.
4. 04Focused on Koos grade 4 (largest) tumors, where post-treatment imaging interpretation is most challenging.
5. 05Findings are observational and require prospective validation before changing clinical surveillance guidelines.

PMID

42184073

DOI

10.1007/s11060-026-05619-y.

Journal

Journal of Neuro-Oncology

Publication type

research_article

Evidence level

4

Population

Patients with Koos grade 4 vestibular schwannomas treated with primary stereotactic radiosurgery

Intervention

Stereotactic radiosurgery for Koos grade 4 vestibular schwannoma