The aim of this study was to evaluate freedom from tumor progression and clinical outcomes in older adults with small- to medium-sized vestibular schwannoma (VS) managed by observation versus stereotactic radiosurgery (SRS) to better inform optimal management in this patient population.
Audiologists co-managing older patients with small vestibular schwannomas should note this retrospective evidence on hearing outcomes with active surveillance vs. radiosurgery, though prospective data are needed before definitive guidance can be issued.
Treatment decisions for small vestibular schwannomas in elderly patients are clinically contentious; comparative outcome data for this age group can meaningfully inform multidisciplinary management discussions.
- 01Retrospective comparison of active surveillance vs. stereotactic radiosurgery for small (Koos I–II) vestibular schwannomas in patients ≥60 years.
- 02Koos grade I–II tumors are the smallest classification, confined to the internal auditory canal or minimally extending into the posterior fossa.
- 03Age-specific data are important because older patients face different risk-benefit trade-offs than younger cohorts.
- 04Published in Journal of Neurosurgery (2026); relevant to audiologists involved in vestibular schwannoma monitoring.
- 05Retrospective design limits causal inference; prospective studies needed.
Active surveillance and stereotactic radiosurgery have different outcomes profiles for Koos grade I–II vestibular schwannomas in patients aged 60 or older.
studypartially supported- PMID
- 42139729
- DOI
- 10.3171/2026.1.JNS242756.
- Journal
- Journal of Neurosurgery
- Publication type
- research_article
- Evidence level
- 4
- Population
- Patients aged 60 years or older with Koos grade I or II vestibular schwannoma
- Intervention
- Stereotactic radiosurgery
- Comparator
- Active surveillance
Primary outcomes
Hearing preservation; Tumor control; Clinical outcomes and quality of life