Prolactinomas are the most prevalent functional pituitary adenomas. Significant advancements have been made in the diagnostic and therapeutic concepts for prolactinomas, driven by progress in surgical techniques and the accumulation of new clinical evidence-based medicine. Based on the 2014 version of the “Chinese Consensus on the Diagnosis and Treatment of Pituitary Prolactin Adenoma,” the China Pituitary Adenoma Specialist Council has revised this consensus in accordance with the latest evidence-based medical finding and clinical experience, aiming to provide standardized diagnosis and treatment recommendations for clinicians. The consensus systematically elaborates on the epidemiological characteristics, clinical manifestations, diagnostic criteria, differential diagnosis process, and treatment strategies for prolactinomas, and proposes individualized management suggestions for special populations (such as pregnant women, male patients, and refractory cases). Treatment decisions strongly advocate for comprehensive evaluation by a multidisciplinary team of experts, including neurosurgery, endocrinology, radiology, radiation oncology, pathology, ophthalmology, and obstetrics/gynecology. Through the formulation of recommendation questions, evidence summary and evaluation, formation of recommendation opinions, expert discussions, and integration with clinical practice, 36 recommendations have been developed covering aspects such as screening, assessment, diagnosis, treatment, and monitoring. This consensus balances clinical needs with international evidence-based standards, provides a highly reliable reference for diagnosis and treatment, and is expected to enhance the standardization and overall level of prolactinoma diagnosis and treatment in China. Practice guideline registration International Practice Guideline Registration for Transparency (PREPARE-2025CN1518).

INTRODUCTION:This study evaluated local control and overall survival following hypofractionated stereotactic radiosurgery (HF-SRS) using the CyberKnife system for brain metastases ≥ 10 cm3, addressing the challenges of balancing efficacy and toxicity in larger lesions. METHODS:We enrolled patients with 1-4 newly diagnosed brain metastases from lung or breast cancer. The primary endpoint was local control of the treated metastases. The secondary endpoints were overall survival and incidence of radiation necrosis. Survival endpoints were evaluated using the Kaplan-Meier method. A Cox proportional hazards regression model was used to test for significant associations between clinical factors and outcomes. RESULTS:Between December 2016 and December 2018, 63 patients with 65 large brain metastases were included in this study. Of all the 63 cases, 55 cases were initially treated with HF-SRS; eight had tumour recurrence after gamma knife treatment. The radiosurgical margin dose (median, 30 Gy; range, 25-34 Gy) was prescribed at an isodose curve of 60%-75% (median, 67%) with multiple fractions (median, three fractions; range, 2-4), targeting a median tumour volume of 18.1 cm3 (range, 10.1-39.6 cm3). The median follow-up was 19 months. The local tumour control rates were 100%, 100%, and 92.58% at 6, 12, and 18 months, respectively. The 6-, 12-, and 18-month survival rates were 95.24%, 82.51%, and 68.61%, respectively. The cumulative incidence of radiation necrosis in patients who underwent primary HF-SRS was 7.02% and 14.04% at 1 year and 18 months, respectively. CONCLUSION:We report our experience treating large brain metastases with HF-SRS. HF-SRS showed favourable local control with low incidence of complications.

Aumolertinib and osimertinib are both orally administered third-generation, irreversible epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI). The incidence of Adverse events (AEs) between osimertinib and aumolertinib treatment is different. There had some cases reported that osimertinib-induced AEs and switched to aumolertinib. However, data from a multicenter study of successful treatment with aumolertinib following osimertinib-induced adverse reaction has not been reported.

(1) Background: Hypofractionated stereotactic radiotherapy (HSRT) and anti-vascular endothelial growth factor (VEGF) antibodies have been reported to have a promising survival benefit in recent studies. Anlotinib is a new oral VEGF receptor inhibitor. This report describes our experience using HSRT and anlotinib for recurrent glioblastoma (rGBM). (2) Methods: Between December 2019 and June 2020, rGBM patients were retrospectively analysed. Anlotinib was prescribed at 12 mg daily during HSRT. Adjuvant anlotinib was administered d1-14 every 3 weeks. The primary endpoint was the objective response rate (ORR). Secondary endpoints included overall survival (OS), progression-free survival (PFS) after salvage treatment, and toxicity. (3) Results: Five patients were enrolled. The prescribed dose was 25.0 Gy in 5 fractions. The median number of cycles of anlotinib was 21 (14–33). The ORR was 100%. Three (60%) patients had the best outcome of a partial response (PR), and 2 (40%) achieved a complete response (CR). One patient died of tumour progression at the last follow-up. Two patients had grade 2 hand-foot syndrome. (4) Conclusions: Salvage HSRT combined with anlotinib showed a favourable outcome and acceptable toxicity for rGBM. A prospective phase II study (NCT04197492) is ongoing to further investigate the regimen.

Objective This study aimed to study the efficiency and safety of a dose-staged Gamma Knife radiosurgery strategy for large meningiomas or meningiomas close to important nerve structures. Methods This study evaluates the outcome of a prospectively accrued series of 71 consecutive patients with meningiomas treated with staged dose-fractionated Gamma Knife radiosurgery. The average peripheral doses for the first and second fractions were 9.0 ± 0.9 Gy (8–12 Gy) and 8.6 ± 0.7 Gy (range, 7–10 Gy), respectively. The interval between fractions was 6.1 ± 1.9 months (range, 3–12 months). The median follow-up time was 36 months (12–96 months). Results During the follow-up period after the second fraction, 97.2% achieved tumor control in our series. A total of 2 patients exhibited local recurrence at 30 and 60 months after the second fraction, respectively. No treatment-related complications or new long-term neurological dysfunctions were reported. MRIs observed slightly or moderately increased peritumoral edema in six patients, but no specific neurological complaints are attributed to this finding. Conclusion This study investigates the efficiency and safety of dose-staged Gamma Knife radiosurgery as an alternative option for meningiomas that were large in volume, adjacent to crucial structures, or in patients with contraindications to craniotomy.

Background The most frequently diagnosed primary brain tumor is glioblastoma (GBM). Nearly all patients experience tumor recurrence and up to 90% of which is local recurrence. Thus, increasing the therapeutic ratio of radiotherapy using hypofractionated stereotactic radiotherapy (HSRT) can reduce treatment time and may increase tumor control and improve survival. To evaluate the efficacy and toxicity of the combination of HSRT and intensity-modulated radiotherapy (IMRT) with temozolomide after surgery in GBM patients and provide evidence for further randomized controlled trials. Methods/design HSCK-010 is an open-label, single-arm phase II trial (NCT04547621) which includes newly diagnosed GBM patients who underwent gross total resection. Patients will receive the combination of 30 Gy/5fx HSRT, and 20 Gy/10fx IMRT adjuvant therapy with concurrent temozolomide and adjuvant chemotherapy. The primary endpoint is overall survival (OS). Secondary outcomes include progression-free survival (PFS) rate, objective-response rate (ORR), quality of life (Qol) before and after the treatment, cognitive function before and after the treatment, and rate of treatment-related adverse events (AE). The combination of HSRT and IMRT with temozolomide can benefit the patients after surgery with good survival, acceptable toxicity, and reduced treatment time. Trial registration NCT04547621 . Registered on 14 September 2020.

Background: Gamma knife radiosurgery(GKS) is well established in the management of cavernous sinus hemangiomas(CaSHs) alternative to microsurgery. Tumor regrowth is occasionally encountered and the role of repeat GKS in these situations is still unclear. Objective: The goal of this study was to investigate whether repeat GKS is an effective and safe treatment for recurrent CaSHs after initial GKS. Methods: Between January 2008 and November 2009, 42 patients haboring CaSHs were treated with GKS at Gamma Knife Center of Huashan Hospital. Of these, 2 patients had regrowth of residual tumor and 1 patient habored still large volume of tumor after initial GKS. Repeat GKS was performed in all these three patients, 2 of whom were female. Results: The median age was 41 (range, 7-54) years old. The median tumor volume was 8.98 ml and 5.80 ml at initial and second GKS, respectively. Patients received a median prescription dose of 13.5 Gy and 14.0 Gy at first and second treatments, respectively. The median follow-up was 130 (range, 122-149) months. The median follow-up period after repeat GKS was 31 (range, 27-48) months and median interval between these interventions was 99 (range, 74-122) months. At last follow-up, we report no cases of failure in repeat GKS for CaSHs. All three patients demonstrated again a significant reduction in tumor volume. The median tumor volume reduction was 83.6% (range, 73.1%-84.3%) and 54.3% (range, 45.3%-58.3%) after initial and repeat GKS treatments compared with the pre-GKS volumes, respectively. Post-GKS clinical improvement was achieved in all three patients (100%). No radiation-induced neurological deficits or delayed complications secondary to GKS were observed during the long follow-up period. Conclusion: Regrowing of remnant CaSHs after GKS can be detected during long-term follow-up. Repeat GKS represents a safe and effective treatment in patients harboring regrowth of CaSHs that have previously been treated with GKS.

Background Solitary intracranial hypothalamic mass occurs rarely. The etiological diagnosis of solitary hypothalamus lesion is challenging and often unachievable. Although previous studies indicated that lesions affecting the hypothalamus often cause significant metabolic disorders, few reports about the metabolic disturbances of patients with solitary hypothalamic mass have been reported. Method Twenty-five patients with solitary hypothalamus lesions who had been evaluated and treated in Huashan Hospital from January 2010 to December 2020 were retrospectively enrolled. The clinical manifestations, radiological features, endocrine and metabolic disorders, and pathology were analyzed. Results The male to female ratio was 5/20. The median age of onset was 22 (19, 35) years old. The most common initial symptom was polydipsia/polyuria (19/25, 76.0%) and amenorrhea (9/20, 45.0%). A high prevalence of hypopituitarism of different axes was found, with almost all no less than 80%. Central hypogonadism (21/22, 95.5%) and central diabetes insipidus (19/21, 90.5%) were the top two pituitary dysfunctions. Conclusive diagnoses were achieved by intracranial surgical biopsy/resection or stereotactic biopsy in 16 cases and by examining extracranial lesions in 3 cases. The pathological results were various, and the most common diagnoses were Langerhans cell histiocytosis (7/19) and hypothalamitis (5/19). The mean timespan from onset to diagnosis in the 19 cases was 34 ± 26 months. Metabolic evaluations revealed remarkable metabolic disorders, including hyperlipidemia (13/16, 81.3%), hyperglycemia (10/16, 62.5%), hyperuricemia (12/20, 60%), overweight/obesity (13/20, 65.0%), and hepatic adipose infiltration (10/13, 76.6%). Conclusion Either surgical or stereotactic biopsy will be a reliable and relatively safe procedure to help to confirm the pathological diagnosis of solitary hypothalamic mass. Metabolic disorders were severe in patients with solitary hypothalamic mass. The management of such cases should cover both the treatment of the primary disease, as well as the endocrine and metabolic disorders

OBJECTIVE:The primary aim of this study was to investigate the value of multidisciplinary team (MDT) management in treating patients with Cushing's disease (CD). The secondary aim was to assess the concordance of bilateral inferior petrosal sinus sampling (BIPSS) lateralization with intraoperative observations.METHODS:The authors recruited 124 consecutive patients (128 procedures) who had undergone endoscopic endonasal resection of adrenocorticotropic hormone-secreting pituitary adenomas from May 2014 to April 2018 and assessed their clinical characteristics, surgical outcomes, and adjuvant therapies. The criteria for surgical remission were normalized serum and urinary cortisol levels, which could be suppressed by a low-dose dexamethasone suppression test at 3-months' follow-up without adjuvant treatment.RESULTS:The remission rates of the 113 patients with long-term follow-up (20.3 ± 12.2 months) were 83.2% after surgery alone and 91.2% after adjuvant therapy. The surgical remission rates of macroadenomas, MRI-visible microadenomas, and MRI-negative tumors were 66.7% (12/18), 89.3% (67/75), and 75% (15/20), respectively (p = 0.039). The surgical remission rates had a trend of improvement during the study period (87.5% in 2017-2018 vs 76.5% in 2014, p = 0.517). Multivariate regression analysis showed that a history of previous pituitary surgery (OR 0.300, 95% CI 0.100-0.903; p = 0.032) and MRI-visible microadenoma (OR 3.048, 95% CI 1.030-9.019; p = 0.044) were independent factors influencing surgical remission. The recurrence rate was 3.2% after a mean of 18 months after surgery. The remission rate of postoperative MDT management in patients with persistent disease was higher than non-MDT management (66.7% vs 0%, p = 0.033). In cases with preoperative BIPSS lateralization, 84.6% (44/52) were concordant with intraoperative findings.CONCLUSIONS:MRI-visible microadenoma and primary surgery were independent predictors of surgical remission in CD. The MDT management strategy helps to achieve a better overall outcome. BIPSS may help to lateralize the tumor in MRI-negative/equivocal microadenomas.

OBJECTIVE:The differences in mesial temporal epilepsy (MTE) stereo-electroencephalography (SEEG) seizure-onset patterns and their clinical implications remains unclear.METHODS:We analyzed consecutive patients with MTE undergoing non-invasive workup, SEEG evaluation and resective surgery. Cases were classified into either mesial temporal sclerosis (MTS) group or non-MTS group based on magnetic resonance imaging (MRI). Seizure-onset patterns of SEEG were classified to analyze their correlation with surgical outcome and clinical subtypes.RESULTS:Twenty-eight patients were studied. Twenty (71.4%) patients had Engel I outcome. Thirteen patients had one seizure-onset pattern, 15 had two or more patterns. Five patterns of seizure-onset were identified and seizure-onset zones differed significantly across the 5 patterns. No difference was observed in surgical outcome between patients with single or multiple seizure-onset patterns. Periodic spike-onset pattern was associated with MTS (P = 0.003) while burst-onset was associated with non-MTS lesions (P = 0.003). Patients with seizure-onsets outside the resected temporal lobe (multiple onsets) had poorer prognosis (P = 0.0046).CONCLUSION:We identified 5 distinct onset patterns of MTE and correlated two of them with MRI findings. Multiple seizure-onset patterns in MTE may not necessarily suggest poor outcome. Patients with multi-focal seizure-onsets including seizures originating outside the resected temporal lobe have poorer outcome.SIGNIFICANCE:This study identifies distinct onset patterns of MTE and their clinical implications.

Objective Exploring the role of amygdala enlargement (AE) in temporal lobe epilepsy (TLE) without ipsilateral mesial temporal sclerosis (MTS) using comprehensive presurgical workup tools including traditional tools, automatically volumetric analysis, high-density EEG (HD-EEG) source imaging (HD-ESI), and stereoelectroencephalography (SEEG). Methods Nine patients diagnosed with TLE-AE who underwent resective surgeries encompassing the amygdala were retrospectively studied. HD-ESI was obtained using 256-channel HD-EEG on the individualized head model. For automatic volumetric analysis, 48 matched controls were enrolled. Diagnosis and surgical strategies were based on a comprehensive workup following the anatomo-electro-clinical principle. Results At post-operative follow-up (average 30.9 months), eight patients had achieved Engel class I and one Engel class II recovery. HD-ESI yielded unifocal source estimates in anterior mesial temporal region in 85.7% of cases. Automatic volumetric analysis showed the AE sides were consistent with the values determined through other preoperative workup tools. Furthermore, the amygdala volume of the affected sides in AE was significantly greater than that of the larger sides in controls ( p < 0.001). Meanwhile, the amygdala volume lateral index (LI) of AE was significantly higher than in controls ( p < 0.001). SEEG analysis showed that ictal onsets arose from the enlarged amygdala (and hippocampus) in all cases. Conclusion In addition to traditional workup tools, automatic volumetric analysis, HD-ESI on individualized head model, and invasive SEEG can provide evidence of epileptogenicity in TLE-AE. Resective surgical strategies encompassing the amygdala result in better prognosis. In suspected TLE cases, more attention should be focused on detecting enlargement of amygdala which sometimes is “hidden” in “MR-negative” non-MTS cases.

Online date: November 16, 2020 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

OBJECTIVE:To evaluate epileptic source estimation using multiple sparse priors (MSP) inverse method and high-resolution, individual electrical head models.METHODS:Accurate source localization is dependent on accurate electrical head models and appropriate inverse solvers. Using high-resolution, individual electrical head models in fifteen epilepsy patients, with surgical resection and clinical outcome as criteria for accuracy, performance of MSP method was compared against standardized low-resolution brain electromagnetic tomography (sLORETA) and coherent maximum entropy on the mean (cMEM) methods.RESULTS:The MSP method performed similarly to the sLORETA method and slightly better than the cMEM method in terms of success rate. The MSP and cMEM methods were more focal than sLORETA with the advantage of not requiring an arbitrary selection of a hyperparameter or thresholding of reconstructed current density values to determine focus. MSP and cMEM methods were better than sLORETA in terms of spatial dispersion.CONCLUSIONS:Results suggest that the three methods are complementary and could be used together. In practice, the MSP method will be easier to use and interpret compared to sLORETA, and slightly more accurate and faster than the cMEM method.SIGNIFICANCE:Source localization of interictal spikes from dense-array electroencephalography data has been shown to be a reliable marker of epileptic foci and useful for pre-surgical planning. The advantages of MSP make it a useful complement to other inverse solvers in clinical practice.

Spinal DSA is the “gold standard” technique to identify the spinal vascular diseases with venous hypertensive myelopathy (VHM). However, sometimes spinal DSA can find nothing in patients with confirmed spinal vascular anomalies. Many of the reasons are avoidable technical factors. Nevertheless, there are also some non-technical factors. The objective of this study was to identify the non-technical factors. The cause of the missed findings was found as the non-technical factors in 14 patients. The clinical records and radiological findings of the 14 patients were reviewed. The so-called standard spinal angiography can found nothing in the 14 patients. Additional angiography was performed and detected the lesions. Eight patients were found lesions supplied by carotid arteries or iliac arteries, including 2 cranial DAVF with internal carotid artery blood supply, 3 cranial DAVF with external carotid artery blood supply and 2 pelvic AVF with internal iliac artery blood supply and 1 pelvic AVM with internal iliac artery blood supply. Six patients were caused by stenosis of spinal draining vein, including 3 stenosis of the third lumbar veins and 3 stenosis of left renal veins combined with the reno–spinal trunk. In order to avoid the missed findings of spinal vascular diseases with VHM, the technical factors should be reduced by performing a rigorous comprehensive angiography. To reduce the non-technical factors, the angiography of the internal iliac artery, the carotid artery systems and spinal draining veins should be performed in some special cases if the routine spinal angiography can find nothing.

INTRODUCTION: Localization-related epilepsy frequently involves mesial temporal lobe structures (MTLS), but sometimes presurgical workup can be confusing since shortage of definite structural lesional evidence or inconsistency among multimodal tools. Occasionally invasive workup is applied. This study evaluates the application of multimodal workup in surgical strategy making of localization-related epilepsy involving MTLS. METHODS: Our study includes patients with significant or subtle MTLS abnormality (or magnetic resonance imaging (MRI) negative) in 3.0T MRI and then underwent resective surgeries encompassing MTLS. In addition to conventional workup tools, accurate EEG source imaging (ESI) technique based on individual head models is available. Patients accepted either 1-stage resective surgeries or staged surgeries (SEEG implantation + stage-2 resective surgeries). Contributions of structural MRI, fluorodeoxyglucose-positron emission tomography (FDG-PET), accurate ESI, and ictal EEG to surgical strategies were evaluated by criteria defining epileptogenic zone (resective scope in cases with good outcome). RESULTS: Thirty-five patients who achieved Engel grade I + II outcome after resective surgeries were included. All together, 68.6% cases showed ESI sources totally falling into resective scope. 42.9% ictal EEG estimates, 57.1% PET focal hypometabolistic regions, 74.3% MRI structural lesions fitted the resective scope/side. In total, 75% 1-stage cases showed ESI sources being confined in MTLS region, while PET showed focal hypometabolism in 66.7% and MRI indicated single MTLS lesions (including subtle ones) in 79.2% cases. In total, 54.5% ESI sources and 63.6% MRI abnormality (single, including subtle ones) in staged cases showed complete concordance with SEEG findings. In subtle lesional/MRI negative cases, ESI generated sources confined within MTLS in 77.8% cases, while PET estimates are focally localizing in 44.4% cases and 55.6% showed subtle MRI lesions which were firstly diagnosed “negative.” CONCLUSION: Multimodal noninvasive workup are contributable to help decide strategy of 1-stage resective surgeries and SEEG plans in localization-related epilepsy. High-quality structural MRI, accurate ESI technique based on scalp EEG as well as FDG-PET are key to presurgical planning of epilepsy involving MTLS.

We examined the effects of slow-pulsed transcranial electrical stimulation (TES) in suppressing epileptiform discharges in seven adults with refractory epilepsy. An MRI-based realistic head model was constructed for each subject and co-registered with 256-channel dense EEG (dEEG). Interictal spikes were localized, and TES targeted the cortical source of each subject's principal spike population. Targeted spikes were suppressed in five subject's (29/35 treatment days overall), and nontargeted spikes were suppressed in four subjects. Epileptiform activity did not worsen. This study suggests that this protocol, designed to induce long-term depression (LTD), is safe and effective in acute suppression of interictal epileptiform discharges.

e13579 Background: Treatment for recurrent brain metastasis remains uncertain. The purpose of this research was to evaluate the efficacy and toxicity of FSRS with adjuvant bevacizumab as a new salvage treatment for locally recurrent brain metastases with high dose irradiation previously. Methods: Patients with locally recurrent intracranial metastasis with irradiation previously were enrolled in this prospective study. Salvage FSRS dose ranged from 9.5 to 29 Gy in two to five sessions with 62–75% isodose line. Adjuvant bevacizumab was prescribed four cycles (5 mg/kg, q3w). Magnetic resonance imaging (MRI), Karnofsky Performance Scale (KPS), adverse events and clinical outcomes were recorded. The primary objective of this study was to identify the overall survival after salvage treatment. Secondary objectives included clinical response (KPS), imaging response (MRI) and adverse events. Results: From December 2009 to October 2016, 24 patients were enrolled. Of these patients, 9 received WBRT followed by SRS, and 15 underwent SRS. The median 1-year overall survival (OS) after salvage SRS was 87.5%. No treatment-related grade 4 adverse events were recorded. Grade 1/2 fatigue was observed in 8 (33%) patients followed by headache, hypertension and nausea. Grade 3 fatigue and headache occurred in 1 patient. No grade 4 toxicity was observed. Conclusions: Salvage FSRS with early use of low dose adjuvant bevacizumab treatment showed favourable clinical and radiologic control with manageable toxicity for locally recurrent brain metastasis patients who underwent high dose irradiation previously. The diagnosis of RN and LR after salvage FSRS merit further study. [Table: see text][Table: see text][Table: see text]

PURPOSE:High-density electroencephalographic source imaging (HD-ESI) has emerged as a useful tool for pre-surgical epilepsy workup. However, it is not routinely used in clinical evaluations due to several factors, one of which is the challenge associated with creating anatomically accurate head models. Reasonable solutions now exist and the present study aims to evaluate the use of these highly resolved individual head models in pre-surgical epilepsy evaluation.METHODS:Nine patients with intractable epilepsy who were candidates for resective epilepsy surgeries participated in the study. For each patient, 256-channel electroencephalography data were acquired along with individual structural MRI data that was used to construct individual finite difference models (iFDM). Accuracy of HD-ESI based on iFDM (HD-ESI-iFDM) was evaluated using multiple criteria, including concordance with intracranial electroencephalography (icEEG) and location of surgical resection. Performance of HD-ESI-iFDM was also compared against MRI and positron emission tomography (PET) results.RESULTS:In all but one patient resective surgeries resulted in seizure-free outcome. Source locations derived from HD-ESI-iFDM demonstrated concordance with surgical resection and with icEEG data, when available. The HD-ESI-iFDM also contributed to the planning of intracranial electrodes implantation. Compared to MRI or PET, HD-ESI-iFDM provided more accurate localization of the epileptogenic zone.CONCLUSION:When acquired with high-density sensor arrays and source imaging is performed with anatomically accurate head models, electroencephalography can contribute meaningfully to epilepsy pre-surgical workup for localization of the epileptogenic zone. Now that both high-density electroencephalography and individualized FDM models can be routinely obtained, it can be incorporated as part of clinical practice.

Feng, Rui MD, PhD; Hu, Jie; Wu, Jinsong; Ma, Chengxin; Lang, Liqin; Sun, Bing MD, PhD; Pan, Li Author Information

Background: Hearing preservation rate after Gamma Knife radiosurgery (GKRS) for vestibular schwannoma (VS) remains low. The aim of this study was to study hearing outcomes between multisession and single session GKRS in patients with VS and determine prognostic factors associated with hearing preservation. Methods: A retrospective analysis of 561 consecutive patients with VS subjected to multisession (74 patients) or single session (487 patients) GKRS (from June 2011 to April 2015) was performed. Propensity score matching (PSM) based on patient age, gender, tumor volume and pre-GKRS hearing was used to compare the two groups. The tumor control rate and complications were evaluated, especially hearing preservation and its prognostic factors. Results: According to PSM, 29 patients from each group with similar characteristics were selected for the study. Patients' age, tumor volume, pre-GKRS pure tone average (PTA) and radiographic follow-up period were not significantly different between the two groups (P>0.05). The tumor control rate was 75.9% for the multisession group compared with 62.1% for the single session group (P=0.1142); 20 patients had a less than 20 dB change in PTA in multisession group, with the hearing preservation rate of 69.0% (20/29) compared with 65.5% (19/29) in single session group (P=0.08). Multivariate analysis revealed that linear internal auditory canal (IAC) length was the only significant predictor of hearing loss in the multisession group. At last follow-up, one patient complaining of sudden hearing loss was diagnosed with tumor bleeding 12 months after multisession GKRS. One patient from multisession group and two patients from single session group suffered from temporal facial numbness. Facial spasm developed in one patient after multisession GKRS. Conclusions: Our results supported that multisession GKRS could be an effective and safe treatment option for VS compared to single session GKRS. The hearing preservation rate after multisession GKRS was not superior to single session radiosurgery in our short-term follow-up study. However, patients with longer IAC length may benefit from multisession strategy in terms of hearing preservation.