Vestibular Schwannoma International Study of Active Surveillance Versus Stereotactic Radiosurgery: the VISAS Study

Background The present study assesses the safety and efficacy of stereotactic radiosurgery (SRS) versus observation for Koos grade I and II vestibular schwannoma (VS), benign tumors affecting hearing and neurological function. Methods This multicenter study analyzed data from Koos grade I and II VS patients managed with SRS (SRS group) or observation (observation group). Propensity score matching balanced patient demographics, tumor volume, and audiometry. Outcomes measured were tumor control, serviceable hearing preservation (SHP), and neurological outcomes. Results In 125 matched patients in each group with a 36-month median follow-up (p=0.49), SRS yielded superior 5- and 10-year tumor control rates (99%, CI: 97.1%-100%, and 91.9%, CI: 79.4%-100%) vs. observation (45.8%, CI: 36.8%-57.2%, and 22%, CI: 13.2%-36.7%; p<0.001). SHP rates at 5 and 9 years were comparable (SRS 60.4%, CI: 49.9%-73%, vs. observation 51.4%, CI: 41.3%-63.9%, and SRS 27%, CI: 14.5%-50.5%, vs. observation 30%, CI: 17.2%-52.2%; p=0.53). SRS were associated with lower odds of tinnitus (OR=0.39, p=0.01), vestibular dysfunction (OR=0.11, p=0.004), and any cranial nerve palsy (OR=0.36, p=0.003), with no change in cranial nerves V or VII (p>0.05). Composite endpoints of tumor progression and/or any of the previous outcomes showed significant lower odds associated with SRS compared to observation alone (p < 0.001). Conclusion SRS management in matched cohorts of Koos grade I and II VS patients demonstrated superior tumor control, comparable hearing preservation rates, and significantly lower odds of experiencing neurological deficits. These findings delineate the safety and efficacy of SRS in in the management of this patient population.