Journal of Neurosurgery 2026;145(5):1344–1351
For octogenarians with a symptomatic or growing vestibular schwannoma, tumor progression after single-session radiosurgery was uncommon. At five years, the estimated risk of progression was 5.2%, compared with a 19.8% risk of death before progression. For a patient deciding whether to intervene, these estimates put the prospect of tumor control in the context of life expectancy. The outlook for hearing is less certain.
Study and key findings
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Across 27 centers, 309 patients underwent Gamma Knife radiosurgery at a median age of 82 years. Median tumor volume was 2.1 cm³, the median margin dose was 12 Gy, and median imaging follow-up was 33.5 months. Of 16 patients with radiographic progression during follow-up, seven underwent repeat radiosurgery and one underwent surgery. Communicating hydrocephalus developed in 13 patients (4.2%), of whom 12 required a ventriculoperitoneal shunt.
Before treatment, 84 of 244 patients with audiometry had serviceable hearing in the affected ear. Only 85 patients had audiograms both before and after radiosurgery. Hearing class remained stable in 67, worsened in 15 and improved in three. A stable class could therefore include patients whose hearing was already poor.
Interpretation and limitations
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The participating centers selected patients for symptoms or growth on surveillance. Pretreatment growth rates were inconsistently recorded, and follow-up audiometry was incomplete. Without a comparable observation group, the study cannot quantify how much radiosurgery improved the course of an individual tumor or the probability of retaining useful hearing.
Clinical takeaway
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For an octogenarian considering treatment, review serial MRI alongside baseline audiometry and ask which symptom matters most to the patient. The cohort provides a five-year estimate for tumor control and a concrete risk of subsequent shunting. Counseling about hearing should start with how well the affected ear functions today.