Treatment of Medium-Sized Vestibular Schwannoma (Koos Grades III–IV, Diameter <3 cm) with Vestibular or Cochlear Symptoms
Medium-sized vestibular schwannomas classified as Koos grades III or IV with a diameter below 3 cm most commonly present with vestibular or cochlear symptoms. The combination of considerable tumor volume and symptomatic burden makes active intervention the recommended course.
Clinical Scenario
Most patients with medium-sized tumors present with vestibular or cochlear symptoms. Due to the symptomatic burden and considerable tumor volume, therapy should be performed in this population.
Treatment Approach
For this scenario, both a surgical and a radiosurgical approach are supported by the evidence and can be recommended at a comparable level. The specific interventions, their selection criteria, and alternative strategies — including function-preserving options — are detailed in the complete protocol.
References
DOI: 10.1093/neuonc/noz153
Most patients with medium sized tumors present with vestibular or cochlear symptoms.
Due to the symptomatic burden and considerable tumor volume, therapy should be performed.
Surgery or radiosurgery can be recommended at a very similar level (recommendation level C).
Also subtotal resection to preserve function might be an option, if subsequent SRS of a growing tumor rest can be provided (good practice point).
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