This protocol addresses the management of patients with a small vestibular schwannoma — classified as Koos grade I or II — in the specific setting of complete hearing loss on the affected side.
The tumor is small (Koos grades I–II) and hearing is already completely lost on the affected side. In this setting, the aim of therapy can be cure or tumor control while preserving facial nerve function.
Long-term tumor control or cure — defined as no growth of the vestibular schwannoma on serial MRI — while preserving facial nerve function.
Multiple management strategies can be justified in this clinical scenario. A period of active monitoring is commonly the initial approach, as no critical function is immediately threatened. For patients in whom active intervention is preferred, additional options — involving either a radiosurgical or a surgical approach — may be appropriate based on individual goals.
In these patients, the aim of therapy can be cure or tumor control while preserving facial nerve function.
All options can be justified in these cases.
Observation is usually the first option, since there is no function endangered for a long period of time (evidence class III, recommendation level C).
SRS or surgery carries a low risk of facial nerve damage and may provide long-term control or cure, respectively.
Besides facial nerve function, SRS carries a lower risk profile than surgery, making SRS the first option if tumor control is regarded sufficient by the patient (evidence class II, recommendation level B).
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