When a small vestibular schwannoma (Koos grades I–II) becomes symptomatic — producing vestibular and/or auditory symptoms alongside impaired hearing with residual function still present — active treatment becomes a timely consideration to prevent further deterioration.
Small vestibular schwannoma, Koos grade I or II, with onset of vestibular and/or auditory symptoms. Hearing is impaired but residual hearing is present. Once symptoms appear at this stage, therapy should be discussed to avoid further decline in hearing and vestibular function.
A stereotactic radiosurgical approach is among the recommended options in this setting, carrying particular advantages over surgical resection with respect to hearing preservation. The full protocol outlines the available interventions and the considerations that guide their selection.
If patients with small tumors become symptomatic with vestibular and/or auditory symptoms, therapy should be discussed to avoid further deterioration.
In these cases, SRS offers a better rate of hearing preservation and a lower risk for facial paresis than surgery (recommendation level C).
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