Gamma Knife radiosurgery for vestibular schwannomas

Gamma knife stereotactic radiosurgery is one of the most common procedures performed to manage patients with vestibular schwannoma. With a history that spans over 40 years, there has been continued evolution in radiosurgery technique and understanding of outcomes. The goal has always been to achieve long-term inactivation of tumor growth, commonly with tumor volumetric regression, and preservation of neurologic function. Challenges remain particularly pertaining to hearing preservation and other related symptoms such as those related to balance and tinnitus. Current discussions span a variety of topics including the importance of cochlear dose, the timing of the radiosurgery intervention as opposed to initial observation, the interpretation of imaging changes after radiosurgery, and the value of hearing augmentation strategies.