ReviewActa neurochirurgica2026
Clinical management of vestibular schwannoma - what's the evidence?
Review in Acta neurochirurgica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundClinical management of vestibular schwannomas (VS) encompasses three main strategies: observation ("wait-and-scan"), stereotactic radiosurgery, and microsurgery. Despite extensive literature, a consensus on the optimal modality is lacking due to the scarcity of high-level evidence.
methodsThis narrative review explores the current understanding of the most significant clinical and radiographic outcomes following wait-and-scan, radiosurgery, and microsurgery. This is not a systematic review of the literature.
resultsObservational studies indicate that approximately one-third of tumors demonstrate growth within 3 years, and approximately 40% of patients eventually require active treatment. Radiosurgery achieves high long-term control, with radiological control exceeding 90% and clinical control above 95% at 10 years. However, hearing preservation is variable and time-dependent. Microsurgery can achieve gross total tumor removal and high long-term tumor control, with reported recurrence rates below 2% following gross total resection. However, recurrence estimates vary according to follow-up methodology and definitions of recurrence. Risks of hearing deterioration and facial nerve impairment increase with tumor size and extent of resection. Comparative studies, largely nonrandomized, suggest that radiosurgery offers better hearing and facial nerve outcomes than microsurgery in small- to medium-sized tumors. Quality-of-life assessments show little difference among treatment modalities. The V-REX trial remains the only randomized study to date, showing that upfront radiosurgery reduces tumor volume but does not yield superior clinical outcomes compared with observation.
conclusionThe current evidence is dominated by retrospective case series with heterogeneous methodologies. Prospective, randomized controlled trials (RCTs) are critically needed to guide superior treatment strategies and enhance patient care.
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Registered trials
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