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Purpose <p>Gamma Knife radiosurgery (GKRS) as definitive treatment for vestibular schwannomas (VS) provides high rates of tumor control. Traditionally, treatment immobilization necessitated a rigid stereotactic frame. The Gamma Knife Icon (Elekta AB) system enables frameless, mask-based immobilization. This study evaluates tumor control and hearing preservation after single- or five-fraction frameless GKRS for VS.</p> Methods <p>We reviewed 206 patients with unilateral VS who underwent definitive single- or five-fraction GKRS with frameless immobilization between 2017 and 2024, ultimately including 170 patients with untreated VS. Radiographic follow-up was available for 112 patients, 40 of whom had both baseline and follow-up audiometric follow-up. Tumor control was assessed volumetrically on MRI and categorized as progressive, stable, partial response, complete response, or transient swelling. Serviceable hearing was defined as American Academy of Otolaryngology–Head and Neck Surgery class A or B. Kaplan–Meier methods estimated tumor control and and serviceable hearing preservation, and Cox regression evaluated associations with outcomes.</p> Results <p>Among 112 patients with radiographic follow-up (median 2.3 years), 1- and 3-year tumor control rates were 97.1% and 93.7%. At last follow-up, 75.9% demonstrated stable disease or partial response, and 7 patients (6.3%) developed progressive disease. Of 76 patients with baseline serviceable hearing, 40 had audiometric follow-up; serviceable hearing preservation at 1 and 3 years was 71.1% and 33.8%, though 3-year data was limited. No factors were significantly associated with tumor control or hearing preservation.</p> Conclusions <p>Frameless GKRS for VS achieves acceptable tumor control that is comparable to historical frame-based series. These findings support the selective use of frameless GKRS, although warrant prospective studies with standardized radiologic and audiologic follow-up.</p>

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Frameless gamma knife stereotactic radiosurgery for over two hundred vestibular schwannoma patients – a single institution experience

  • 期刊论文

  • 发表日期：

    2026年7月28日

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  • Kayla M. Daniell,
  • Matthew Gallitto,
  • Hong Li,
  • Juan Pablo Garcia Camargo,
  • Yuxuan Chen,
  • Geoffrey Sedor,
  • Madhav Patel,
  • Yuanguang Xu,
  • Rompin Shih,
  • Carl Elliston,
  • Tony J. C. Wang,
  • Michael B. Sisti

摘要

Purpose

Gamma Knife radiosurgery (GKRS) as definitive treatment for vestibular schwannomas (VS) provides high rates of tumor control. Traditionally, treatment immobilization necessitated a rigid stereotactic frame. The Gamma Knife Icon (Elekta AB) system enables frameless, mask-based immobilization. This study evaluates tumor control and hearing preservation after single- or five-fraction frameless GKRS for VS.

Methods

We reviewed 206 patients with unilateral VS who underwent definitive single- or five-fraction GKRS with frameless immobilization between 2017 and 2024, ultimately including 170 patients with untreated VS. Radiographic follow-up was available for 112 patients, 40 of whom had both baseline and follow-up audiometric follow-up. Tumor control was assessed volumetrically on MRI and categorized as progressive, stable, partial response, complete response, or transient swelling. Serviceable hearing was defined as American Academy of Otolaryngology–Head and Neck Surgery class A or B. Kaplan–Meier methods estimated tumor control and and serviceable hearing preservation, and Cox regression evaluated associations with outcomes.

Results

Among 112 patients with radiographic follow-up (median 2.3 years), 1- and 3-year tumor control rates were 97.1% and 93.7%. At last follow-up, 75.9% demonstrated stable disease or partial response, and 7 patients (6.3%) developed progressive disease. Of 76 patients with baseline serviceable hearing, 40 had audiometric follow-up; serviceable hearing preservation at 1 and 3 years was 71.1% and 33.8%, though 3-year data was limited. No factors were significantly associated with tumor control or hearing preservation.

Conclusions

Frameless GKRS for VS achieves acceptable tumor control that is comparable to historical frame-based series. These findings support the selective use of frameless GKRS, although warrant prospective studies with standardized radiologic and audiologic follow-up.