Vestibular Schwannoma Koos Grade I International Study of Active Surveillance versus Stereotactic Radiosurgery: The VISAS-K1 Study
Bibliographic record
Abstract
Objectives: The appropriate management of Koos grade I vestibular schwannomas (VS) remains controversial. This study evaluates the safety and efficacy of stereotactic radiosurgery (SRS) versus observation for Koos grade I VS. Methods: In a multicenter study, this report gathered and analyzed data retrospectively on Koos grade I VS patients who underwent SRS (SRS group) or were observed (observation group). Propensity score matching was utilized to equilibrate demographics, tumor size, and audiometric data across groups. The outcome analyzed included tumor control, preservation of serviceable hearing (SHP), and neurological function. Results: The study matched 142 patients, providing a median follow-up period of 36 months. SRS significantly enhanced tumor control compared to observation, with a 100% control rate at both 5- and 8-year marks in the SRS group versus 49.7 and 33% in the observation group at the same time intervals, respectively ( p < 0.001; [ Fig. 1 ]). SHP outcomes between groups showed no significant difference at 5 and 8 years, ensuring a comparable quality of auditory function (SRS 70.1% vs. observation 53.4% at 5 years; p = 0.33; [ Fig. 2 ]). Furthermore, SRS was associated with a reduced likelihood of tinnitus (OR = 0.46, p = 0.04), vestibular dysfunction (OR = 0.17, p = 0.002), and overall cranial nerve dysfunction (OR = 0.49, p = 0.03) at last follow-up. Conclusion: SRS management of Koos grade I VS patients was associated with superior tumor control and reduced odds for dysfunction of various cranial nerves, while not compromising hearing preservation compared to observation. These findings support the safety and efficacy of SRS as a potential management modality for this patient population. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".