Bomberman,
I looked at your symptoms and diagnosis date and we are remarkably alike.
You have a 29 mm tumor with slight hearing loss and some face/lip numbness.
I have a 27 mm tumor with slight hearing loss and one side of the tongue has altered taste sensation.
A surgeon's bias is to operate. A radiosurgeon's bias is to radiate. They rarely agree, so they both can't be right for the optimal solution. Yours and my bias is to get the best outcome for ourselves.
You may be interested in reading, if you haven't already, "What intervention is best practice for vestibular schwannomas? A systematic review of controlled studies" at
http://bmjopen.bmj.com/content/3/2/e001345.full.pdf [2013]. The conclusion is "The available evidence indicates radiosurgery to be the best practice for solitary vestibular schwannomas up to 30 mm in cisternal diameter". That's us!
There are also some articles that go beyond the 30 mm criteria:
"Gamma Knife radiosurgery for larger-volume vestibular schwannomas"
http://thejns.org/doi/pdf/10.3171/2010.8.JNS10674%40sup.2013.119.issue-suppl [2011]
"Gamma Knife Radiosurgery as Primary Treatment for Large Vestibular Schwannomas: Clinical Results at Long-Term Follow-Up in a Series of 59 Patients"
http://www.worldneurosurgery.org/article/S1878-8750(16)30666-0/abstract [25 mm plus tumor control = 98.3%]
"Long-term tumor control and cranial nerve outcomes following γ knife surgery for larger-volume vestibular schwannomas"
https://www.ncbi.nlm.nih.gov/pubmed/22175724 [2011] [25mm plus tumor control = 91%?]
The first article's conclusion is "Although microsurgical resection remains the primary management choice in patients with low comorbidities, most vestibular schwannomas with a maximum diameter less than 4 cm and without significant mass effect can be managed satisfactorily with Gamma Knife radiosurgery"
The second article's conclusion is "Surgical resection remains the primary approach for large VS with symptomatic brainstem compression. GKRS can be considered a safe and effective option in particular in patients who are not good candidates for surgery."
The third article's conclusion is "Single-session radiosurgery is a successful treatment for the majority of patients with larger VSs. Although tumor control rates are lower than those for smaller VSs managed with GKS, the cranial nerve morbidity of GKS is significantly lower than that typically achieved via resection of larger VSs"
I've included these articles since we still fall under the 3 cm criteria, just to let you know there is a buffer. I have another one at home that I can include in the list.
From what I can gather, if you have no symptoms of brainstem compression, which includes both of us, there's some room to move.
You are lucky to be in the US since you can talk to one of the authors directly (Dr Lunsford) and can also talk to Dr Chan who I know has done radiosurgery at 3.2 cm.
