What is the role of radiation in intra labyrinthine (cochlear) schwannoma?

This is a bit of a tricky question to answer without knowing the size of the lesion, the age of the patient, their current symptoms, and whether they have serviceable hearing.

If the tumor is small, and the patient has residual serviceable hearing, it might be best to delay treatment and order a repeat MRI in 6 months to assess the rate of growth of the schwannoma. These benign tumors grow at a rate of ~2 mm per year and sometimes they stop growing for a while. A meta-analysis showed that over a period of 3.2 years follow-up, 57% of these tumors failed to progress, and some even regressed. Smouha et al., PMID 15744156

A conservative management approach of watchful waiting will allow the patient to enjoy bilateral hearing if he/she still has i...

We have treated these (3 cases) the same as any other case, wth the caveat that hearing preservation is not a goal, as it is often lost, and there is a slight but unquantifiable increased risk of vestibular dysfunction. Our patients have received 12 Gy in a single session with the Gamma Knife.