The evolution of stereotactic radiosurgery for vestibular schwannomas: recent evidence and outcomes.

PURPOSE: Vestibular schwannomas (VS) are benign tumors of the vestibular nerve, increasingly detected due to improved and more frequent neuroimaging studies. A summary of the evolution of radiosurgery for VS management is undertaken.

METHODS

We broadly review the history and current state of stereotactic radiosurgery in the management of vestibular schwannomas.

RESULTS

Management includes observation, microsurgical resection, and stereotactic radiosurgery (SRS). First used for VS in the late 1960s, SRS achieves > 90% tumor control with safe complication profile. In small VS, early SRS reduces tumor progression and the need for delayed intervention with better cranial nerve outcomes compared to observation. For large VS, SRS provides high tumor control with exceedingly lower complications than surgery in select cases. In neurofibromatosis type 2 (NF2), SRS offers durable tumor control, though hearing preservation and clinical outcomes varies as it contingent on the complex clinical presentation and disease burden, a unique challenge of NF2 patients. Comparative studies and randomized trials reinforce SRS as an effective, minimally invasive treatment with superior long-term tumor control and lower morbidity. Hearing preservation depends on cochlear radiation dose, tumor volume, degree of hearing at time of intervention, age, and tumor morphology. In NF2 and large VS, careful patient selection is critical.

CONCLUSION

Stereotactic radiosurgery is playing an increasingly important role in the management of patients with vestibular schwannomas. Future research will refine dose optimization, patient selection, and long-term functional outcomes.