Stereotactic Radiosurgery for Vestibular Schwannoma — A Case-Based Practice Guide From the Radiosurgery Society

Purpose: Vestibular schwannomas (VS) are the most common benign intracranial nerve sheath tumors. Surgery and radiation therapy – particularly stereotactic radiosurgery (SRS) – are the primary treatment options. SRS is the dominant treatment for small- and medium-sized VS and selected larger tumors due to its excellent local control rates and favorable safety profile compared with surgery. However, careful treatment planning is essential, taking into account patient preferences, tumor location and size, symptoms, and anticipated treatment-related toxicity. Methods and Materials: Four clinical VS scenarios have been selected to illustrate the use of SRS, including a unilateral small intracanalicular VS, a large VS with cystic components, reirradiation with SRS after local tumor recurrence, and bilateral VS in the setting of neurofibromatosis type 2-related schwannomatosis. Results: SRS is an effective and safe treatment modality for the majority of VS cases, requiring careful treatment planning and a thorough understanding of potential limitations and challenges. Conclusions: This case-based practice guide aims to provide a concise overview of the treatment of VS with SRS. We present and discuss 4 different clinical scenarios of VS to highlight the pitfalls and best practice recommendations.