Linear accelerator radiosurgery for treatment of vestibular schwannomas in neurofibromatosis 2

Management of vestibular schwannomas in patients with neurofibromatosis 2 (NF2) balances growth control against preservation of hearing with the primary aim of maintaining patient quality of life. Surgical resection of these lesions carries greater risk of functional deterioration than in sporadic cases. Stereotactic radiosurgery is a less invasive option that provides comparable, if not superior outcomes to resection. Previous studies on the efficacy of stereotactic radiosurgery for vestibular schwannomas in NF2 have reported results from delivery by Gamma Knife systems. The efficacy of linear accelerator (LINAC) delivered treatment has not been specifically addressed. Modelling studies suggest that lesional conformality is superior with Gamma Knife, but clinical studies on sporadic vestibular schwannomas show equivalent results between the two systems. Our experience with LINAC radiosurgery in NF2 reported here shows good long-term growth control in four patients with vestibular schwannomas.