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Case Reports
. 2025 Jul-Aug;15(4):335-346.
doi: 10.1016/j.prro.2025.01.010. Epub 2025 Feb 3.

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

Felix Ehret  1 , Archis R Bhandarkar  2 , Michael Chisam  3 , Victor Goulenko  4 , Ritesh Kumar  5 , Fatemeh Fekrmandi  4 , Karin A Skalina  6 , John Kresl  7 , Simon S Lo  8 , Iris C Gibbs  9 , Scott G Soltys  9 , Jason P Sheehan  10 , Christoph Fürweger  11 , Ben J Slotman  12 , Helen A Shih  13 , Samuel T Chao  14
Affiliations
Case Reports

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

Felix Ehret et al. Pract Radiat Oncol. 2025 Jul-Aug.

Abstract

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.

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Conflict of interest statement

Disclosures Felix Ehret acknowledges funding from the German Cancer Aid and Accuray and received honoraria and travel support from ZAP Surgical Systems, all outside the submitted work. He is also a member of the Residents’ Executive Committee for the Radiosurgery Society. Karin A. Skalina is chairwoman of the Residents’ Executive Committee for the Radiosurgery Society. John Kresl is president-elect of the Radiosurgery Society and declares that he has received payments or honoraria for lectures, presentations, participation in speakers bureaus, manuscript writing, or involvement in educational events from Accuray, ViewRay, Varian, and Brainlab. Simon S. Lo declares that he is a coprincipal investigator on a research project funded by the Kuni Foundation and has received research funding in this capacity. He also serves as the lead academic participating site for the Hutchinson Center under the NIH-funded grant UG1 CA 233328. Moreover, he serves as a member of the Board of Directors for the Radiosurgery Society and as the Medical Director of Distinction in the Stereotactic Radiotherapy Program. In addition, he is a counselor and chair of the Nominating Committee for the Council of the American College of Radiology (ACR), including its CARROS (Committee on Accreditation and Recognition of Radiology Organizations and Services) subcommittee. Iris C. Gibbs declares that she has received honoraria and travel support for lectures and educational events from Accuray. In addition, she holds leadership and fiduciary roles within several professional organizations, including serving on the board or in other leadership capacities with the Radiosurgery Society, the American Society for Radiation Oncology, the Council of Affiliated Regional Radiation Oncology Societies (CARROS), and the California Radiological Society. Scott G. Soltys declares that his institution has received research funding from Novocure. He has received consulting fees from Novocure for his expertise or advisory services. He has also received honoraria for participation in educational programs from Accuray and BrainLab. Jason P. Sheehan is a board member of the American Association of Neurological Surgeons and vice president of the International Stereotactic Radiosurgery Society. Christoph Fürweger has received speaker fees for lectures and presentations from Accuray and ZAP Surgical Systems. He is chair of the physics committee of the Radiosurgery Society. Ben J. Slotman is president of the Radiosurgery Society. Helen A. Shih is a section editor and writer for UpToDate, a writer for MedLink Neurology, received research support from AbbVie to the institution, is on the advisory board of Advanced Accelerator Applications, Servier Pharmaceuticals, and Ion Beam Applications, and is a consultant for Servier Pharmaceuticals. She also received consulting fees from HealthConnect and is a board member of the Society of Neuro-Oncology, the Radiosurgery Society, and the National Association for Proton Therapy.

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