Stereotactic radiosurgery for vestibular schwannomas in neurofibromatosis type 2: a systematic review and meta-analysis

Background: Management of neurofibromatosis type 2 (NF2)- associated vestibular schwannomas (VSs) is challenging due to their multiplicity, early onset, proximity to the brainstem, unpredictable growth, and aggressive behavior. The optimal therapeutic intervention remains controversial in the literature, and the advantages and disadvantages of each treatment option should be evaluated for each patient. Stereotactic radiosurgery (SRS) has exhibited favorable results in the management of NF2-associated VSs. This systematic review and meta-analysis aimed to assess the role of SRS in NF2-associated VSs. Methods: On August 22, 2024, four electronic databases, comprising PubMed, Embase, Scopus, and Web of Science, were comprehensively searched. Studies that assessed SRS’s radiological and clinical outcomes in NF2-associated VSs were enrolled. Results: Nineteen studies were included with 960 individuals and 1310 NF2-associated VSs. The analysis showed a pooled local control (LC) rate of 83% (95%CI:74-90%). Older age (P = 0.001), prior resection (P = 0.003), and lower tumor volume (P = 0.019) were associated with higher LC rates. The results demonstrated a pooled serviceable hearing preservation (SHP) rate of 42% (95%CI:34-51%), trigeminal nerve worsening rate of 2% (95%CI:1-4%), and a facial nerve worsening rate of 5% (95%CI:2-9%). None of the patients experienced radionecrosis (RN) following SRS. Sensitivity analyses revealed a moderate to high robustness of the results. No publication bias was identified. Conclusion: SRS is an effective therapeutic modality for managing VSs, especially small—to medium-sized lesions. We showed that SRS is associated with favorable LC and SHP rates and considerably low trigeminal or facial nerve worsening and RN rates. © The Author(s) 2025.