Stereotactic Radiation for Vestibular Schwannomas and Meningiomas in NF2-Related Schwannomatosis: Treatment Selection and Long-Term Care

Neurofibromatosis type 2 (NF2)-related schwannomatosis (NF2-SWN) presents a lifelong challenge in which multiple tumors, evolving functional deficits, and prior interventions complicate decisions about stereotactic radiation. We conducted a structured narrative review of the literature through 12 October 2026, prioritizing NF2-SWN cohorts and separable subgroups and using sporadic-tumor evidence only where NF2-specific data were limited. The synthesis focused on baseline assessment, tumor-growth behavior, radiation outcomes, functional endpoints, salvage and reirradiation, systemic therapy, and longitudinal surveillance. Available evidence supports stereotactic radiosurgery as an important option for selected lesions, particularly when durable local control can be achieved without compromising functional reserve or future treatment options. However, published outcomes are difficult to compare because of heterogeneous populations, imaging and progression definitions, follow-up, functional measures, and potential cohort overlap. Tumor control should not be interpreted in isolation: treatment selection should integrate growth trajectory, anatomical risk, hearing and neurological function, prior surgery or radiation, bilateral disease, patient priorities, and subsequent treatment options. Surveillance remains an active strategy when immediate intervention is unlikely to improve the balance of benefit and harm. We propose a longitudinal framework and core reporting domains to distinguish treated-lesion control from progression elsewhere and support more patient-centered evaluation of treatment sequencing in NF2-SWN.