• Othman Bin-Alamer, Andrew Faramand, Norah A Alarifi, Zhishuo Wei, Arka N Mallela, Victor M Lu, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, Khaled Abdelkarim, El-ShehabyAmr M NAMNGamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.Neurosurgery Department, Ain Shams University, Cairo, Egypt., Reem M Emad, Selcuk Peker, Yavuz Samanci, Cheng-Chia Lee, Huai-Che Yang, Violaine Delabar, David Mathieu, Manjul Tripathi, Kathryn Nicole Kearns, Adomas Bunevicius, Jason P Sheehan, Tomas Chytka, Roman Liscak, Nuria Martínez Moreno, Roberto Martínez Álvarez, Inga S Grills, Jacob S Parzen, Christopher P Cifarelli, Azeem A Rehman, Herwin Speckter, Ajay Niranjan, L Dade Lunsford, and Hussam Abou-Al-Shaar.
• Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
• Neurosurgery. 2023 May 1; 92 (5): 934944934-944.

BackgroundVestibular schwannomas (VSs) related to neurofibromatosis type 2 (NF2) are challenging tumors. The increasing use of stereotactic radiosurgery (SRS) necessitates further investigations of its role and safety.ObjectiveTo evaluate tumor control, freedom from additional treatment (FFAT), serviceable hearing preservation, and radiation-related risks of patients with NF2 after SRS for VS.MethodsWe performed a retrospective study of 267 patients with NF2 (328 VSs) who underwent single-session SRS at 12 centers participating in the International Radiosurgery Research Foundation. The median patient age was 31 years (IQR, 21-45 years), and 52% were male.ResultsA total of 328 tumors underwent SRS during a median follow-up time of 59 months (IQR, 23-112 months). At 10 and 15 years, the tumor control rates were 77% (95% CI: 69%-84%) and 52% (95% CI: 40%-64%), respectively, and the FFAT rate were 85% (95% CI: 79%-90%) and 75% (95% CI: 65%-86%), respectively. At 5 and 10 years, the serviceable hearing preservation rates were 64% (95% CI: 55%-75%) and 35% (95% CI: 25%-54%), respectively. In the multivariate analysis, age (hazards ratio: 1.03 [95% CI: 1.01-1.05]; P = .02) and bilateral VSs (hazards ratio: 4.56 [95% CI: 1.05-19.78]; P = .04) were predictors for serviceable hearing loss. Neither radiation-induced tumors nor malignant transformation were encountered in this cohort.ConclusionAlthough the absolute volumetric tumor progression rate was 48% at 15 years, the rate of FFAT related to VS was 75% at 15 years after SRS. None of the patients with NF2-related VS developed a new radiation-related neoplasm or malignant transformation after SRS.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.

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