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Linear accelerator radiosurgery for vestibular schwannomas.

Linear accelerator (LINAC) radiosurgery was developed in the 1980s. The treatment paradigm uses the rotating high-energy X-ray output of the LINAC to focus many hundreds of 'beam equivalents' on intracranial or spinal targets. At the University of Florida, 450 vestibular schwannomas have been treated. Tumor control has been achieved in 90% (5- year actuarial data). 99% of patients treated have required no further intervention. Since reducing the treatment dose to 1,250 cGy, in 1994, the incidence of facial and trigeminal nerve injury has been <1%. No instance of malignant tumor transformation has been observed. Other institutions using modern LINAC techniques report similar excellent results. We believe that radiosurgery is the treatment of choice for smaller vestibular schwannomas.