Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder with marked clinical heterogeneity and increased tumor risk, complicating disease surveillance, risk stratification and treatment decisions. This review summarizes current evidence on transcriptomic approaches relevant to NF1, with particular emphasis on extracellular vesicles (EVs), EV-associated RNA and bioinformatic strategies. NF1-specific evidence on EVs remains limited and has mainly addressed EV-associated proteins, biological effects and experimental models, whereas comprehensive transcriptomic profiling of circulating EVs in well-characterized NF1 cohorts remains largely unexplored. Transcriptomic and multi-omics studies of NF1-associated tumors provide complementary information on molecular heterogeneity, tumor progression and the tumor microenvironment, while studies of EV-associated RNA in other diseases provide a broader biological and methodological framework. Bioinformatic approaches may facilitate the processing and integration of EV-associated RNA datasets, the identification of candidate molecular signatures and their integration with clinical and genomic information. However, the diagnostic, prognostic and predictive value of EV-associated RNAs in NF1 remains investigational and requires independent clinical validation. Future studies should focus on well-characterized longitudinal cohorts, standardized EV isolation and characterization, reproducible analytical workflows and integration of molecular profiles with clinical and genomic data. These approaches may determine whether EV-associated transcriptomic signatures can contribute to disease characterization, risk stratification and treatment monitoring in NF1.