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.

In peri-optic sellar and parasellar tumors, visual preservation requires protection from both radiation injury and progression of inadequately controlled disease. This structured narrative review synthesizes guidelines, systematic reviews, and clinical cohorts identified through targeted PubMed/MEDLINE searches updated through 22 August 2026, covering pituitary neuroendocrine tumors, craniopharyngiomas, and meningiomas. Predominantly retrospective evidence and inconsistent functional reporting limit comparisons between radiation modalities. We propose an anatomy-based framework integrating therapeutic intent, tumor–optic geometry, achievable target coverage, anatomical stability, prior treatment, and baseline visual and endocrine function. Minimum tumor–optic distance alone is insufficient for modality selection. Single-fraction stereotactic radiosurgery is suited to compact, stable targets when disease-specific coverage is achievable within organ-at-risk limits. Hypofractionated stereotactic radiotherapy in three to five fractions may address focal peri-optic dose conflicts, whereas conventionally fractionated precision radiotherapy may accommodate broad contact, complex geometry, or dynamic cystic disease. Automated perimetry, optical coherence tomography, and axis-specific endocrine assessment support longitudinal surveillance; isolated retinal thinning does not establish radiation-induced optic neuropathy. New functional deficits require assessment of tumor status, treatment chronology, spatial dose, and competing causes. The proposed framework requires prospective validation and provides a practical basis for multidisciplinary decisions that jointly evaluate durable tumor control and long-term functional preservation.