A Review of Stereotactic Radiosurgery Practice in the Management of Skull Base Meningiomas

Abstract

Gross total resection of skull base meningiomas poses a surgical challenge due to their proximity to neurovascular structures. Once the gold standard therapy for skull base meningiomas, microsurgery has been gradually replaced by or used in combination with stereotactic radiosurgery (SRS). This review surveys the safety and efficacy of SRS in the treatment of cranial base meningiomas including 36 articles from 1991 to 2010. SRS produces excellent tumor control with low morbidity rates compared with surgery alone for asymptomatic small skull base meningiomas, patients with risk factors precluding conventional surgery, and as adjuvant therapy for recurrent or residual lesions.

Indications, feasibility, safety, and efficacy of CyberKnife radiotherapy for the treatment of olfactory groove meningiomas: a single institutional retrospective series

“…cardiovascular disease or prior stroke on anticoagulation, patients with brittle diabetes or those with significant pulmonary or end-stage renal disease) [16]; 2) Tumors less than 10 cm 3 in size with progressive symptoms or continuous growth in elderly patients [17]; 3) Subtotally resected residual or recurrent OGMs demonstrating growth in patients who are not surgical candidates or do not wish to pursue second surgical intervention [15,17,18]; and 4) patients with residual OGMs diagnosed with high WHO grade pathology [12,15,18]. SRS can be considered suitable for tumors that are limited in size up to 3 cm in maximal diameter or 10 cm 3 in volume with distinct margins, limited mass effect, minimal to no surrounding edema, with a sufficient distance of 3 to 5 mm from nearby critical organs at risk to allow for appropriate tissue sparing via dose restriction [15,17,19,20]. In our case series, 5 of 13 patients with OGMs whose median tumor volume was 4.57 cm 3 safely received single fraction SRS with a median prescribed dose of 14.8 Gy.…”

“…In our current study, we observed minor treatment-associated peritumoral edema in 5 of 12 patients ( Table 4). Factors that make a patient more prone to developing post-SRT treatment edema for the treatment of skull-based meningiomas include: Tumor volumes > 10 cm 3 ; pre-existing peritumoral edema prior to receiving RT; and age > 60 years [15,17]. We attributed our increased incidence of post-CKRT edema to the fact that our patients already had a high incidence of pre-treatment peritumoral edema (6/13), relatively larger tumors volumes at the time of treatment compared to that reported by Zaorsky et al (median volume 8.12 vs 3.57 cm 3 ), and that our patients were significantly older (median age 71.2 years vs 57 years).…”

Identification of PD-L2, B7-H3 and CTLA-4 immune checkpoint proteins in genetic subtypes of meningioma

“…Surgical resection remains the primary treatment. Residual tumor, particularly those involving the skull base and/or those invading the draining venous sinuses or of higher grade 6,7 are often managed with either radiosurgery or radiotherapy. No chemotherapy exists.…”

Mapping angiography and transarterial technetium macroaggregated albumin particle simulation of recurrent atypical intracranial meningioma: feasibility for potential vascular brachytherapy

“…Therefore the concept of transarterial brachytherapy for recurrent AM refractory to standard treatment is intriguing. [11 , 12] , therefore, the concept of transarterial brachytherapy for recurrent AM refractory to standard treatment is intriguing. An established advantage of brachytherapy over stereotactic radiosurgery lies in its highly conformal energy deposition with zero entry dose.…”