Outcomes following stereotactic radiosurgery for foramen magnum meningiomas: a single-center experience and systematic review of the literature

Abstract

OBJECTIVE Foramen magnum meningiomas (FMMs) pose a unique challenge given their intimate anatomical relationship with the craniovertebral junction. While resection has been studied extensively, much less has been reported about the use of stereotactic radiosurgery (SRS) for FMMs. This study includes what is to the authors’ knowledge the first systematic review in the literature that summarizes patient and treatment characteristics and synthesizes outcomes following SRS for FMMs. METHODS A retrospective chart review was conducted at a single major academic institution, and a systematic review was performed according to PRISMA guidelines. The initial search on the PubMed and Scopus databases yielded 530 results. Key data extracted from both databases included Karnofsky Performance Status (KPS) score and neurological deficits at presentation, tumor location, treatment indication, target volume, single versus multiple fractions, marginal and maximum doses, isodose line, clinical and radiographic follow-up times, and primary (clinical stability and local control at last follow-up) and secondary (mortality, adverse radiation events, time to regression, progression-free survival) outcomes. RESULTS The study patients included 9 patients from the authors’ institution and 165 patients across 4 studies who received SRS for FMMs. The weighted median age at treatment was 60.2 years, and 73.9% of patients were female. Common presenting symptoms included headache (33.9%), dizziness/ataxia (29.7%), cranial nerve deficit(s) (27.9%), numbness (22.4%), weakness (15.2%), and hydrocephalus (4.2%). Lateral/ventrolateral (64.2%) was the most common tumor location. SRS was utilized as the primary therapy in 63.6% of patients and as salvage (21.8%) or adjuvant (14.5%) therapy for the rest of the patients. Most patients (91.5%) were treated with a single fraction. A tumor with a weighted median target volume of 2.9 cm3 was treated with a weighted median marginal dose, maximum dose, and isodose line of 12.9 Gy, 22.8 Gy, and 58%, respectively. Clinical stability and local control at last follow-up were achieved in 98.8% and 97.0% of patients, respectively. Only one possible adverse radiation event occurred, and no mortality directly related to the tumor or SRS was reported. CONCLUSIONS In this retrospective analysis and systematic review, the authors demonstrate SRS to be an effective and safe treatment option for carefully selected patients with FMMs.

Surgical corridors to foramen magnum meningiomas: a mini-review

“…Surveillance and conservative management are warranted for small and asymptomatic FMMs. Tumors with progressive enlargement or symptomatic tumors have surgery as a primary treatment option, but adjuvant radiotherapy, including stereotactic radiosurgery (SRS) or fractionated external beam radiotherapy, or a combination of both resection and radiotherapy are alternatives ( 34 ). Although GTR is the ideal goal of surgery, this is not always possible for FMMs, and SRS has been proposed also for alternative complementary treatment for residual tumors when reducing mass effect is not necessary ( 34 ).…”

“…Tumors with progressive enlargement or symptomatic tumors have surgery as a primary treatment option, but adjuvant radiotherapy, including stereotactic radiosurgery (SRS) or fractionated external beam radiotherapy, or a combination of both resection and radiotherapy are alternatives ( 34 ). Although GTR is the ideal goal of surgery, this is not always possible for FMMs, and SRS has been proposed also for alternative complementary treatment for residual tumors when reducing mass effect is not necessary ( 34 ). The evidence is insufficient to determine if upfront radiosurgery should be recommended in favor of conservative treatment for residual tumors and literature has demonstrated satisfactory results in both scenarios ( 35 , 36 ).…”