Radiosurgery for benign tumors and arteriovenous malformations of the central nervous system

At 5 years, single-fraction stereotactic radiosurgery, alone or in conjunction with subtotal surgical resection, appears to yield local control rates that are comparable to those achieved by complete resection of the meningioma, with progression-free survival at or above 90%. Complication rates are low, as long as doses to critical structures, particularly to the optic apparatus, are maintained below 8.0 Gy in a single fraction. Stereotactic radiotherapy is an alternative treatment with low rates of toxicity for meningiomas in excess of 3.0 cm size, or for those near the optic nerves or other sensitive areas, although follow-up data for treatment efficacy and safety are still very short for this fractionated technique. Given the lack of available long-term follow-up data for stereotactic radiosurgery, complete surgical resection remains the optimal, first choice of treatment for benign meningiomas.