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Single-session stereotactic radiosurgery for large perioptic meningiomas.

Amr M N El-Shehaby1,2, Wael A Reda1,2, Khaled M Abdel Karim1,3

  • 11Gamma Knife Center Cairo.

Journal of Neurosurgery
|February 22, 2023
PubMed
Summary

Single-session stereotactic radiosurgery (SRS) is effective for large perioptic meningiomas. This treatment offers high tumor control and preserves or improves vision in most patients, with a low rate of serious side effects.

Keywords:
largemeningiomasparasellarperiopticsingle-session stereotactic radiosurgery

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Area of Science:

  • Neurosurgery
  • Radiation Oncology
  • Ophthalmology

Background:

  • Perioptic meningiomas pose surgical challenges due to proximity to the optic pathway.
  • Microsurgery for large tumors risks vision loss and limits recovery potential.
  • Fractionated stereotactic radiotherapy is typically reserved for complex cases.

Purpose of the Study:

  • To evaluate the long-term efficacy and safety of single-session stereotactic radiosurgery (SRS).
  • To assess SRS as a treatment for large (≥ 10 cm3) benign perioptic intracranial meningiomas.

Main Methods:

  • Retrospective analysis of 175 patients with large perioptic meningiomas (≥ 10 cm3).
  • Treatment involved single-session SRS with a median dose of 12 Gy.
  • Perioptic tumors were defined as those within 3 mm of the optic pathway.

Main Results:

  • 92% tumor control rate with 97% and 80% progression-free survival at 5 and 10 years, respectively.
  • Favorable visual outcomes in 97% of patients; 27% with pre-existing blind eyes showed improvement.
  • Low incidence of symptomatic adverse effects (4%), with ocular nerve palsy improving in 61%.

Conclusions:

  • Single-session stereotactic radiosurgery is an effective and safe treatment for large perioptic meningiomas.
  • SRS offers significant benefits in tumor control and visual preservation/improvement.
  • This modality provides a valuable alternative to surgery for selected patients.