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Updated: Aug 9, 2025
Stereotactic Radiosurgery for Gynecologic Cancer
Published on: April 17, 2012
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.
Objective:
Meningiomas close to the optic pathway are commonly candidates for microsurgical decompression, more so if they are large perioptic meningiomas. However, microsurgery itself imposes risk to vision, and the larger the tumor, the more the risk and the lower the possibility of postoperative visual recovery. Fractionated stereotactic radiotherapy is usually reserved for such cases. The purpose of this study was to assess the long-term efficacy and safety of single-session stereotactic radiosurgery (SRS) for large (≥ 10 cm3) perioptic intracranial benign meningiomas.
Methods:
This retrospective study included 175 patients with large perioptic benign meningiomas (≥ 10 cm3) who were treated by single-session SRS. Perioptic meningiomas were defined as meningiomas touching, compressing, or within 3 mm of the optic pathway. The median tumor volume was 15 cm3 (range 10-57.3 cm3, IQR 8.4 cm3). The median prescription dose was 12 Gy (range 9-14 Gy, IQR 1 Gy).
Results:
The median follow-up period was 72 months (range 13-217 months, IQR 65 months). The tumor control rate was 92%. The progression-free survival rates at 5 and 10 years were 97% and 80%, respectively. Favorable (better/stable) visual outcome was reported in 169 patients (97%) and unfavorable (worse) outcome in 6 patients (3%). Temporary adverse radiation effects were observed in 21 patients (12%), but only 7 patients (4%) were symptomatic. Sixty-three patients had a blind/nonuseful eye according to the pretreatment visual field examination. Visual improvement was observed in the blind/nonuseful eye in 17 patients (27%), while vision remained unchanged in 46 patients (73%). Ocular nerve palsy improved in 36 patients (61%). Tumor shrinkage was not a prerequisite for cranial nerve improvement.
Conclusions:
SRS provides an effective and safe treatment option for large perioptic meningiomas.
Insights
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.
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.
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