Promising treatment options for cerebellopontine angle meningiomas: a longitudinal retrospective cohort study

Although gross total resection (GTR) is the standard treatment for meningiomas, its application in the cerebellopontine angle (CPA) remains controversial. Previous studies have not systematically compared long-term tumor control and functional outcomes between surgical resection and Gamma Knife radiosurgery (GKRS) for CPA meningiomas.

CPA meningioma cases were extracted from a cohort of 10,392 patients diagnosed with meningiomas. Two strategies were used: a tumor-free approach (GTR) to ensure complete tumor resection, and a tumor-reduced approach (upfront GKRS or subtotal resection plus adjuvant GKRS) to reduce tumor burden. Outcomes were assessed by progression-free survival, Karnofsky Performance Status (KPS) scores, and neurological function recovery.

This study followed 158 patients for a median of 85.4 months. The tumor-free group had a progression rate of 5.7%, significantly lower than the 22.7% (p = 0.002) in the tumor-reduced group. Kaplan-Meier analysis showed significantly better tumor control in the tumor-free group (p = 0.043), especially in posterior tumors (p = 0.008). Regarding functional outcomes, the overall cranial nerve improvement rate was 54.2%, with a neurological deterioration rate of 7.6%. ΔKPS indicated better functional recovery in the tumor-reduced group (+12.95 vs. tumor-free group: +7.57, p = 0.005), especially for anterior tumors (+14.76 vs. +0.71, p < 0.001).

For posterior CPA meningiomas, prioritizing surgical GTR may lead to optimal tumor control. For anterior meningiomas, a tumor-reduced approach (either upfront GKRS or STR followed by adjuvant GKRS) may be preferred to achieve a better functional outcome. The selection between upfront GKRS and STR + GKRS should be guided by tumor size and the presence of neural compression symptoms.