Stereotactic Radiosurgery For Meningiomas Research Articles

Stereotactic Radiosurgery for Meningiomas in Children and Adolescents: An International Multi-Institutional Study.

Meningiomas in children are uncommon, with distinct characteristics that set them apart from their adult counterparts. The existing evidence for stereotactic radiosurgery (SRS) in this patient population is limited to only case series. The objective of this study was to evaluate the safety and efficacy of SRS in managing pediatric meningiomas. Children and adolescents who had been treated for meningioma with single-fraction SRS were included in this retrospective, multicenter study. The assessment included local tumor control, any complications related to the tumor or SRS, and the emergence of new neurological deficits after SRS. The cohort included 57 patients (male-to-female ratio 1.6:1) with a mean age of 14.4 years who were managed with single-fraction SRS for 78 meningiomas. The median radiological and clinical follow-up periods were 69 months (range, 6-268) and 71 months (range, 6-268), respectively. At the last follow-up, tumor control (tumor stability and regression) was achieved in 69 (85.9%) tumors. Post-SRS, new neurological deficits occurred in 2 (3.5%) patients. Adverse radiation effects occurred in 5 (8.8%) patients. A de novo aneurysm was observed in a patient 69 months after SRS. SRS seems to be a safe and effective up-front or adjuvant treatment option for surgically inaccessible, recurrent, or residual pediatric meningiomas.

Clinical and radiologic outcomes after stereotactic radiosurgery for meningiomas in direct contact with the optic apparatus: an international multicenter study.

Resection of meningiomas in direct contact with the anterior optic apparatus carries risk of injury to the visual pathway. Stereotactic radiosurgery (SRS) offers a minimally invasive alternative. However, its use is limited owing to the risk of radiation-induced optic neuropathy. Few SRS studies have specifically assessed the risks and benefits of treating meningiomas in direct contact with the optic nerve, chiasm, or optic tract. The authors hypothesized that SRS is safe for select patients with meningiomas in direct contact with the anterior optic apparatus. The authors performed an international multicenter retrospective analysis of 328 patients across 11 institutions. All patients had meningiomas in direct contract with the optic apparatus. Patients were followed for a median duration of 56 months after SRS. Neurological examinations, including visual function evaluations, were performed at follow-up visits. Clinical and treatment variables were collected at each site according to protocol. Tumor volumes were assessed with serial MR imaging. Variables predictive of visual deficit were identified using univariable and multivariable logistic regression. SRS was the initial treatment modality for 64.6% of patients, and 93% of patients received SRS as a single fraction. Visual information was available for 302 patients. Of these patients, visual decline occurred in 29 patients (9.6%), of whom 12 (41.4%) had evidence of tumor progression. Visual decline in the remaining 17 patients (5.6%) was not associated with tumor progression. Pre-SRS Karnofsky Performance Status predicted visual decline in adjusted analysis (adjusted OR 0.9, 95% CI 0.9-1.0, p < 0.01). Follow-up imaging data were available for 322 patients. Of these patients, 294 patients (91.3%) had radiographic evidence of stability or tumor regression at last follow up. Symptom duration was associated with tumor progression in adjusted analysis (adjusted OR 1.01, adjusted 95% CI 1.0-1.02, adjusted p = 0.02). In this international multicenter study, the vast majority of patients exhibited tumor control and preservation of visual function when SRS was used to treat meningioma in direct contact with the anterior optic pathways. SRS is a relatively safe treatment modality for select patients with perioptic meningiomas in direct contact with the optic apparatus.

Our experience in treating meningiomas with radiosurgery

Introduction: Radiosurgery is ionizing radiation treatment. Concentration of a large amount of radiation in an area of ​​the brain results in ablation of the lesion. The technique was designed and perfected by Dr. Lars Lexell, Swedish neurosurgeon, in 1951. Meningiomas are usually benign and slow-growing tumors, derived from the leptomeninges. First line treatment for meningiomas is surgery. They occasionally are difficult to treat surgically because of their location, the associated vascular and nerve structures and patient comorbidities. Stereotactic Radiosurgery (SRS) is an option to manage these cases. Objective: This studi is retrospective, from Novembner 2013 to January 2018 (4 years), SRS for meningioma in X-Knife Unit, Neurosurgery Service prof. Kurti UC, Mother Theresa,, Tirana. During this period we evaluated the long term effect of SRS on tumor control. Material and Methods: We analyzed data from 17 Meningiomas in 14 patinets (4 meningiomatosis) to these variables: age, presenting symptoms, intracranial location of meningiomas, surgery prior to SRS, extension of tumor resection, the radiation dose, tumor volume coverage, pre-SRS tumor volume, tumor volume on latest follow up MR biopsy results, Assessment of tumor control was based on VOLUMETRIC criteria and RECIST criteria. Results: 14 patients in a total (17 meningiomas, 4 of them was meningiomatosis), (Male 4 (23%), Female 13 (77%), Age 45-75 years (average 59.5 Median 62.0). Follow up from (23 months), (Range 59.9-99 99.5), intracranial localization of meningiomas: Medial sphenoid crystal – 8, Convection – 7, Falx/Parasagittal – 2. Residual 4 - (24%), Recurence 5 - (29%), New 8 – (47%), WHO I – 8 (47%), WHO II – 4 (23%), WHO III – 1 (7%). With out biopsy – 4. Prescripted dose – 14-16 Gy, tumor coverage – 59 – 100%, (91.70), median 95.40, tumor volume – 0.27 – 10.36 cc (3.84), 1-isocenter – 9 cases, 2-isocenter – 8 cases. Number for arcs for isocenter – 1-5. Tumor volume, controlled - 12 (70%), reduced – 22 (48%) – 5 (PR), unchanged – 7 (SD), adult (WHO 2 and 3) – 5 (PD), side effects - 0. Follow up from 2-51 months (23 months) Mean tumor volume on follow up MRI was 0.31 cm3 and maximum Diameter over 4.83 cm. According to Volumetric criteria and RECIST criteria (adapted version), remained stable disease and excellent control - 70% total, 100% grade 1 WHO). Conclusions: SRS is one of the safest and most effective strategies to keep meningiomas under control and management in different patients, both those with primary tumors and those with relapses or those left over from previous interventions. Doing the comparative analysis shows an improved analysis and long-term effects with SRS. The criteria used during the evaluation and standardization of these criteria make possible the effect on the duration of treatment of meningiomas with SRS.

Radiation-induced cavernous malformation after stereotactic radiosurgery for cavernous sinus meningioma: a case report

BackgroundRadiation-induced cavernous malformation (RICM) is a rare sequela of stereotactic radiosurgery (SRS) treatment of intracranial tumors. To date, no study reported on RICM after SRS for meningiomas originating from the skull base. The relationship between locus of initial meningioma and RICM has not been studied.Case presentationA 57-year-old woman presented with persistent headaches and blepharoptosis at initial episode. MRI disclosed a right parasellar lesion, diagnosed as a cavernous sinus meningioma (CSM). After receiving a single-fractionated SRS, headache relieved, but blepharoptosis did not significantly improve. Three years and three months later, she returned with headaches and dizziness. MRI showed an enlarged CSM. Moreover, a new mass-like lesion, suspected hemangioma, appeared in the nearby right temporal lobe. After surgical removal of the new lesion and the CSM, the patient’s neurological symptoms significantly improved. Pathology confirmed CSM and temporal RICM.ConclusionsWe report the first rare case of RICM occurring after SRS for CSM. The RICM may be in the same region as the initial tumor. Surgical intervention was preferred for symptomatic RICM and initial meningioma. We recommend long-term regular followup MRIs for patients with meningioma after SRS treatment.

Stereotactic Radiosurgery for Meningiomas: Effect of Dose on Local Control

Stereotactic Radiosurgery for Meningiomas: Effect of Dose on Local Control

Long-term stroke risk of single-fraction photon-based stereotactic radiosurgery for meningioma.

2021Background: A recent randomized study of fractionated radiation therapy (RT) examining 44 subtotally resected/recurrent benign meningioma patients revealed that at median follow-up of 17.1 year...

Change in plasma vascular endothelial growth factor after gamma knife radiosurgery for meningioma: a preliminary study.

ObjectiveThe purpose of this study was to investigate changes in the plasma level of vascular endothelial growth factor (VEGF) after Gamma Knife radiosurgery (GKRS) for the treatment of meningioma.MethodsFourteen patients with meningiomas had peripheral venous blood collected at the time of GKRS and at 1 week, 1 month, 3 month and 6 month visits. Plasma VEGF levels were measured using commercially available enzyme-linked immunosorbent assay. For controls, peripheral blood samples were obtained from 20 healthy volunteers.ResultsThe mean plasma VEGF level (29.6 pg/mL) in patients with meningiomas before GKRS was significantly lower than that of the control group (62.4 pg/mL, p=0.019). At 1 week after GKRS, the mean plasma VEGF levels decreased to 23.4 pg/mL, and dropped to 13.9 pg/mL at 1 month, 14.8 pg/mL at 3 months, then increased to 27.7 pg/mL at 6 months. Two patients (14.3%) with peritumoral edema (PTE) showed a level of VEGF 6 months after GKRS higher than their preradiosurgical level. There was no significant association found in an analysis of correlation between PTE and tumor size, marginal dose, age, and sex.ConclusionOur study is first in demonstrating changes of plasma VEGF after stereotactic radiosurgery (SRS) for meningioma. This study may provide a stimulus for more work related to whether measurement of plasma level has a correlation with tumor response after SRS for meningioma.

Patterns of recurrence after stereotactic radiosurgery for treatment of meningiomas

The purpose of this study was to evaluate patterns of failure after stereotactic radiosurgery (SRS) for meningiomas and factors that may influence these outcomes. Based on a retrospective chart review, 279 patients were treated with SRS for meningiomas between January 1999 and March 2011 at Wake Forest Baptist Health. Disease progression was determined using serial imaging, with a minimum follow-up of 6 months (median 34.2 months). The median margin dose was 12.0 Gy (range 8.8-20 Gy). Local control rates for WHO Grade I tumors were 96.6%, 84.4%, and 75.7% at 1, 3, and 5 years, respectively. WHO Grade II and III tumors had local control rates of 72.3%, 57.7%, and 52.9% at 1, 3, and 5 years, respectively. Tumors without pathological grading had local control rates of 98.7%, 97.6%, and 94.2% at 1, 3, and 5 years, respectively. Of the local recurrences, 63.1% were classified as marginal (within 2 cm of treatment field). The 1-, 3-, and 5-year rates of distant failure were 6.5%, 10.3%, and 16.6%, respectively, for Grade I tumors and 11.4%, 17.2%, and 22.4%, respectively, for Grade II/III tumors. Tumors without pathological grading had distant failure rates of 0.7%, 3.2%, and 6.5% at 1, 3, and 5 years, respectively. Wilcoxon analysis revealed that multifocal disease (p < 0.001) and high-grade histology (WHO Grade II or III; p < 0.001) were significant predictors of local recurrence. Additionally, male sex was a significant predictor of distant recurrence (p = 0.04). Multivariate analysis also showed that doses greater than or equal to 12 Gy were associated with improved local control (p = 0.015). In this patient series, 12 Gy was the minimum sufficient margin dose for the treatment of meningiomas. Male sex is a risk factor for distant failure, whereas high-grade histology and multifocal disease are risk factors for local failure.

Risk Factors for Posttreatment Edema in Patients Treated With Stereotactic Radiosurgery for Meningiomas

Peritumoral edema is a recognized complication following stereotactic radiosurgery (SRS). To evaluate the risk of posttreatment peritumoral edema following SRS for intracranial meningiomas and determine predictive factors. Between 2002 and 2008, 173 evaluable patients underwent CyberKnife or Gamma Knife SRS for meningiomas. Eighty-four patients (49%) had prior surgical resections, 13 patients had World Health Organization grade II (atypical) meningiomas, and 117 patients had a neurological deficit before SRS. Sixty-two tumors were in parasagittal, parafalcine, and convexity locations. The median tumor volume was 4.7 mL (range, 0.1-231.8 mL). The median prescribed dose and median prescribed biologically equivalent dose were 15 Gy (range, 9-40 Gy) and 67 Gy (range, 14-116 Gy), respectively. Ninety-seven patients were treated with single-fraction SRS, 74 received 2 to 5 fractions, and 2 received >5 fractions. The median follow-up was 21.0 months. Thirteen patients (8%) developed symptomatic peritumoral edema, with a median onset time of 4.5 months (range, 0.2-9.5 months). The 3-, 6-, 12-, and 24-month actuarial symptomatic edema rates were 2.9%, 4.9%, 7.7%, and 8.5%, respectively. The crude tumor control rate was 94%. On univariate analysis, large tumor volume (P = .01) and single-fraction SRS (P = .04) were predictive for development of posttreatment edema. SRS meningioma treatment demonstrated a low incidence of toxicity; however, large tumor volumes and single-fraction SRS treatment had an increased risk for posttreatment edema. Risk factors for edema should be considered in meningiomas treatment.

Peritumoral edema after stereotactic radiosurgery for meningioma

Peritumoral edema induced by radiosurgery after the treatment of intracranial meningioma has been reported and its mechanism remains unclear. A 65-year-old woman presented with a history of intermittent dizziness. A CT scan and MRI of the brain revealed an extra-axial space-occupying lesion in the left frontal region. She was treated by stereotactic radiosurgery (SRS). Seven months later, the patient began experiencing general weakness and drowsiness. She developed peritumoral edema around the left frontal tumor. Similarly, a 55-year-old woman complained of unstable gait and dizziness 1 month prior to admission. A CT scan and MRI of the brain revealed an extra-axial space-occupying lesion in the right posterior temporal region. Six months after SRS, this patient experienced deteriorated consciousness and general weakness. Peritumoral edema in the right temporal region was noted. We report these two patients, discuss possible causes and review the relevant literature.

Improvement in Vision and Cranial Neuropathies After Stereotactic Radiotherapy for the Treatment of Skull Base Meningiomas

Materials/Methods: Two hundred and thirty nine patients were treated with fractionated stereotactic radiosurgery for meningiomas at the Jefferson Hospital for Neurosciences between 1994 and 2002. Of these patients, 117 had tumors located in the anterior skull base. All patients were immobilized using a GTC relocatable frame and underwent CT-MRI fusion for treatment planning. The mean target volume was 11.7cc (range 0.7 45.1cc). Patients were treated with a dedicated 6 MV linear accelerator using circular collimators directed in noncoplanar arcs with an average of 2.6 isocenters (range 1 7). Dose was delivered in 1.8 Gy fractions to a median cumulative dose of 54.0 Gy (range, 9.0 56.0 Gy), during a 5-week period. The median follow-up time was 32 months (range 7 96 months). Patients were examined and imaged with MRI during the first 3 months after receiving SRT and every 6 months thereafter. Baseline cranial neuropathies were evaluated clinically and characterized as stable, improved, resolved or progressive in the follow-up period. Preand post-radiotherapy serial radiographic evaluations, including MRI scans were compared to establish objective tumor response and local control.

Glioblastoma induction after radiosurgery for meningioma

A 70-year-old woman developed a glioblastoma in the irradiated field 7 years after stereotactic radiosurgery for meningioma. Glioma induction has been previously reported after external beam radiation for leukaemia, pituitary adenoma, tinea capitus, and meningioma. This radiosurgery-induced malignancy may portend further reports of tumour induction. The theoretical risk of tumour induction by low doses of radiation to normal neural tissue after radiosurgery is now confirmed. Reports of additional cases of radiosurgery-induced tumours might temper the use of this increasingly used technique for benign surgically accessible lesions.