Skip to main content
Log in

Stereotactic Radiosurgery for Benign Brain Tumors: Treatment Rationale and Outcomes

  • Published:
Journal of Radiosurgery

Abstract

Stereotactic radiosurgery has become a well established territory in the neurosurgical treatment armamentarium. The spectrum of clinical applications of stereotactic radiosurgery has greatly expanded to include a wide variety of benign brain tumors. The radiobiological basis and possible mechanisms for tumor responses following stereotactic radiosurgery treatment have been elucidated. The following sections in this review summarize the reported results of the radiosurgery treatment for the different categories of benign brain tumors. The author concluded the analytical review by proposing a treatment rationale for benign brain tumors in light of the risk-benefit ratios of other available treatment options.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

REFERENCES

  1. Anniko M. Early morphological changes following gamma irradiation. Acta Path Microbiol Immunol Scand A 89:113–124, 1981

    Google Scholar 

  2. Anniko M, Arndt J, Noren G. The human acoustic neurinoma in organ culture II. Tissue changes after gamma irradiation. Acta Otolaryngol (Stockholm) 91:223–235, 1981

    Google Scholar 

  3. Backlund E-O. Studies on craniopharyngiomas. IV stereotactic treatment with radiosurgery. Acta Chir Scand 139:344–351, 1973

    Google Scholar 

  4. Backlund E-O. Stereotactic treatment of craniopharyngiomas. Acta Neurochir Suppl 21:177–183, 1974

    Google Scholar 

  5. Backlund EO. Tumour changes after single dose irradiation by stereotactic radiosurgery in “non-active” pituitary adenomas and prolactinomas. In Stereotactic Cerebral Irradiation. INSERM Symposium No. 12. Szikla G (ed.). Amsterdam: Elsevier / North-Holland Biomedical Press, 1979, pp. 199–206.

    Google Scholar 

  6. Backlund EO. Solid craniopharyngiomas treated by stereotactic radiosurgery. In Stereotactic Cerebral Irradiation. INSERM Symposium No. 12. Szikla G (ed.). Amsterdam: Elsevier / North-Holland Biomedical Press, 1979, pp. 271–281.

    Google Scholar 

  7. Backlund EO. Radiosurgery in intracranial tumors and vascular malformations. J Neurosurg Sci 33(1):91–93, 1989

    Google Scholar 

  8. Backlund EO, Ganz JG. Pituitary adenomas: Gamma knife. In Stereotactic Radiosurgery. Alexander E III, Loeffler JS, Lunsford LD (eds.). New York: McGraw-Hill, 1993, pp. 167–173.

  9. Barbaro NM, Gutin PH, Wilson CB, Sheline GE, Boldrey EB, Wara WM. Radiation therapy in the treatment of parresected meningiomas. Neurosurgery 20(4):525–528, 1987

    Google Scholar 

  10. Bederson JB, von Ammon K, Wichmann WW, Yasargil MG. Conservative treatment of patients with acoustic tumors. Neurosurgery 28:646–651, 1991

    Google Scholar 

  11. Chakrabarti KB, Doughty D, Plowman PN. Stereotactic multiple arc radiotherapy. II-Cranial neuroma. Br J Neurosurg 10(6): 577–583, 1996

    Google Scholar 

  12. Chandler HC Jr., Friedman WA. Radiosurgical treatment of a hemangioblastoma: case report. Neurosurgery 34(2):353–355, 1994

    Google Scholar 

  13. Chang SD, Adler JR Jr. Treatment of cranial base meningiomas with linear accelerator radiosurgery. Neurosurgery 41(5): 1019–1027, 1997

    Google Scholar 

  14. Chasan CB, Goetsch S, Ott K. Radiosurgery for pineal tumors: is biopsy indicated? Stereotact Functional Neurosurg 66(Suppl 1): 157–163, 1996

    Google Scholar 

  15. Colombo F, Benedetti A, Pozza F, Avanzo RC, Marchetti C, Chierego G, et al. External stereotactic irradiation by linear accelerator. Neurosurgery 16(2):154–160, 1985

    Google Scholar 

  16. Degerblad M, Rähn T, Bergstrand G, Thorén M. Long-term results of stereotactic radiosurgery to the pituitary gland in Cushing's disease. Acta Endocrinol (Copenhagen) 112(3):310–314, 1986

    Google Scholar 

  17. Duma C, Lunsford LD, Kondziolka D, Harsh GR IV, Flickinger JC. Stereotactic radiosurgery of cavernous sinus meningiomas as an addition or alternative to microsurgery. Neurosurgery 32(5): 699–705, 1993

    Google Scholar 

  18. Engenhart R, Kimmig BN, Höver K, Wowra B, Sturm V, van Kaick G, et al. Stereotactic single high dose radiation therapy of benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 19(4):1021–1026, 1990

    Google Scholar 

  19. Fischer EG, Welch K, Shillo J, Jr., Winston KR, Tarbell NJ. Craniopharyngiomas in children. Long-term effects of conservative surgical procedures combined with radiation therapy. J Neurosurg 73(4):534–540, 1990

    Google Scholar 

  20. Flickinger JC, Kondziolka D, Pollock BE, Lunsford LD. Evolution in technique for vestibular schwannoma radiosurgery and effect on outcome. Int J Radiat Oncol Biol Phys 36(2):275–280, 1996

    Google Scholar 

  21. Flickinger JC, Loeffler JS, Larson DA. Stereotactic radiosurgery for intracranial malignancies. Oncology 8(1):81–89, 1994

    Google Scholar 

  22. Foote RL, Coffey RJ, Gorman DA, Earle JD, Schomberg PJ, Kline RW, et al. Stereotactic radiosurgery for glomus jugulare tumors: a preliminary report. Int J Radiat Oncol Biol Phys 38(3): 491–495, 1997

    Google Scholar 

  23. Ganz JC, Backlund EO, Thorsen FA. The effects of gamma knife surgery of pituitary adenomas on tumor growth and endocrinopathies. Stereotact Functional Neurosurg 61 (Suppl 1):30–37, 1993

    Google Scholar 

  24. Gardner G, Moretz WH Jr., Robertson JH, Clark C, Shea JJ Jr. Nonsurgical management of small and intracanalicular acoustic tumors. Otolaryngol Head Neck Surg 94:328–333, 1986

    Google Scholar 

  25. Hakim R, Alexander E III, Loeffler JS, Shrieve DC, Wen P, Fallon MP, et al. Results of linear accelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 42:446–454, 1998

    Google Scholar 

  26. Hall EJ, Brenner DJ. The radiobiology of radiosurgery: rationale for different treatment regimes for AVMs and malignancies. Int J Radiat Oncol Biol Phys 25(2):381–385, 1993

    Google Scholar 

  27. Inoue HK, Kohga H, Kagegawa T, Ono N, Hirato M, Nakamura M, et al. Radiosensitive craniopharyngiomas: the role of radiosurgery. Acta Neurochir Suppl 62:43–46, 1994

    Google Scholar 

  28. Kamerer DB, Lunsford LD, Møller M. Gamma knife: an alternative treatment for acoustic neurinomas. Ann Otol Rhinol Laryngol 97:631–635, 1988

    Google Scholar 

  29. Kaplan ID, Castro JR, Phillips TL. Helium charged particle radiotherapy for meningioma: experience at UCLBL. Int J Radiat Oncol Biol Phys 28(1):257–261, 1993

    Google Scholar 

  30. Kaye AH, Hahn JF, Kinney SE, Hardy RW, Bay JW. Jugular foramen schwannomas. J Neurosurg 60:1045–1053, 1984

    Google Scholar 

  31. Kjellberg RN, Shintani A, Frantz AG, Kliman B. Proton-beam therapy in acromegaly. N Engl J Med 278:689–695, 1968

    Google Scholar 

  32. Kleihues P, Burger PC, Scheithauer BW. Histological Types of tumours of the Central Nervous System, 2nd ed. Berlin: Springer-Verlag, 1993

    Google Scholar 

  33. Kobayashi T, Tanaka T, Kida Y. Stereotactic radiosurgery of craniopharyngiomas. Pediatr Neurosurg 21(suppl 1):69–74, 1994

    Google Scholar 

  34. Kondziolka D, Lunsford LD, Claassen D, Pandalai S, Maitz AH, Flickinger JC. Radiobiology of radiosurgery: part II. The rat C6 glioma model. Neurosurgery 31(2):280–288, 1992

    Google Scholar 

  35. Kondziolka D, Lunsford LD, Coffey RJ, Flickinger JC. Stereotactic radiosurgery of meningiomas. J Neurosurg 74:552–599, 1991

    Google Scholar 

  36. Landolt AM, Haller D, Lomax N, Scheib S, Schubiger O, Siegfried J, et al. Stereotactic radiosurgery for recurrent surgically treated acromegaly: comparison with fractionated radiotherapy. J Neurosurg 88:1002–1008, 1998

    Google Scholar 

  37. Larson D, Flickinger JC, Loeffler JS. Stereotactic radiosurgery: techniques and results. In Principles and Practice of Oncology, PPO Update. DeVita VT Jr., Hellman S, Rosenberg SA (eds.). Philadelphia, Pennsylvania, J.B. Lippincott, 1993, pp. 1–13.

    Google Scholar 

  38. Larson D, Flickinger JC, Loeffler JS. The radiobiology of radiosurgery. Int J Radiat Oncol Biol Phys 25(3):557–561, 1993

    Google Scholar 

  39. Leber KA, Berglöff J, Pendl G. Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 88:43–50, 1998

    Google Scholar 

  40. Lederman G, Lowry J, Wertheim S, Fine M, Lombardi E, Wronski M, et al. Acoustic neuroma: potential benefits of fractionated stereotactic radiosurgery. Stereotact Functional Neurosurg 69: 175–182, 1997

    Google Scholar 

  41. Leksell L. A note on the treatment of acoustic tumours. Acta Chir Scand 137:763–765, 1971

    Google Scholar 

  42. Levy RP, Fabricant JI, Frankel KA, Phillips MH, Lyman JT, Lawrence JH, et al. Heavy-charged-particle radiosurgery of the pituitary gland: clinical results of 840 patients. Stereotact Functional Neurosurg 57:22–35, 1991

    Google Scholar 

  43. Linskey ME, Flickinger JC, Lunsford LD. Cranial nerve length predicts the risk of delayed facial and trigeminal neuropathies after acoustic tumor stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 25(2):227–233, 1993

    Google Scholar 

  44. Linskey ME, Lunsford LD, Flickinger JC. Neuroimaging of acoustic nerve sheath tumors after stereotaxic radiosurgery. AJNR 12: 1165–1175, 1991

    Google Scholar 

  45. Linskey ME, Lunsford LD, Flickinger JC. Tumor control after stereotactic radiosurgery in neurofibromatosis patients with bilateral acoustic tumors. Neurosurgery 31(5):829–839, 1992

    Google Scholar 

  46. Linskey ME, Martinez AJ, Kondziolka D, Flickinger JC, Maitz AH, Whiteside T, et al. The radiobiology of human acoustic schwannoma xenografts after stereotactic radiosurgery evaluated in the subrenal capsule of athymic mice. J Neurosurg 78: 645–653, 1993

    Google Scholar 

  47. Lunsford LD. Contemporary management of meningiomas: irradiation therapy as an adjuvant and radiosurgery as an alternative to surgical removal? J Neurosurg 80:187–190, 1994

    Google Scholar 

  48. Lunsford LD, Kondziolka D, Flickinger JC. Radiosurgery as an alternative to microsurgery of acoustic tumors. Clin Neurosurg 38:619–634, 1992

    Google Scholar 

  49. Lunsford LD, Pollock BE, Kondziolka D, Levine G, Flickinger JC. Stereotactic options in the management of craniopharyngioma. Pediatr Neurosurg 21(suppl 1):90–97, 1994

    Google Scholar 

  50. Manera L, Regis J, Chinot O, Porcheron D, Levrier O, Farnarier P, et al. Pineal region tumors: the role of stereotactic radiosurgery. Stereotact Functional Neurosurg 66(Suppl 1):164–173, 1996

    Google Scholar 

  51. Mehta MP, Kinsella TJ. Cavernous sinus cranial neuropathies: is there a dose-reponse relationship following radiosurgery? Int J Radiat Oncol Biol Phys 27(2):477–480, 1993

    Google Scholar 

  52. Mendenhall WM, Friedman WA, Bova FJ. Linear acceleratorbased stereotactic radiosurgery for acoustic schwannomas. Int J Radiat Oncol Biol Phys 28(4):803–810, 1994

    Google Scholar 

  53. Mendenhall WM, Friedman WA, Buatti JM, Bova FJ. Preliminary results of linear accelerator radiosurgery for acoustic schwannomas. J Neurosurg 85:1013–1019, 1996

    Google Scholar 

  54. Meyn RE, Stephens LC, Ang KK, Hunter NR, Brock WA, Milas L, et al. Heterogeneity in the development of apoptosis in irradiated murine tumours of different histologies. Int J Radiat Oncol Biol Phys 64:583–591, 1993

    Google Scholar 

  55. Motti ED, Losa M, Pieralli S, Zecchinelli A, Longobardi B, Giugni E, et al. Stereotactic radiosurgery of pituitary adenomas, Metabolism 45(8 Suppl 1):111–114, 1996

    Google Scholar 

  56. Neumann HPH, Berger DP, Sigmund G, Blum U, Schmidt D, Parmer RJ et al. Pheochromocytomas, multiple endocrine neoplasia type 2, and Von Hippel-Lindau disease. N Engl J Med 329: 1531–1538, 1993

    Google Scholar 

  57. Niemelä M, Lim YJ, Söderman M, Jääskeläinen J, Lindquist C. Gamma knife radiosurgery in 11 hemangioblastomas. J Neurosurg 85:591–596, 1996

    Google Scholar 

  58. Norén G, Arndt J, Hindmarsh T. Stereotactic radiosurgery in cases of acoustic neurinoma: further experience. Neurosurgery 13(1):12–22, 1983

    Google Scholar 

  59. Norén G, Greitz D, Hirsch A, Lax I. Gamma knife radiosurgery in acoustic neurinoma In Radiosurgery Baseline and Trends. Steiner L (ed.). New York: Raven Press, 1992, pp. 141–148.

    Google Scholar 

  60. Ogunrinde OK, Lunsford LD, Flickinger JC, Kondziolka D. Stereotactic radiosurgery for acoustic nerve tumors in patients with useful preoperative hearing: results at 2-year follow-up examination. J Neurosurg 80:1011–1017, 1994

    Google Scholar 

  61. Ogunrinde OK, Lunsford LD, Flickinger JC, Kondziolka D. Cranial nerve preservation after stereotactic radiosurgery for small acoustic tumors. Arch Neurol 52:73–79, 1995

    Google Scholar 

  62. Page KA, Wayson K, Steinberg GK, Adler JR Jr. Stereotaxic radiosurgical ablation: an alternative treatment for recurrent and multifocal hemangioblastomas. A report of four cases. Surg Neurol 40:424–428, 1993

    Google Scholar 

  63. Pan DH-C, Lee L-S, Huang C-I, Wong T-T, Stereotactic internal irradiation for cystic craniopharyngiomas: A 6-year experience. Stereotact Functional Neurosurg 54, 55:525–530, 1990

    Google Scholar 

  64. Park YG, Chang JW, Kim EY, Chung SS. Gamma knife surgery in pituitary microadenomas. Yonsei Med J 37(3):165–173, 1996

    Google Scholar 

  65. Patrice SJ, Sneed PK, Flickinger JC, Shrieve DC, Pollock BE, Alexander E III, et al. Radiosurgery for hemangioblastoma: results of a multiinstitutional experience. Int J Radiat Oncol Biol Phys 35(3):493–499, 1996

    Google Scholar 

  66. Pollack IF, Lunsford LD, Slamovits TL, Gumerman LW, Levine G, Robinson AG. Stereotaxic intracavitary irradiation for cystic craniopharyngiomas. J Neurosurg 68: 227–233, 1988

    Google Scholar 

  67. Pollack IF, Sekhar LN, Jannetta PJ, Janecka IP. Neurilemmomas of the trigeminal nerve. J Neurosurg 70:737–745, 1989

    Google Scholar 

  68. Pollock BE, Kondziolka D, Flickinger JC, Maitz A, Lunsford LD. Preservation of cranial nerve function after radiosurgery for nonaschwannomas. Neurosurgery 33(4):597–601, 1993

    Google Scholar 

  69. Pollock BE, Kondziolka D, Lunsford LD, Flickinger JC. Stereotactic radiosurgery for pituitary adenomas: imaging, visual and endocrine results. Acta Neurochir Suppl (Wien) 62: 33–38, 1994

    Google Scholar 

  70. Pollock BE, Lunsford LD, Kondziolka D, Flickinger JC, Bissonette DJ, Kelsey SF, et al. Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery. Neurosurgery 36(1):215–229, 1995

    Google Scholar 

  71. Rähn T, Thorén M, Hall K, Backlund EO. Stereotactic radiosurgery in the treatment of MB cushing. In Stereotactic Cerebral Irradiation. INSERM Symposium No. 12 Szikla G (ed.). Amsterdam: Elsevier/North-Holland Biomedical Press, 1979, pp. 207–212.

    Google Scholar 

  72. Rähn T, Thorén M, Hall K, Backlund E-O. Stereotactic radiosurgery in Cushing's syndrome: acute radiation effects. Surg Neurol 14: 85–92, 1980.

    Google Scholar 

  73. Rajan B, Ashley S, Gorman C, Jose CC, Horwich A, Bloom HJ, et al. Craniopharyngioma-a long-term results following limited surgery and radiotherapy. Radiother Oncol 26(1):1–10, 1993

    Google Scholar 

  74. Regine WF, Kramer S. Pediatric craniopharyngiomas: long term results of combined treatment with surgery and radiation. Int J Radiat Oncol Biol Phys 24(4):611–617, 1992

    Google Scholar 

  75. Seo Y, Fukuoka S, Takanashi M, Sasaki T, Suematsu K, Nakamura J. Gamma knife surgery for cushing's disease. Surg Neurol 43:170–176, 1995

    Google Scholar 

  76. Shapiro K, Till K, Grant DN. Craniopharyngioma in childhood. A rational approach to treatment. J Neurosurg 50:617–623, 1979

    Google Scholar 

  77. Sheline GE, Wara WM, Smith V. Therapeutic irradiation and brain injury. Int J Radiat Oncol Biol Phys 6:1215–1228, 1980

    Google Scholar 

  78. Smalley SR, Schomberg PJ, Earle JD, Laws ER, Scheithauer BW, O'Fallon JR. Radiotherapeutic considerations in the treatment of hemangioblastomas of the central nervous system. Int J Radiat Oncol Biol Phys 18:1165–1171, 1990.

    Google Scholar 

  79. Steiner L, Prasad D, Lindquist C, Karlsson B, Steiner M. Gamma knife surgery in vascular, neoplastic, and functional disorders of the nervous system. In Operative Neurosurgical Techniques: Indications, Methods, and Results. 3rd ed. Schmidek HH, Sweet WH (eds.). Philadelphia: W. B. Saunders, 1995, pp.667–694.

    Google Scholar 

  80. Stephanian E, Lunsford LD, Coffey RJ, Bissonette DJ, Flickinger JC. Gamma knife surgery for sellar and suprasellar tumors. Neurosurg Clin N Am 3(1):207–218, 1992

    Google Scholar 

  81. Stephens LC, Hunter NR, Ang KK, Milas L, Meyn RE. Development of apoptosis in irradiated murine tumors as a function of time and dose. Radiat Res 135:75–80, 1993

    Google Scholar 

  82. Subach BR, Lunsford LD, Kondziolka D, Maitz AH, Flickinger JC. Management of petroclival meningioma by stereotactic radiosurgery. Neurosurgery 42:437–445, 1998

    Google Scholar 

  83. Sung D, Chang CH, Harisiadis L. cerebellar hemangioblastomas Cancer 49:553–555, 1982

    Google Scholar 

  84. Taylor BW Jr., Marcus RB Jr., Friedman WA, Ballinger WE Jr., Million RR. The meningioma controversy: postoperative radiation therapy. Int J Radiat Oncol Biol Phys 15(2):299–304, 1988

    Google Scholar 

  85. Thompson BG, Coffey RJ, Flickinger JC, Lunsford LD. Stereotactic radiosurgery of small intracranial tumors: neuropathological correlation in three patients. Surg Neurol 33:96–104, 1990

    Google Scholar 

  86. Thorén M, Rähn T, Guo W-Y, Werner S. Stereotactic radiosurgery with cobalt-60 gamma unit in the treatment of growth hormoneproducing pituitary tumors. Neurosurgery 29(5):663–668, 1991

    Google Scholar 

  87. Thorén M, Rähn T, Hall K, Backlund EO. Treatment of pituitary dependent cushing's syndrome with closed stereotactic radiosurgery by means of 60Co gamma radiation. Acta Endocrinol (Copenhagen) 88(1):7–17, 1978

    Google Scholar 

  88. Thorén M, Rähn T, Hallengren B, Kaad PH, Nilsson KO, Ravn H, et al. Treatment of cushing's disease in childhood and adolescence by stereotactic pituitary irradiation. Acta Paediatr Scand 75(3): 388–395, 1986

    Google Scholar 

  89. Tishler RB, Loeffler JS, Lunsford LD, Duma C, Alexander E III, Kooy HM, et al. Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27(2): 215–221, 1993

    Google Scholar 

  90. Valentino V. Postoperative radiosurgery of pituitary adenomas. J Neurosurg Sci 35(4):207–211, 1991

    Google Scholar 

  91. Valentino V, Schinaia G, Raimondi AJ. The results of radiosurgical management of 72 middle fossa meningiomas. Acta Neurochir (Wien) 122:60–70, 1993

    Google Scholar 

  92. Varlotto JM, Shrieve DC, Alexander E III, Kooy HM, Black PM, Loeffler JS. Fractionated stereotactic radiotherapy for the treatment of acoustic neuromas: preliminary results. Int J Radiat Oncol Biol Phys 36(1):141–145, 1996

    Google Scholar 

  93. Wallner KE, Pitts LH, Davis RL, Sheline GE. Radiation therapy for the treatment of non-eight nerve intracranial neurilemmoma. Int J Radiat Oncol Biol Phys 14:287–290, 1988

    Google Scholar 

  94. Wallner KE, Sheline GE, Pitts LH, Wara WM, Davis RL, Boldrey EB. Efficacy of irradiation for incompletely excised acoustic neurilemomas. J Neurosurg 67:858–863, 1987

    Google Scholar 

  95. Wen BC, Hussey DH, Staples J, Hitchon PW, Jani SK, Vigliotti AP, et al. A comparison of the roles of surgery and radiation therapy in the management of craniopharyngiomas. Int J Radiat Oncol Biol Phys 16(1):17–24, 1989

    Google Scholar 

  96. Wyllie AH, Kerr JFR, Currie AR. Cell death: the significance of apoptosis. Intern Rev Cytol 68:251–306, 1980

    Google Scholar 

  97. Yamaguchi N, Yamashima T, Yamashita J. A histological and flow cytometric study of dog brain endothelial cell injuries in delayed radiation necrosis. J Neurosurg 74:625–632, 1991

    Google Scholar 

  98. Yamasaki T, Nagao S, Kagawa T, et al. Therapeutic effectiveness of combined microsurgery and radiosurgery in a patient with a huge trigeminal neurinoma. No To Shinkei 48(9):845–850, 1996 (in Jpn).

    Google Scholar 

  99. Zeng-min T, Gui-quan K, Shi-yue L, Xiao-han C. Stereotactic intracavitary irradiation of huge cystic craniopharygiomas. Stereotact Functional Neurosurg 59:205, 1992 (Abstr).

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abdelaziz, O.S. Stereotactic Radiosurgery for Benign Brain Tumors: Treatment Rationale and Outcomes. Journal of Radiosurgery 3, 29–42 (2000). https://doi.org/10.1023/A:1009573119807

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1009573119807

Navigation