Skip to main content
SpringerLink
Log in

Combined Microsurgical and Radiosurgical Treatment in Intracranial Meningiomas

  • Chapter
  • First Online:
Stereotactic Radiosurgery for the Treatment of Central Nervous System Meningiomas

  • 362 Accesses

Abstract

Surgical resection is the gold standard of therapy for intracranial meningiomas; however, radiosurgery has gained widespread acceptance as a safe and effective option for small tumours, with a local control rate of 95% at 7 years. This is quite similar to radical resection that includes the dural attachment (96%). Despite advances in microsurgical techniques, the removal of large meningiomas in some locations is still associated with a high risk of morbidity. The strategy of removing a large part of the tumour volume and treating the residual with radiosurgery therefore seems a valid alternative, especially for skull base meningiomas and those that infiltrate or invade a dural venous sinus, significantly reducing surgical morbidity with an excellent local control of meningioma growth; indeed the final aim is improving the patient’s quality of life. Combined microsurgery-radiosurgery requires both surgical and radiosurgical skills, since to optimize outcomes it is essential to understand the limitations and combine the advantages of both techniques.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Goldbrunner R, Minniti G, Preusser M, Jenkinson MF, Sallabanda K, Houdart E, et al. EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol. 2016;17(9):e383–91. https://doi.org/10.1016/S1470-2045(16)30321-7.

    Article  PubMed  Google Scholar 

  2. Minniti G, Amichetti M, Enrici E. Radiotherapy and radiosurgery for benign skull base meningiomas. Radiother Oncol. 2009;4:42. https://doi.org/10.1186/1748-717X-4-42.

    Article  Google Scholar 

  3. Fatima N, Meola A, Pollom E, Soltys SG, Chang SD. Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis. Neurosurg Focus. 2019;46(6):E2. https://doi.org/10.3171/2019.3.FOCUS1970.

    Article  PubMed  Google Scholar 

  4. Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 1957;20(1):22–39. https://doi.org/10.1136/jnnp.20.1.22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Condra KS, Buatti JM, Mendenhall WM, Friedman WA, Marcus RB Jr, Rhoton AL. Benign meningiomas: primary treatment selection affects survival. Int J Radiat Oncol Biol Phys. 1997;39(2):427–36. https://doi.org/10.1016/s0360-3016(97)00317-9.

    Article  CAS  PubMed  Google Scholar 

  6. Sughrue ME, Kane AJ, Shangari G, Rutkowski MJ, McDermott MW, Berger MS, et al. The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas. J Neurosurg. 2010;113(5):1029–35. https://doi.org/10.3171/2010.3.JNS091971.

    Article  PubMed  Google Scholar 

  7. Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL. Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg. 1985;62(1):18–24. https://doi.org/10.3171/jns.1985.62.1.0018.

    Article  CAS  PubMed  Google Scholar 

  8. Pollock BE, Stafford SL, Utter A, Giannini C, Schreiner SA. Stereotactic radiosurgery provides equivalent tumor control to Simpson Grade 1 resection for patients with small- to medium-size meningiomas. Int J Radiat Oncol Biol Phys. 2003;55(4):1000–5. https://doi.org/10.1016/s0360-3016(02)04356-0.

    Article  PubMed  Google Scholar 

  9. Oya S, Kim SH, Sade B, Lee JH. The natural history of intracranial meningiomas. J Neurosurg. 2011;114(5):1250–6. https://doi.org/10.3171/2010.12.JNS101623.

    Article  PubMed  Google Scholar 

  10. Clark VE, Harmanci AS, Bai H, Youngblood MW, Lee TI, Baranoski JF, et al. Recurrent somatic mutations in POLR2A define a distinct subset of meningiomas. Nat Genet. 2016;48(10):1253–9. https://doi.org/10.1038/ng.3651.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016;131(6):803–20. https://doi.org/10.1007/s00401-016-1545-1.

    Article  PubMed  Google Scholar 

  12. Agarwal V, McCutcheon BA, Hughes JD, Carlson ML, Glasgow AE, Habermann EB. Trends in management of intracranial meningiomas: analysis of 49,921 cases from modern cohort. World Neurosurg. 2017;106:145–51. https://doi.org/10.1016/j.wneu.2017.06.127.

    Article  PubMed  Google Scholar 

  13. Bondy M, Ligon BL. Epidemiology and etiology of intracranial meningiomas: a review. J Neuro-Oncol. 1996;29(3):197–205. https://doi.org/10.1007/BF00165649.

    Article  CAS  Google Scholar 

  14. Pasquier D, Bijmolt S, Veninga T, Rezvoy N, Villa S, Krengli M, et al. Atypical and malignant meningioma: outcome and prognostic factors in 119 irradiated patients. A multicenter, retrospective study of the Rare Cancer Network. Int J Radiat Oncol Biol Phys. 2008;71(5):1388–93. https://doi.org/10.1016/j.ijrobp.2007.12.020.

    Article  PubMed  Google Scholar 

  15. Stafford SL, Pollock BE, Foote RL, Link MJ, Gorman DA, Schomberg PJ, et al. Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients. Neurosurgery. 2001;49(5):1029–37.; discussion 1037-8. https://doi.org/10.1097/00006123-200111000-00001.

    Article  CAS  PubMed  Google Scholar 

  16. Flickinger JC, Kondziolka D, Maitz AH, Lunsford LD. Gamma knife radiosurgery of imaging-diagnosed intracranial meningioma. Int J Radiat Oncol Biol Phys. 2003;56(3):801–6. https://doi.org/10.1016/s0360-3016(03)00126-3.

    Article  PubMed  Google Scholar 

  17. DiBiase SJ, Kwok Y, Yovino S, Arena C, Naqvi S, Temple R, et al. Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phy. 2004;60(5):1515–9. https://doi.org/10.1016/j.ijrobp.2004.05.073.

    Article  Google Scholar 

  18. Feigl CG, Samii M, Horstmann GA. Volumetric follow-up of meningiomas: a quantitative method to evaluate treatment outcome of Gamma Knife radiosurgery. Neurosurgery. 2007;61(2):281–6.; discussion 286-7. https://doi.org/10.1227/01.NEU.0000279999.95953.EA.

    Article  PubMed  Google Scholar 

  19. Kollova A, Liscak R, Novotny J Jr, Vladyka V, Simonova G, Janouskova L. Gamma Knife surgery for benign meningioma. J Neurosurg. 2007;107(2):325–36. https://doi.org/10.3171/JNS-07/08/0325.

    Article  PubMed  Google Scholar 

  20. Kondziolka D, Mathieu D, Lunsford LD, Martin JJ, Madhok R, Niranjan A, et al. Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery. 2008;62(1):53–8.; discussion 58-60. https://doi.org/10.1227/01.NEU.0000311061.72626.0D.

    Article  PubMed  Google Scholar 

  21. Bledsoe JM, Link MJ, Stafford SL, Park PJ, Pollok BE. Radiosurgery for large-volume (<10 cm3) benign meningiomas. J Neurosurg. 2010;112(5):951–6. https://doi.org/10.3171/2009.8.JNS09703.

    Article  PubMed  Google Scholar 

  22. Zada G, Pagnini PG, Yu C, Erikson KT, Hirschbein J, Zelman V, et al. Long-term outcomes and patterns of tumor progression after gamma knife radiosurgery for benign meningiomas. Neurosurgery. 2010;67(2):322–8.; discussion 328-9. https://doi.org/10.1227/01.NEU.0000371974.88873.15.

    Article  PubMed  Google Scholar 

  23. Santacroce A, Walier M, Regis J, Liscak R, Motti E, Lindquist C, et al. Long-term tumor control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients. Neurosurgery. 2012;70(1):32–9.; discussion 39. https://doi.org/10.1227/NEU.0b013e31822d408a.

    Article  PubMed  Google Scholar 

  24. Pollock BE, Stafford SL, Link MJ, Brown PD, Garces YI, Foote RL. Single-fraction radiosurgery of benign intracranial meningiomas. Neurosurgery. 2012;71(3):604–12.; discussion 613. https://doi.org/10.1227/NEU.0b013e31825ea557.

    Article  PubMed  Google Scholar 

  25. Fokas E, Henzel M, Suber G, Hamm K, Engenhart-Cabillic R. Stereotactic radiation therapy for benign meningioma: long-term outcome in 318 patients. Int J Radiat Oncol Biol Phys. 2014;89(3):569–75. https://doi.org/10.1016/j.ijrobp.2014.02.042.

    Article  PubMed  Google Scholar 

  26. Elia AE, Shih HA, Loeffler JS. Stereotactic radiation treatment for benign meningiomas. Neurosurg Focus. 2007;23(4):E5. https://doi.org/10.3171/FOC-07/10/E5.

    Article  PubMed  Google Scholar 

  27. Koga T, Shin M, Saito N. Role of gamma knife radiosurgery in neurosurgery: past and future perspectives. Neurol Med Chir (Tokyo). 2010;50(9):737–48. https://doi.org/10.2176/nmc.50.737.

    Article  Google Scholar 

  28. Heros RC. Radiosurgery and neurosurgeons. J Neurosurg. 2005;103(2):203–5.; discussion 205. https://doi.org/10.3171/jns.2005.103.2.0203.

    Article  PubMed  Google Scholar 

  29. Natarajan SK, Sekhar LN, Schessel D, Morita A. Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up. Neurosurgery. 2007;60(6):965–79.; discussion 979-81. https://doi.org/10.1227/01.neu.0000255472.52882.d6.

    Article  PubMed  Google Scholar 

  30. Cohen-Inbar O, Lee CC, Sheehan JP. The contemporary role of stereotactic radiosurgery in the treatment of meningiomas. Neurosurg Clin N Am. 2016;27(2):215–28. https://doi.org/10.1016/j.nec.2015.11.006.

    Article  PubMed  Google Scholar 

  31. Nakamura M, Roser F, Michel J, Jacobs C, Samii M. The natural history of incidental meningiomas. Neurosurgery. 2003;53(1):62–70.; discussion 70-1. https://doi.org/10.1227/01.neu.0000068730.76856.58.

    Article  PubMed  Google Scholar 

  32. Lee EJ, Park JH, Park ES, Kim JH. “Wait-and-See” Strategies for newly diagnosed intracranial meningiomas based on the risk of future observation failure. World Neurosurg. 2017;107:604–11. https://doi.org/10.1016/j.wneu.2017.08.060.

    Article  PubMed  Google Scholar 

  33. Sheehan JP, Williams BJ, Yen CP. Stereotactic radiosurgery for WHO grade I meningiomas. J Neuro-Oncol. 2010;99(3):407–16. https://doi.org/10.1007/s11060-010-0363-x.

    Article  Google Scholar 

  34. Ding D, Starke RM, Hantzmon J, Yen CP, Williams BJ, Sheehan JP. The role of radiosurgery in the management of WHO Grade II and III intracranial meningiomas. Neurosurg Focus. 2013;35(6):E16. https://doi.org/10.3171/2013.9.FOCUS13364.

    Article  PubMed  Google Scholar 

  35. Weber DC, Ares C, Villa S, Peerdeman SM, Renard L, Baumert BG, et al. Adjuvant postoperative high-dose radiotherapy for atypical and malignant meningioma: a phase-II parallel non-randomized and observation study (EORTC 22042-26042). Radiother Oncol. 2018;128(2):260–5. https://doi.org/10.1016/j.radonc.2018.06.018.

    Article  PubMed  Google Scholar 

  36. Rogers L, Zhang P, Vogelbaum MA, Perry A, Ashby L, Modi J, et al. Intermediate-risk meningioma: initial outcomes from NRG oncology/RTOG-0539. J Neurosurg. 2018;129(1):35–47. https://doi.org/10.3171/2016.11.JNS161170.

    Article  PubMed  Google Scholar 

  37. Hardesty DA, Wolf AB, Brachman DG, McBride HL, Youssef E, Nakaji P, et al. The impact of adjuvant stereotactic radiosurgery on atypical meningioma recurrence following aggressive microsurgical resection. J Neurosurg. 2013;119(2):475–81. https://doi.org/10.3171/2012.12.JNS12414.

    Article  PubMed  Google Scholar 

  38. Harris AE, Lee JY, Omalu B, Flickinger JC, Kondziolka D, Lunsford LD. The effect of radiosurgery during management of aggressive meningiomas. Surg Neurol. 2003;60(4):298–305.; discussion 305. https://doi.org/10.1016/s0090-3019(03)00320-3.

    Article  PubMed  Google Scholar 

  39. Kano H, Takahashi JA, Katsuki T, Araki N, Oya N, Hiraoka M, et al. Stereotactic radiosurgery for atypical and anaplastic meningiomas. J Neuro-Oncol. 2007;84(1):41–7. https://doi.org/10.1007/s11060-007-9338-y.

    Article  Google Scholar 

  40. Starke RM, Przybylowski CJ, Sugoto M, Fezeu F, Awad AJ, Ding D, et al. Gamma Knife radiosurgery of large skull base meningiomas. J Neurosurg. 2015;122(2):363–72. https://doi.org/10.3171/2014.10.JNS14198.

    Article  PubMed  Google Scholar 

  41. Joshi KC, Raghavan A, Muhsen B, Hsieh J, Borghei-Razavi H, Chao ST, et al. Gene H. Fractionated Gamma Knife radiosurgery for skull base meningiomas: a single-institution experience. Neurosurg Focus. 2019, 46(6):E8. https://doi.org/10.3171/2019.3.FOCUS1963.

  42. Seung SK, Larson DA, Galvin JM, Mehta MP, Potters L, Schultz CJ, et al. American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO) Practice Guideline for the Performance of Stereotactic Radiosurgery (SRS). Am J Clin Oncol. 2013;36(3):310–5. https://doi.org/10.1097/COC.0b013e31826e053d.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Marchetti M, Bianchi S, Milanesi I, Bergantin A, Bianchi L, Broggi G, et al. Multisession radiosurgery for optic nerve sheath meningiomas: an effective option: preliminary results of a single-center experience. Neurosurgery. 2011;69(5):1116–22.; discussion 1122-3. https://doi.org/10.1227/NEU.0b013e31822932fe.

    Article  PubMed  Google Scholar 

  44. Milano M, Grimm J, Soltys SG, Yorke E, Moiseenko V, Tomé WA, et al. Single- and multi-fraction stereotactic radiosurgery dose tolerances of the optic pathways. Int J Radiat Oncol Biol Phys. 2021;110:87–99. https://doi.org/10.1016/j.ijrobp.2018.01.053.

    Article  PubMed  Google Scholar 

  45. Igaki H, Maruyama K, Koga T, Murakami N, Tago M, Terahara A, et al. Stereotactic radiosurgery for skull base meningioma. Neurol Med Chir (Tokyo). 2009;49(10):456–61. https://doi.org/10.2176/nmc.49.456.

    Article  Google Scholar 

  46. Ganz JC, Backlund EO, Thorsen FA. The results of Gamma Knife surgery of meningiomas, related to size of tumor and dose. Stereotact Funct Neurosurg. 1993;61(Suppl. 1):23–9. https://doi.org/10.1159/000100656.

    Article  PubMed  Google Scholar 

  47. Girvigian MR, Chen JC, Rahimian J, Miller MJ, Tome M. Comparison of early complications for patients with convexity and parasagittal meningiomas treated with either stereotactic radiosurgery or fractionated stereotactic radiotherapy. Neurosurgery. 2008;62(5 Suppl):A19–27.;discussion A27-8. https://doi.org/10.1227/01.neu.0000325933.34154.cb.

    Article  PubMed  Google Scholar 

  48. Mahadevan A, Floyd S, Wong E, Chen C, Kasper E. Clinical outcome after hypofractionated stereotactic radiotherapy (HSRT) for benign skull base tumors. Comput Aided Surg. 2011;16(3):112–20. https://doi.org/10.3109/10929088.2011.565160.

    Article  PubMed  Google Scholar 

  49. Morimoto M, Yoshioka Y, Shiomi H, Isohashi F, Konishi K, Kotsuma T, et al. Significance of tumor volume related to peritumoral edema in intracranial meningioma treated with extreme hypofractionated stereotactic radiation therapy in three to five fractions. Jpn J Clin Oncol. 2011;41(5):609–16. https://doi.org/10.1093/jjco/hyr022.

    Article  PubMed  Google Scholar 

  50. Unger KR, Lominska CE, Chanyasulkit J, Randolph-Jackson P, White RL, Aulisi E, et al. Risk factors for posttreatment edema in patients treated with stereotactic radiosurgery for meningiomas. Neurosurgery. 2012;70(3):639–45. https://doi.org/10.1227/NEU.0b013e3182351ae7.

    Article  PubMed  Google Scholar 

  51. Han MS, Jang WY, Moon KS, Lim SH, Kim IY, et al. Is fractionated Gamma Knife radiosurgery a safe and effective treatment approach for large volume (>10 cm3) intracranial meningiomas? World Neurosurg. 2017;99:477–83. https://doi.org/10.1016/j.wneu.2016.12.056.

    Article  PubMed  Google Scholar 

  52. Aichholzer M, Bertalanffy A, Dietrich W, Roessler K, Pfisterer W, Ungersboeck K, et al. Gamma Knife radiosurgery of skull base meningiomas. Acta Neurochir. 2000;142(6):647–52.; discussion 652-3. https://doi.org/10.1007/s007010070108.

    Article  CAS  PubMed  Google Scholar 

  53. Barzaghi LR, Spina A, Gagliardi F, Boari N, Mortini P. Transfrontal-sinus-subcranial approach to olfactory groove meningiomas: surgical results and clinical and functional outcome in a consecutive series of 21 patients. World Neurosurg. 2017;101:315–24. https://doi.org/10.1016/j.wneu.2017.02.039.

    Article  PubMed  Google Scholar 

  54. Jung HW, Yoo H, Paek SH, Choi KS. Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases. Neurosurgery. 2000;46(3):567–74.; discussion 574-5. https://doi.org/10.1097/00006123-200003000-00008.

    Article  CAS  PubMed  Google Scholar 

  55. Morita A, Coffey RJ, Foote RL, Schiff D, Gorman D. Risk of injury to cranial nerves after Gamma Knife radiosurgery for skull base meningiomas: experience in 88 patients. J Neurosurg. 1999;90(1):42–9. https://doi.org/10.3171/jns.1999.90.1.0042.

    Article  CAS  PubMed  Google Scholar 

  56. Eustacchio S, Trummer M, Fuchs I, Schrottner O, Sutter B, Pendl G. Preservation of cranial nerve function following Gamma Knife radiosurgery for benign skull base meningiomas: experience in 121 patients with follow-up of 5–9.8 years. Acta Neurochir Suppl. 2002;84:71–6. https://doi.org/10.1007/978-3-7091-6117-3_8.

    Article  CAS  PubMed  Google Scholar 

  57. Kreil W, Luggin J, Fuchs I, Weigl V, Eustacchio S, Papaefthymiou G. Long term experience of gamma knife radiosurgery for benign skull base meningiomas. J Neurol Neurosurg Psychiatry. 2005;76(10):1425–30. https://doi.org/10.1136/jnnp.2004.049213.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Zachenhofer I, Wolfsberger S, Aichholzer M, Bertalanffy A, Roessler K, Kitz K, et al. Gamma-knife radiosurgery for cranial base meningiomas: experience of tumor control, clinical course, and morbidity in a follow-up of more than 8 years. Neurosurgery. 2006;58(1):28–36.; discussion 28-36. https://doi.org/10.1227/01.neu.0000190654.82265.a3.

    Article  PubMed  Google Scholar 

  59. Davidson L, Fishback D, Russin JJ, Weiss MH, Yu C, Pagnini PG, et al. Postoperative Gamma Knife surgery for benign meningiomas of the cranial base. Neurosurg Focus. 2007;23(4):E6. https://doi.org/10.3171/FOC-07/10/E6.

    Article  PubMed  Google Scholar 

  60. Han JH, Kim DG, Chung HT, Park CK, Paek SH, Kim CY, et al. Gamma Knife radiosurgery for skull base meningiomas: long-term radiologic and clinical outcome. Int J Radiat Oncol Biol Phys. 2008;72(5):1324–32. https://doi.org/10.1016/j.ijrobp.2008.03.028.

    Article  PubMed  Google Scholar 

  61. Hayashi M, Chernov M, Tamura N, Izawa M, Muragaki Y, Iseki H, et al. Gamma Knife robotic microradiosurgery for benign skull base meningiomas: tumor shrinkage may depend on the amount of radiation energy delivered per lesion volume (unit energy). Stereotact Funct Neurosurg. 2011;89(1):6–16. https://doi.org/10.1159/000321184.

    Article  PubMed  Google Scholar 

  62. Iwai Y, Yamanaka K, Ikeda H. Gamma Knife radiosurgery for skull base meningioma: long-term results of low-dose treatment. J Neurosurg. 2008;109(5):804–10. https://doi.org/10.3171/JNS/2008/109/11/0804.

    Article  PubMed  Google Scholar 

  63. Starke RM, Williams BJ, Hiles C, Nguyen JH, Elsharkawy MY, Sheehan JP. Gamma Knife surgery for skull base meningiomas. J Neurosurg. 2012;116(3):588–97. https://doi.org/10.3171/2011.11.JNS11530.

    Article  PubMed  Google Scholar 

  64. Duma CM, Lunsford LD, Kondziolka D, Harsh GR, Flickinger JC. Stereotactic radiosurgery of cavernous sinus meningiomas as an addition or alternative to microsurgery. Neurosurgery. 1993;32:699–704. https://doi.org/10.1227/00006123-199305000-00001.

    Article  CAS  PubMed  Google Scholar 

  65. Roche PH, Régis J, Dufour H, Fournier HD, Delsanti C, Pellet W, et al. Gamma Knife radiosurgery in the management of cavernous sinus meningiomas. J Neurosurgery. 2000;93(Suppl 3):68–73. https://doi.org/10.3171/jns.2000.93.supplement.

    Article  Google Scholar 

  66. Shin M, Kurita H, Sasaki T, Kawamoto S, Tago M, Kawahara N, et al. Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas. J Neurosurg. 2001;95(3):435–9. https://doi.org/10.3171/jns.2001.95.3.0435.

    Article  CAS  PubMed  Google Scholar 

  67. Nicolato A, Foroni R, Alessandrini F, Bricolo A, Gerosa M. Radiosurgical treatment of cavernous sinus meningiomas: experience with 122 treated patients. Neurosurgery. 2002;51(5):1153–9.; discussion 1159-61. https://doi.org/10.1097/00006123-200211000-00009.

    Article  PubMed  Google Scholar 

  68. Lee JY, Niranjan A, McInerney J, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurg. 2002;97(1):65–72. https://doi.org/10.3171/jns.2002.97.1.0065.

    Article  PubMed  Google Scholar 

  69. Iwai Y, Yamanaka K, Ishiguro T. Gamma Knife radiosurgery for the treatment of cavernous sinus meningiomas. Neurosurgery. 2003;52(3):517–24.; discussion 523-4. https://doi.org/10.1227/01.neu.0000047814.18819.9f.

    Article  PubMed  Google Scholar 

  70. Maruyama K, Shin M, Kurita H, Kawahara N, Morita A, Kirino T. Proposed treatment strategy for cavernous sinus meningiomas: a prospective study. Neurosurgery. 2004;55(5):1068–75. https://doi.org/10.1227/01.neu.0000140839.47922.5a.

    Article  PubMed  Google Scholar 

  71. Pollock BE, Stafford SL. Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys. 2005;62(5):1427–31. https://doi.org/10.1016/j.ijrobp.2004.12.067.

    Article  PubMed  Google Scholar 

  72. Hasegawa T, Kida Y, Yoshimoto M, Koike J, Iizuka H, Ishii D. Long-term outcomes of Gamma Knife Surgery for cavernous sinus meningioma. J Neurosurg. 2007;107(4):745–51. https://doi.org/10.3171/JNS-07/10/0745.

    Article  PubMed  Google Scholar 

  73. Skeie BS, Enger PO, Skeie GO, Thorsen F, Pedersen PH. Gamma Knife surgery of meningiomas involving the cavernous sinus: long-term follow-up of 100 patients. Neurosurgery. 2010;66(4):661–8.; discussion 668-9. https://doi.org/10.1227/01.NEU.0000366112.04015.E2.

    Article  PubMed  Google Scholar 

  74. Subach BR, Lunsford LD, Kondziolka D, Maitz AH, Flickinger JC. Management of petroclival meningiomas by stereotactic radiosurgery. Neurosurgery. 1998;42(3):437–43.; discussion 443-5. https://doi.org/10.1097/00006123-199803000-00001.

    Article  CAS  PubMed  Google Scholar 

  75. Roche PH, Pellet W, Fuentes S, Thomassin JM, Regis J. Gamma knife radiosurgical management of petroclival meningiomas results and indications. Acta Neurochir. 2003;145(10):883–8.; discussion 888. https://doi.org/10.1007/s00701-003-0123-1.

    Article  PubMed  Google Scholar 

  76. Flannery TJ, Kano H, Lunsford LD, Sirin S, Tormenti M, Niranjan A, et al. Long-term control of petroclival meningiomas through radiosurgery. J Neurosurg. 2010;112(5):957–64. https://doi.org/10.3171/2009.8.JNS09695.

    Article  PubMed  Google Scholar 

  77. Kondziolka D, Madhok R, Lunsford LD, Mathieu D, Martin JJ, Niranjan A, Flickinger JC. Stereotactic radiosurgery for convexity meningiomas. J Neurosurg. 2009;111(3):458–63. https://doi.org/10.3171/2008.8.JNS17650.

    Article  PubMed  Google Scholar 

  78. Hasegawa T, Kida Y, Yoshimoto M, Iizuka H, Ishii D, Yoshida K. Gamma Knife surgery for convexity, parasagittal and falcine meningiomas. J Neurosurg. 2011;114:1392–8. https://doi.org/10.3171/2010.11.JNS10112.

    Article  PubMed  Google Scholar 

  79. Sen C, Hague K. Meningiomas involving the cavernous sinus: histological factors affecting the degree of resection. J Neurosurg. 1997;87(4):535–43. https://doi.org/10.3171/jns.1997.87.4.0535.

    Article  CAS  PubMed  Google Scholar 

  80. O'Sullivan MG, van Loveren HR, Tew JM Jr. The surgical resectability of meningiomas of the cavernous sinus. Neurosurgery. 1997;40(2):238–44. discussion 245-7

    Article  CAS  Google Scholar 

  81. Pichierri A, Santoro A, Raco A, Paolini S, Cantore G, Delfini R. Cavernous sinus meningiomas: retrospective analysis and proposal of a treatment algorithm. Neurosurgery. 2009;64(6):1090–9.; discussion 1099-101. https://doi.org/10.1227/01.NEU.0000346023.52541.0A.

    Article  PubMed  Google Scholar 

  82. De Jesus O, Sekhar LN, Parikh HK, Wright DC, Wagner DP. Long-term follow-up of patients with meningiomas involving the cavernous sinus: recurrence, progression, and quality of life. Neurosurgery. 1996;39(5):915–9.; discussion 919-20. https://doi.org/10.1097/00006123-199611000-00005.

    Article  PubMed  Google Scholar 

  83. Dufour H, Muracciole X, Metellus P, Regis J, Chinot O, Grisoli F. Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with or without previous surgery: is there an alternative to aggressive tumor removal? Neurosurgery. 2001;48(2):285–94.; discussion 294-6. https://doi.org/10.1097/00006123-200102000-00006.

    Article  CAS  PubMed  Google Scholar 

  84. Abdel-Aziz KM, Froelich SC, Dagnew E, Jean W, Breneman JC, Zuccarello M, et al. Large sphenoid wing meningiomas involving the cavernous sinus: conservative surgical strategies for better functional outcomes. Neurosurgery. 2004;54(6):1375–83.; discussion 1383-4. https://doi.org/10.1227/01.neu.0000125542.00834.6d.

    Article  PubMed  Google Scholar 

  85. Larson JJ, van Loveren HR, Balko MG, Tew JM Jr. Evidence of meningioma infiltration into cranial nerves: clinical implications for cavernous sinus meningiomas. J Neurosurg. 1995;83(4):596–9. https://doi.org/10.3171/jns.1995.83.4.0596.

    Article  CAS  PubMed  Google Scholar 

  86. Liscak R, Simonova G, Vymazal J, Janouskova L, Vladyka V. Gamma knife radiosurgery of meningiomas in the cavernous sinus region. Acta Neurochir. 1999;141(5):473–80. https://doi.org/10.1007/s007010050327.

    Article  CAS  PubMed  Google Scholar 

  87. Van Havenbergh T, Carvalho G, Tatagiba M, Plets C, Samii M. Natural history of petroclival meningiomas. Neurosurgery. 2003;52(1):55–62.; discussion 62-4. https://doi.org/10.1097/00006123-200301000-00006.

    Article  PubMed  Google Scholar 

  88. Bambakidis NC, Kakarla UK, Kim LJ, Nakaji P, Porter RW, Daspit CP, Spetzler RF. Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery. 2007;61(5 Suppl 2):202–9.; discussion 209-11. https://doi.org/10.1227/01.neu.0000303218.61230.39.

    Article  PubMed  Google Scholar 

  89. Park CK, Jung HW, Kim JE, Paek SH, Kim DG. The selection of the optimal therapeutic strategy for petroclival meningiomas. Surg Neurol. 2006;66(2):160–5.; discussion 165-6. https://doi.org/10.1016/j.surneu.2005.12.024.

    Article  PubMed  Google Scholar 

  90. Seifert V. Clinical management of petroclival meningiomas and the eternal quest for preservation of quality of life: personal experiences over a period of 20 years. Acta Neurochir. 2010;152(7):1099–116. https://doi.org/10.1007/s00701-010-0633-6.

    Article  PubMed  Google Scholar 

  91. Sindou M. Meningiomas invading the sagittal or transverse sinuses, resection with venous reconstruction. J Clin Neurosci. 2001;8(Suppl 1):8–11. https://doi.org/10.1054/jocn.2001.0868.

    Article  PubMed  Google Scholar 

  92. Schmid-Elsaesser R, Steiger HJ, Yousry T, Seelos KC, Reulen HJ. Radical resection of meningiomas and arteriovenous fistulas involving critical dural sinus segments: experience with intraoperative sinus pressure monitoring and elective sinus reconstruction in 10 patients. Neurosurgery. 1997;41(5):1005–16.; discussion 1016-8. https://doi.org/10.1097/00006123-199711000-00001.

    Article  CAS  PubMed  Google Scholar 

  93. Sekhar LN, Chanda A, Morita A. The preservation and reconstruction of cerebral veins and sinuses. J Clin Neurosci. 2002;9(4):391–9. https://doi.org/10.1054/jocn.2001.1008.

    Article  PubMed  Google Scholar 

  94. Buster WP, Rodas RA, Fenstermaker RA, Kattner KA. Major venous sinus resection in the surgical treatment of recurrent aggressive dural based tumors. Surg Neurol. 2004;62(6):522–9.; discussion 529-530. https://doi.org/10.1016/j.surneu.2004.02.020.

    Article  PubMed  Google Scholar 

  95. Sindou MP, Alvernia JE. Results of attempted radical tumor removal and venous repair in 100 consecutive meningiomas involving the major dural sinuses. J Neurosurg. 2006;105(4):514–25. https://doi.org/10.3171/jns.2006.105.4.514.

    Article  PubMed  Google Scholar 

  96. Raza SM, Gallia GL, Brem H, Weingart JD, Long DM, Olivi A. Perioperative and long-term outcomes from the management of parasagittal meningiomas invading the superior sagittal sinus. Neurosurgery. 2010;67(4):885–93.; discussion 893. https://doi.org/10.1227/NEU.0b013e3181ef2a18.

    Article  PubMed  Google Scholar 

  97. Sughrue ME, Rutkowski MJ, Shangari G, Parsa AT, Berger MS, McDermott MW. Results with judicious modern neurosurgical management of parasagittal and falcine meningiomas. Clinical article. J Neurosurg. 2011;114(3):731–7. https://doi.org/10.3171/2010.9.jns10646.

    Article  PubMed  Google Scholar 

  98. Mathiesen T, Pettersson-Segerlind J, Kihlstrom L, Ulfarsson E. Meningiomas engaging major venous sinuses. World Neurosurg. 2014;81(1):116–24. https://doi.org/10.1016/j.wneu.2013.01.095.

    Article  PubMed  Google Scholar 

  99. Kondziolka D, Flickinger JC, Perez B. Judicious resection and/or radiosurgery for parasagittal meningiomas: outcomes from a multicenter review. Gamma Knife Meningioma Study Group. Neurosurgery. 1998;43(3):405–13.; discussion 413-4. https://doi.org/10.1097/00006123-199809000-00001.

    Article  CAS  PubMed  Google Scholar 

  100. Gatterbauer B, Gevsek S, Hoftberger R, Lutgendorf-Caucig C, Ertl A, Mallouhi A, et al. Multimodal treatment of parasagittal meningiomas: a single-center experience. J Neurosurg. 2017;127(6):1249–56. https://doi.org/10.3171/2016.9.jns161859.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Lina Raffaella Barzaghi, Veronica Parisi, Alfio Spina & Pietro Mortini

Authors
  1. Lina Raffaella Barzaghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Veronica Parisi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alfio Spina
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pietro Mortini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lina Raffaella Barzaghi .

Editor information

Editors and Affiliations

  1. Department of Neuroscience, Radiosurgery and Stereotactic Neurosurgery Section – Neurosurgery B Unit, University Hospital, Verona, Italy

    Michele Longhi

  2. Department of Neurological Sciences, Neurosurgery, University of Milan GVM Care & Research – Maria Cecilia Hospital, Cotignola, Italy

    Enrico D. F. Motti

  3. Department of Neuroscience, Radiosurgery and Stereotactic Neurosurgery Section – Neurosurgery B Unit, University Hospital, Verona, Italy

    Antonio Nicolato

  4. Director of Functional Neurosurgery & Gamma Knife Unit, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy

    Piero Picozzi

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Barzaghi, L.R., Parisi, V., Spina, A., Mortini, P. (2021). Combined Microsurgical and Radiosurgical Treatment in Intracranial Meningiomas. In: Longhi, M., Motti, E.D.F., Nicolato, A., Picozzi, P. (eds) Stereotactic Radiosurgery for the Treatment of Central Nervous System Meningiomas. Springer, Cham. https://doi.org/10.1007/978-3-030-79419-4_13

Download citation

Publish with us

Policies and ethics

Search

Navigation