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Upfront stereotactic radiosurgery versus adjuvant radiosurgery for parasagittal and parafalcine meningiomas: a systematic review and meta-analysis

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Abstract

Parafalcine and parasagittal (PFPS) are common locations for meningiomas. Surgical resection for these tumors, the first-line treatment, poses challenges due to their proximity to critical structures. This systematic review investigates the use of stereotactic radiosurgery (SRS) as a treatment for PFPS meningiomas, aiming to elucidate its safety and efficacy. The review adhered to PRISMA guidelines. Searches were conducted on MEDLINE, Embase, and Cochrane. Inclusion criteria involved studies on SRS for PFPS meningiomas, reporting procedure outcomes and complications. Tumors were presumed or confirmed to be WHO grade 1. Data was systematically extracted. Meta-analysis was performed where applicable. The review included data from eight studies, 821 patients with 878 lesions. Tumor control was achieved in greater than 80% of cases. Adverse radiation effects were reported in 7.3% of them. Recurrence and further surgical approach were observed in 17.1% and 9.2% of cases, respectively. Symptom improvement was noted in 33.2% of patients. Edema occurred in approximately 25.1% of patients. A subgroup of 283 patients had upfront SRS, achieving tumor control in approximately 97% of such cases. SRS is a safe and effective treatment for PFPS meningiomas, both as an adjuvant therapy and as an upfront treatment for often smaller tumors. Post-SRS edema can typically be managed medically and usually does not require further surgical intervention. Further studies should provide more specific data on PFPS meningiomas. The use of single and hypofractionated SRS for larger volume PFPS meningiomas should be more explored to better define the risks and benefits.

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Authors and Affiliations

  1. Vivian L Smith, Department of Neurosurgery, Texas Institute for Restorative Neurotechnologies, UTHealth Houston, 6431 Fannin St, Houston, TX, 77030, USA

    Fernando De Nigris Vasconcellos, Pavel Pichardo-Rojas, Jowah Gorbachev & Josh Bandopadhay

  2. Department of Neurosurgery, University of Miami, Miami, USA

    Augusto Muller Fieldler, Hayes Fountain & Timoteo Almeida

  3. Department of Neurosurgery, Rutgers University, Newark, USA

    Elad Mashiach

  4. Department of Neurosurgery, New York University, New York, USA

    Brandon Santhumayor

  5. Department of Neurosurgery, University of Virginia, Charlottesville, USA

    Jason Sheehan

Authors
  1. Fernando De Nigris Vasconcellos
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Contributions

F.D.N.V participated in screening studies, extracting data, meta-analysis, and writing the manuscript. P.P.R and A.M.F were involved in the screening of studies, and tables and figures creation. B.S., J.G., H.F., J.B., were involved in data extraction and bias assessment. E.M. was responsible for descriptive and meta-analyses, while also doing the first review of the manuscript. T.A. and J.S. were responsible for the final review of the manuscript, and mentorship throughout its elaboration.

Corresponding author

Correspondence to Fernando De Nigris Vasconcellos.

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Not applicable. This review followed the PRISMA guidelines for systematic reviews.

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De Nigris Vasconcellos, F., Pichardo-Rojas, P., Fieldler, A.M. et al. Upfront stereotactic radiosurgery versus adjuvant radiosurgery for parasagittal and parafalcine meningiomas: a systematic review and meta-analysis. Neurosurg Rev 47, 127 (2024). https://doi.org/10.1007/s10143-024-02360-w

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