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Stereotactic radiosurgery for clinoid meningiomas: a multi-institutional study

  • Original Article - Tumor - Meningioma
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Abstract

Purpose

Resection of clinoid meningiomas can be associated with significant morbidity. Experience with stereotactic radiosurgery (SRS) for clinoid meningiomas remains limited. We studied the safety and effectiveness of SRS for clinoid meningiomas.

Methods

From twelve institutions participating in the International Radiosurgery Research Foundation, we pooled patients treated with SRS for radiologically suspected or histologically confirmed WHO grade I clinoid meningiomas.

Results

Two hundred seven patients (median age: 56 years) underwent SRS for clinoid meningiomas. Median treatment volume was 8.02 cm3, and 87% of tumors were immediately adjacent to the optic apparatus. The median tumor prescription dose was 12 Gy, and the median maximal dose to the anterior optic apparatus was 8.5 Gy. During a median post-SRS imaging follow-up of 51.1 months, 7% of patients experienced tumor progression. Greater margin SRS dose (HR = 0.700, p = 0.007) and pre-SRS radiotherapy (HR = 0.004, p < 0.001) were independent predictors of better tumor control. During median visual follow-up of 48 months, visual function declined in 8% of patients. Pre-SRS visual deficit (HR = 2.938, p = 0.048) and maximal radiation dose to the optic apparatus of ≥ 10 Gy (HR = 11.297, p = 0.02) independently predicted greater risk of post-SRS visual decline. Four patients experienced new post-SRS cranial nerve V neuropathy.

Conclusions

SRS allows durable control of clinoid meningiomas and visual preservation in the majority of patients. Greater radiosurgical prescription dose is associated with better tumor control. Radiation dose to the optic apparatus of ≥ 10 Gy and visual impairment before the SRS increase risk of visual deterioration.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of Virginia, Charlottesville, VA, 22908, USA

    Adomas Bunevicius, Stylianos Pikis, Rithika Kormath Anand & Jason Sheehan

  2. Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt

    Ahmed M. Nabeel, Wael A. Reda, Sameh R. Tawadros, Khaled Abdelkarim, Amr M. N. El-Shehaby & Reem M. Emad

  3. Neurosurgery Department, Benha University, Qalubya, Egypt

    Ahmed M. Nabeel

  4. Neurosurgery Department, Ain Shams University, Cairo, Egypt

    Wael A. Reda, Sameh R. Tawadros, Khaled Abdelkarim & Amr M. N. El-Shehaby

  5. National Cancer Institute, Cairo, Egypt

    Reem M. Emad

  6. Stereotactic and Radiation Neurosurgery Department, Na Homolce Hospital, Prague, Czech Republic

    Tomas Chytka & Roman Liscak

  7. Department of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada

    Marco Perez Caceres & David Mathieu

  8. Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan

    Cheng-chia Lee & Huai-che Yang

  9. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Cheng-chia Lee & Huai-che Yang

  10. Department of Neurosurgery, Humanitas Clinical and Research Center – IRCCS, Rome, Italy

    Piero Picozzi, Andrea Franzini & Luca Attuati

  11. Centro Gamma Knife Dominicano and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic

    Herwin Speckter & Jeremy Olivo

  12. Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Canada

    Samir Patel

  13. Department of Neurosurgery, West Virginia University, Morgantown, USA

    Christopher P. Cifarelli & Daniel T. Cifarelli

  14. Department of Radiation Oncology, West Virginia University, Morgantown, USA

    Christopher P. Cifarelli & Joshua D. Hack

  15. Department of Neurosurgery, University of Southern California, Los Angeles, USA

    Ben A. Strickland & Gabriel Zada

  16. Department of Radiation Oncology, University of Southern California, Los Angeles, USA

    Eric L. Chang

  17. Department of Radiation Oncology, University of Colorado, Boulder, USA

    Kareem R. Fakhoury & Chad G. Rusthoven

  18. Gamma Knife Center, Mayfield Clinic, Cincinnati, OH, USA

    Ronald E. Warnick

Authors
  1. Adomas Bunevicius
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  2. Stylianos Pikis
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  20. Jeremy Olivo
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  24. Joshua D. Hack
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  26. Gabriel Zada
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  27. Eric L. Chang
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  28. Kareem R. Fakhoury
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  29. Chad G. Rusthoven
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  30. Ronald E. Warnick
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  31. Jason Sheehan
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Corresponding author

Correspondence to Jason Sheehan.

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Conflict of interest

R.L. consultant of Elekta; C.P.C. Carl Zeiss Meditech AG (Speaking Honoraium, unrelated).

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Bunevicius, A., Pikis, S., Anand, R.K. et al. Stereotactic radiosurgery for clinoid meningiomas: a multi-institutional study. Acta Neurochir 163, 2861–2869 (2021). https://doi.org/10.1007/s00701-021-04972-3

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