Skip to main content
SpringerLink
Log in

Stereotactic radiosurgery for WHO grade I meningiomas

  • Invited Review
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Meningiomas represent a common intracranial tumor in the adult population. Although extirpation to achieve a gross total resection or at least decrease mass effect has been the mainstay of treatment, stereotactic radiosurgery has come to play an increasingly important role in the management of patients with meningiomas. Radiosurgery utilizes highly focused, beams of ionizing radiation to inactivate tumor cells. Image guidance and a steep dose fall off are critical features of this approach. The radiobiology of radiosurgery differs in certain advantageous ways from conventional radiotherapy. Radiosurgery initially was utilized to treat recurrent or residual skull base meningiomas. As success was observed in this setting, radiosurgery has gradually expanded its role so as to treat convexity meningiomas; it is also used as an upfront treatment for patients for whom clinical and neuro-imaging findings are consistent with a meningioma. Most large series demonstrate tumor control rates for patients with grade I meningiomas in excess of 85%. Neurological function is generally preserved or improved for patients with meningiomas. However, complications can occur. Longitudinal follow-up including neurologic and radiologic assessment is required. Single and multisession stereotactic radiosurgery will likely play an expanded role in the treatment of patients with meningiomas.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Deltour I, Johansen C, Auvinen A, Feychting M, Klaeboe L, Schuz J (2009) Time trends in brain tumor incidence rates in Denmark, Finland, Norway, and Sweden, 1974–2003. J Natl Cancer Inst 101(24):1721–1724

    Article  PubMed  Google Scholar 

  2. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114(2):97–109

    Article  PubMed  Google Scholar 

  3. Kleihues P, Louis DN, Scheithauer BW, Rorke LB, Reifenberger G, Burger PC, Cavenee WK (2002) The who classification of tumors of the nervous system. J Neuropathol Exp Neurol 61(3):215–225 (Discussion: 226–219)

    PubMed  Google Scholar 

  4. Pearson BE, Markert JM, Fisher WS, Guthrie BL, Fiveash JB, Palmer CA, Riley K (2008) Hitting a moving target: evolution of a treatment paradigm for atypical meningiomas amid changing diagnostic criteria. Neurosurg Focus 24(5):E3. doi:10.3171/FOC/2008/24/5/E3

    Article  PubMed  Google Scholar 

  5. Durand A, Labrousse F, Jouvet A, Bauchet L, Kalamarides M, Menei P, Deruty R, Moreau JJ, Fevre-Montange M, Guyotat J (2009) WHO grade ii and iii meningiomas: a study of prognostic factors. J Neurooncol 95(3):367–375

    Article  PubMed  Google Scholar 

  6. Rosenberg LA, Prayson RA, Lee J, Reddy C, Chao ST, Barnett GH, Vogelbaum MA, Suh JH (2009) Long-term experience with World Health Organization grade iii (malignant) meningiomas at a single institution. Int J Radiat Oncol Biol Phys 74(2):427–432

    PubMed  Google Scholar 

  7. Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20(1):22–39

    Article  CAS  PubMed  Google Scholar 

  8. Sughrue ME, Kane AJ, Shangari G, Rutkowski MJ, McDermott MW, Berger MS, Parsa AT (2010) The relevance of Simpson grade i and ii resection in modern neurosurgical treatment of World Health Organization grade i meningiomas. J Neurosurg. doi:10.3171/2010.3.JNS091971

  9. Minniti G, Amichetti M, Enrici RM (2009) Radiotherapy and radiosurgery for benign skull base meningiomas. Radiat Oncol 4:42. doi:1748-717X-4-42[pii]10.1186/1748-717X-4-42

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Clarke RHV (1906) One method of investigating the deep ganglia and tracts of the central nervous system (cerebellum). Br Med J 2:1799–1800

    Google Scholar 

  12. Spiegel E, Wycis H, Marks M, Lee A (1947) Stereotaxic apparatus for operations on the human brain. Science 106:349–350

    Article  CAS  PubMed  Google Scholar 

  13. Leksell L (1992) Brain fragments in radiosurgery. In: Steiner L (ed) Radiosurgery: baseline and trends. Raven Press, New York, pp 623–692

    Google Scholar 

  14. Kirkpatrick JP, Meyer JJ, Marks LB (2008) The linear-quadratic model is inappropriate to model high dose per fraction effects in radiosurgery. Semin Radiat Oncol 18(4):240–243

    Article  PubMed  Google Scholar 

  15. Garcia-Barros M, Paris F, Cordon-Cardo C, Lyden D, Rafii S, Haimovitz-Friedman A, Fuks Z, Kolesnick R (2003) Tumor response to radiotherapy regulated by endothelial cell apoptosis. Science 300(5622):1155–1159

    Article  CAS  PubMed  Google Scholar 

  16. Ma L, Larson D, Petti P, Chuang C, Verhey L (2007) Boosting central target dose by optimizing embedded dose hot spots for gamma knife radiosurgery. Stereotact Funct Neurosurg 85(6):259–263

    Article  PubMed  Google Scholar 

  17. Jagannathan J, Sheehan JP, Pouratian N, Laws ER, Steiner L, Vance ML (2007) Gamma knife surgery for Cushing’s disease. J Neurosurg 106(6):980–987

    Article  PubMed  Google Scholar 

  18. Leber KA, Bergloff J, Langmann G, Mokry M, Schrottner O, Pendl G (1995) Radiation sensitivity of visual and oculomotor pathways. Stereotact Funct Neurosurg 64(Suppl 1):233–238

    PubMed  Google Scholar 

  19. Leber KA, Bergloff J, Pendl G (1998) Dose–response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 88(1):43–50

    Article  CAS  PubMed  Google Scholar 

  20. Chen JC, Giannotta SL, Yu C, Petrovich Z, Levy ML, Apuzzo ML (2001) Radiosurgical management of benign cavernous sinus tumors: dose profiles and acute complications. Neurosurgery 48(5):1022–1030 (Discussion: 1030–1032)

    Article  CAS  PubMed  Google Scholar 

  21. Lim YL, Leem W, Kim TS, Rhee BA, Kim GK (1998) Four years’ experiences in the treatment of pituitary adenomas with gamma knife radiosurgery. Stereotact Funct Neurosurg 70(Suppl 1):95–109

    Article  PubMed  Google Scholar 

  22. Sheehan JM, Vance ML, Sheehan JP, Ellegala DB, Laws ER Jr (2000) Radiosurgery for Cushing’s disease after failed transsphenoidal surgery. J Neurosurg 93(5):738–742

    Article  CAS  PubMed  Google Scholar 

  23. Witt TC, Kondziolka D, Flickinger JC, Lunsford LD (1998) Gamma knife radiosurgery for pituitary tumors. In: Lunsford LD, Kondziolka D, Flickinger J (eds) Gamma knife brain surgery. Progress in neurological surgery, vol 14. Karger, Basel, pp 114–127

    Chapter  Google Scholar 

  24. Noren G, Greitz D, Hirsch A, Lax I (1993) Gamma knife surgery in acoustic tumours. Acta Neurochir Suppl (Wien) 58:104–107

    CAS  Google Scholar 

  25. Sheehan J, Pan HC, Stroila M, Steiner L (2005) Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors. J Neurosurg 102(3):434–441

    Article  PubMed  Google Scholar 

  26. Tishler RB, Loeffler JS, Lunsford LD, Duma C, Alexander E 3rd, Kooy HM, Flickinger JC (1993) Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27(2):215–221

    CAS  PubMed  Google Scholar 

  27. Kondziolka D, Mathieu D, Lunsford LD, Martin JJ, Madhok R, Niranjan A, Flickinger JC (2008) Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 62(1):53–58 (Discussion: 58–60)

    Article  PubMed  Google Scholar 

  28. Lee JY, Niranjan A, McInerney J, Kondziolka D, Flickinger JC, Lunsford LD (2002) Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurg 97(1):65–72

    Article  PubMed  Google Scholar 

  29. Kreil W, Luggin J, Fuchs I, Weigl V, Eustacchio S, Papaefthymiou G (2005) Long term experience of gamma knife radiosurgery for benign skull base meningiomas. J Neurol Neurosurg Psychiatry 76(10):1425–1430

    Article  CAS  PubMed  Google Scholar 

  30. Spiegelmann R, Cohen ZR, Nissim O, Alezra D, Pfeffer R (2010) Cavernous sinus meningiomas: A large linac radiosurgery series. J Neurooncol 98(2):195–202

    Article  PubMed  Google Scholar 

  31. Flickinger JC, Kondziolka D, Maitz AH, Lunsford LD (2003) Gamma knife radiosurgery of imaging-diagnosed intracranial meningioma. Int J Radiat Oncol Biol Phys 56(3):801–806

    PubMed  Google Scholar 

  32. Colombo F, Casentini L, Cavedon C, Scalchi P, Cora S, Francescon P (2009) Cyberknife radiosurgery for benign meningiomas: short-term results in 199 patients. Neurosurgery 64(2 Suppl):A7–A13

    Article  PubMed  Google Scholar 

  33. Adler JR Jr, Gibbs IC, Puataweepong P, Chang SD (2006) Visual field preservation after multisession cyberknife radiosurgery for perioptic lesions. Neurosurgery 59(2):244–254 (Discussion: 253–254)

    Article  PubMed  Google Scholar 

  34. Nicolato A, Foroni R, Pellegrino M, Ferraresi P, Alessandrini F, Gerosa M, Bricolo A (2001) Gamma knife radiosurgery in meningiomas of the posterior fossa. Experience with 62 treated lesions. Minim Invasive Neurosurg 44(4):211–217

    Article  CAS  PubMed  Google Scholar 

  35. Ganz JC, Reda WA, Abdelkarim K (2009) Gamma knife surgery of large meningiomas: early response to treatment. Acta Neurochir (Wien) 151(1):1–8

    Article  CAS  Google Scholar 

  36. DiBiase SJ, Kwok Y, Yovino S, Arena C, Naqvi S, Temple R, Regine WF, Amin P, Guo C, Chin LS (2004) Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 60(5):1515–1519

    PubMed  Google Scholar 

  37. Kondziolka D, Madhok R, Lunsford LD, Mathieu D, Martin JJ, Niranjan A, Flickinger JC (2009) Stereotactic radiosurgery for convexity meningiomas. J Neurosurg 111(3):458–463

    Article  PubMed  Google Scholar 

  38. Sanai N, Sughrue ME, Shangari G, Chung K, Berger MS, McDermott MW (2010) Risk profile associated with convexity meningioma resection in the modern neurosurgical era. J Neurosurg 112(5):913–919

    Article  PubMed  Google Scholar 

  39. Girvigian MR, Chen JC, Rahimian J, Miller MJ, Tome M (2008) Comparison of early complications for patients with convexity and parasagittal meningiomas treated with either stereotactic radiosurgery or fractionated stereotactic radiotherapy. Neurosurgery 62(5 Suppl):A19–A27 (Discussion: A27–A18)

    Article  PubMed  Google Scholar 

  40. Pamir MN, Peker S, Kilic T, Sengoz M (2007) Efficacy of gamma-knife surgery for treating meningiomas that involve the superior sagittal sinus. Zentralbl Neurochir 68(2):73–78

    Article  CAS  PubMed  Google Scholar 

  41. Kim DG, Kim Ch H, Chung HT, Paek SH, Jeong SS, Han DH, Jung HW (2005) Gamma knife surgery of superficially located meningioma. J Neurosurg 102(Suppl):255–258

    Article  PubMed  Google Scholar 

  42. Umansky F, Shoshan Y, Rosenthal G, Fraifeld S, Spektor S (2008) Radiation-induced meningioma. Neurosurg Focus 24(5):E7. doi:10.3171/FOC/2008/24/5/E7

    Article  PubMed  Google Scholar 

  43. Sheehan J, Yen CP, Steiner L (2006) Gamma knife surgery-induced meningiomas. Report of two cases and review of the literature. J Neurosurg 105(2):325–329

    Article  PubMed  Google Scholar 

  44. Pettorini BL, Park YS, Caldarelli M, Massimi L, Tamburrini G, Di Rocco C (2008) Radiation-induced brain tumours after central nervous system irradiation in childhood: a review. Childs Nerv Syst 24(7):793–805

    Article  PubMed  Google Scholar 

  45. Lillehei KO, Donson AM, Kleinschmidt-DeMasters BK (2008) Radiation-induced meningiomas: clinical, cytogenetic, and microarray features. Acta Neuropathol 116(3):289–301

    Article  CAS  PubMed  Google Scholar 

  46. Kondziolka D, Kano H, Kanaan H, Madhok R, Mathieu D, Flickinger JC, Lunsford LD (2009) Stereotactic radiosurgery for radiation-induced meningiomas. Neurosurgery 64(3):463–469 (Discussion: 469–470)

    Article  PubMed  Google Scholar 

  47. Jensen AW, Brown PD, Pollock BE, Stafford SL, Link MJ, Garces YI, Foote RL, Gorman DA, Schomberg PJ (2005) Gamma knife radiosurgery of radiation-induced intracranial tumors: local control, outcomes, and complications. Int J Radiat Oncol Biol Phys 62(1):32–37

    Article  PubMed  Google Scholar 

  48. Cai R, Barnett GH, Novak E, Chao ST, Suh JH (2010) Principal risk of peritumoral edema after stereotactic radiosurgery for intracranial meningioma is tumor–brain contact interface area. Neurosurgery 66(3):513–522

    Article  PubMed  Google Scholar 

  49. Kollova A, Liscak R, Novotny J Jr, Vladyka V, Simonova G, Janouskova L (2007) Gamma knife surgery for benign meningioma. J Neurosurg 107(2):325–336

    Article  PubMed  Google Scholar 

  50. Jain R, Narang J, Sundgren PM, Hearshen D, Saksena S, Rock JP, Gutierrez J, Mikkelsen T (2010) Treatment induced necrosis versus recurrent/progressing brain tumor: going beyond the boundaries of conventional morphologic imaging. J Neurooncol. doi: 10.1007/s11060-010-0139-3

  51. Kano H, Kondziolka D, Lobato-Polo J, Zorro O, Flickinger JC, Lunsford LD (2010) T1/t2 matching to differentiate tumor growth from radiation effects after stereotactic radiosurgery. Neurosurgery 66(3):486–491 (Discussion: 491–492)

    Article  PubMed  Google Scholar 

  52. Liu AK, Macy ME, Foreman NK (2009) Bevacizumab as therapy for radiation necrosis in four children with pontine gliomas. Int J Radiat Oncol Biol Phys 75(4):1148–1154

    CAS  PubMed  Google Scholar 

  53. Levin VA, Bidaut L, Hou P, Kumar AJ, Wefel JS, Bekele BN, Prabhu S, Loghin M, Gilbert MR, Jackson EF (2010) Randomized double-blind placebo-controlled trial of bevacizumab therapy for radiation necrosis of the central nervous system. Int J Radiat Oncol Biol Phys. doi:10.1016/j.ijrobp.2009.12.061

  54. Cahan WG, Woodard HQ, Higinbotham NL, Stewart FW, Coley BL (1998) Sarcoma arising in irradiated bone: report of eleven cases. 1948. Cancer 82(1):8–34

    Article  CAS  PubMed  Google Scholar 

  55. Ganz JC (2002) Gamma knife radiosurgery and its possible relationship to malignancy: a review. J Neurosurg 97(5 Suppl):644–652

    PubMed  Google Scholar 

  56. Rowe J, Grainger A, Walton L, Silcocks P, Radatz M, Kemeny A (2007) Risk of malignancy after gamma knife stereotactic radiosurgery. Neurosurgery 60(1):60–65 (Discussion: 65–66)

    Article  PubMed  Google Scholar 

  57. Brada M, Ford D, Ashley S, Bliss JM, Crowley S, Mason M, Rajan B, Traish D (1992) Risk of second brain tumour after conservative surgery and radiotherapy for pituitary adenoma. BMJ 304(6838):1343–1346

    Article  CAS  PubMed  Google Scholar 

  58. Stafford SL, Pollock BE, Foote RL, Link MJ, Gorman DA, Schomberg PJ, Leavitt JA (2001) Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients. Neurosurgery 49(5):1029–1037 (Discussion: 1037–1038)

    Article  CAS  PubMed  Google Scholar 

  59. Williams BJ, Yen CP, Starke RM, Bhuvaneswara B, Nguyen J, Rainey J, Sherman J, Schlesinger D, Sheehan J (in press) Gamma Knife radiosurgery for parasellar meningiomas: long term results including complications, predictive factors and progression free survival. J Neurosurg

  60. Nicolato A, Foroni R, Alessandrini F, Bricolo A, Gerosa M (2002) Radiosurgical treatment of cavernous sinus meningiomas: experience with 122 treated patients. Neurosurgery 51(5):1153–1159 (Discussion: 1159–1161)

    Article  PubMed  Google Scholar 

  61. Starke RM, Nguyen J, Reames DL, Rainey J, Sheehan JP (2010) Gamma knife radiosurgery of meningiomas involving the foramen magnum. J Craniovert Jun Spine 1:5

    Article  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia Health Sciences Center, P.O. Box 800212, Charlottesville, Virginia, VA 22908, USA

    Jason P. Sheehan, Brian J. Williams & Chun Po Yen

Authors
  1. Jason P. Sheehan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian J. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chun Po Yen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jason P. Sheehan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sheehan, J.P., Williams, B.J. & Yen, C.P. Stereotactic radiosurgery for WHO grade I meningiomas. J Neurooncol 99, 407–416 (2010). https://doi.org/10.1007/s11060-010-0363-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-010-0363-x

Keywords

Search

Navigation