Extended Long-Term Outcomes of Single-Fraction Stereotactic Radiosurgery for Primary Management of Sporadic Meningiomas

Introduction: Meningiomas are common intracranial lesions, often with benign pathologic and clinical phenotypes. Stereotactic radiosurgery (SRS) has been utilized as a primary agent for well-selected meningiomas and the durability of tumor control for extended follow-up periods remains outstanding. We sought to identify the long-term outcomes for individuals that underwent SRS as the primary treatment modality for intracranial meningiomas.

Methods: Patients who underwent single-fraction SRS for sporadic meningioma at a single institution from 1997 to 2022.

Results: A total of 679 patients were included, with a mean age of 58 years (range: 27–82); 509 (75%) were female. The most common locations were cavernous sinus (n = 136), parafalcine (n = 128), and petroclival (n = 108); 407 (60%) were incidentally discovered. A total of 312 (46%) lesions had documented interval growth pre-SRS. Mean maximal axial diameter pre-SRS was 2 cm (range: 0.8–4), with mean tumor volume of 6.5 cm³ (range: 0.3–35.4), marginal dose of 15 Gy (range: 12–20), maximal dose of 31 Gy (range: 23.3–45). Following SRS, 67 (10%) developed transient symptoms—notably headache (n = 27) or trigeminal neuralgia/paresthesias (n = 24). Cerebral edema was noted in 79 patients (11.6%), and 27 were placed on steroids (3.9%); 675 (99.4%) did not require procedure intervention for treatment-related complications. Only one patient required CSF diversion for development of hydrocephalus (0.6%). Mean follow-up was 107 months (range: 12–292), with 96% tumor control rate. A total of 353 tumors had >10% volume reduction at last follow-up (52%), 9 (1.3%) underwent salvage surgery (6 were grade II/IIIs), and 6 underwent repeat radiation (0.9%). Tumor site of origin, age at treatment, marginal/maximal dose, biologic equivalent dose, presenting symptoms, nor documented surveillance tumor growth did not predict SRS failure. The 5, 10, and 15-year follow-up tumor control rates were 98.7% (n = 474), 97.1% (n = 267), and 96.7% (n = 105), respectively.

Conclusion: Primary single-fraction SRS is a well-tolerated treatment option for intracranial meningioma with excellent long-term tumor control rates.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
05 February 2024