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  • Long Term Follow-up After Stereotactic Radiosurgery For The Treatment of Intracranial Meningiomas

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    John M. McGregor MD; Mario Ammirati MD; Christopher E. Pelloski MD; John Grecula; Nina A Mayr MD; Nilendu Gupta; Lu Lanchun PhD; Susan Bell RN MS CNRN CNP

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Complete surgical resection of intracranial meningiomas including the dura of origin and infiltrated bone remains the treatment of choice. Factors such as residual disease, advanced tumor grade, location within the cranial vault, or patient comorbidities may limit the success of surgery alone. Stereotactic radiosurgery (SRS) expands the options for treatment. We review the outcomes in patients with meningiomas treated with SRS at our institution from 1999 – 2012.

    Methods: A retrospective review was performed of 78 patients with 82 presumed or confirmed meningiomas treated with SRS over the 13 year period. The median age was 56 (range 17-84). There were 19 males and 59 females. The median marginal dose was 15.95 Gy (range 10 -31 Gy) to an averaged 51% isodose line (range 47 – 70%). 39 patients had undergone surgery and 10 patients previous radiation therapy prior to SRS. We report 1, 3, 5 and =10 year followup after SRS.

    Results: The majority (n = 53) of tumors (65%) were located in the falx/parasagital or cerebral convexities while the others (n = 28) involved the skull base (34%). Tumor histology when available included 21 WHO grade I, 15 WHO grade II and 1 WHO grade III meningiomas. 45 patients had no definitive pathology. Seven lesions required further treatment during the follow up period (9%), either further radiation or surgery. Three of these progressive lesions were tumors at the skull base, and 4 were convexity/parasagital in location. Four of these tumors were known WHO grade ll. Two were WHO grade l, and one did not have confirmatory pathology

    Conclusions: Radiosurgery is a reasonable adjunct to management of patients with primary, residual or recurrent meningiomas and presumed meningiomas. The control rates are > 90%. Longer follow up evaluations are still needed.

    Patient Care: Allow clinicians to better discuss the role of SRS in the management of intracranial meningiomas.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1)discuss the role of SRS in the management of intracranial meningiomas, 2) describe the factors that limit the success of radiosurgery, and 3) be able to give reasonable guidelines to patients regarding the likelihood of benefit in SRS for intracranial meningiomas


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