Abstract
Background: Meningiomas in close proximity to the optic pathway are commonly candidates for microsurgical decompression. More so large perioptic meningiomas. However, microsurgery itself imposes risk to vision and the larger the tumor the more the risk and lesser possibility of postoperative visual recovery. Fractionated radiotherapy is usually reserved for such cases. Objective: The purpose of this study is to assess the long-term efficacy and safety of single-session stereotactic radiosurgery for large (10 cc or more) perioptic intracranial benign meningiomas. Patients and methods: In this retrospective study we included 175 patients with large perioptic benign meningiomas (³ 10 cc) who were treated by single-session SRS. Perioptic meningiomas were defined as meningiomas touching, compressing or within 3 mm of the optic pathway. The median tumor volume was 15 (10-57.3 cc (IQR 8.4 cc)). The median prescription dose was 12 Gy (9-14 Gy (IQR 1 Gy)). Results: The median follow up period was 72 months (13-217 months (IQR 65 months)). The tumor control rate was 92%. The PFS at 5- and 10- years was 97% and 80%. Favorable (better/stable) visual outcome was reported in 169 patients (97%) and unfavorable (worse) outcome in 6 patients (3%). Temporary adverse radiation effects were observed in 21 patients (12%) but only 7 (4%) were symptomatic. Sixty-three patients had a blind/non-useful eye according the pre-treatment visual field examination. Visual improvement was observed in blind/non-useful eye in 17 patients (27%) while vision remained unchanged in 46 patients (73%). Ocular nerve palsy improved in 36 patients (61%). Tumor shrinkage was not a prerequisite for cranial nerve improvement. Conclusion: Stereotactic radiosurgery provides an effective and safe treatment option for large perioptic meningiomas. |
