title: Radiosurgery as definitive management of intracranial meningiomas.
abstract: OBJECTIVE
  Stereotactic radiosurgery has become an important primary or adjuvant minimally invasive management strategy for patients with intracranial meningiomas with the goals of long-term tumor growth prevention and maintenance of patient neurological function. We evaluated clinical and imaging outcomes of meningiomas stratified by histological tumor grade.
  
  
  METHODS
  The patient cohort consisted of 972 patients with 1045 intracranial meningiomas managed during an 18-year period. The series included 70% women, 49% of whom had undergone a previous resection and 5% of whom had received previous fractionated radiation therapy. Tumor locations included middle fossa (n = 351), posterior fossa (n = 307), convexity (n = 126), anterior fossa (n = 88), parasagittal region (n = 113), or other (n = 115).
  
  
  RESULTS
  The overall control rate for patients with benign meningiomas (World Health Organization Grade I) was 93%. In those without previous histological confirmation (n = 482), tumor control was 97%. However, for patients with World Health Organization Grade II and III tumors, tumor control was 50 and 17%, respectively. Delayed resection after radiosurgery was necessary in 51 patients (5%) at a mean of 35 months. After 10 years, Grade 1 tumors were controlled in 91% (n = 53); in those without histology, 95% (n = 22) were controlled. None of the patients developed a radiation-induced tumor. The overall morbidity rate was 7.7%. Symptomatic peritumoral imaging changes developed in 4% of the patients at a mean of 8 months.
  
  
  CONCLUSIONS
  Stereotactic radiosurgery provided high rates of tumor growth control or regression in patients with benign meningiomas with low risk. This study confirms the role of radiosurgery as an effective management choice for patients with small to medium-sized symptomatic, newly diagnosed or recurrent meningiomas of the brain.
authors.affiliation: Department of Neurological Surgery, The Center for Image-guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. kondziolkads@upmc.edu
authors.forename: Douglas
authors.initials: D
authors.lastname: Kondziolka
authors.forename: David
authors.initials: D
authors.lastname: Mathieu
authors.forename: L Dade
authors.initials: LD
authors.lastname: Lunsford
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Martin
authors.forename: Ricky
authors.initials: R
authors.lastname: Madhok
authors.forename: Ajay
authors.initials: A
authors.lastname: Niranjan
authors.forename: John C
authors.initials: JC
authors.lastname: Flickinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome