title: Radiosurgery for large-volume (> 10 cm3) benign meningiomas.
abstract: OBJECTIVE
  Stereotactic radiosurgery (SRS) has proven to be a safe and effective treatment for many patients with intracranial meningiomas. Nevertheless, the morbidity associated with radiosurgery of larger meningiomas is poorly understood.
  
  
  METHODS
  The authors performed a retrospective review of 116 patients who underwent SRS for meningiomas (WHO Grade I) > 10 cm3 between 1990 and 2007, with a minimum follow-up of 12 months. Patients with atypical or malignant meningiomas and those who received prior radiotherapy were excluded. The average tumor volume was 17.5 cm3 (range 10.1-48.6 cm3); the average tumor margin dose was 15.1 Gy (range 12-18 Gy); and the mean follow-up duration was 70.1 months (range 12-199 months).
  
  
  RESULTS
  Tumor control was 99% at 3 years and 92% at 7 years after radiosurgery. Thirty complications after radiosurgery were noted in 27 patients (23%), including 7 cases of seizures, 6 cases of hemiparesis, 5 cases of trigeminal injury, 4 cases of headaches, 3 cases of diplopia, 2 cases each of cerebral infarction and ataxia, and 1 case of hearing loss. Patients with supratentorial tumors experienced a higher complication rate compared with patients with skull base tumors (44% compared with 18%) (hazard ratio 2.9, 95% CI 1.3-6.7, p = 0.01).
  
  
  CONCLUSIONS
  The morbidity associated with SRS for patients with benign meningiomas > 10 cm(3) is greater for supratentorial tumors compared with skull base tumors. Whereas radiosurgery is relatively safe for patients with large-volume skull base meningiomas, resection should remain the primary disease management for the majority of patients with large-volume supratentorial meningiomas.
authors.affiliation: Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Bledsoe
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Link
authors.forename: Scott L
authors.initials: SL
authors.lastname: Stafford
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Park
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Pollock
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001259:Ataxia / Q000453:epidemiology / Q000209:etiology; D002544:Cerebral Infarction / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000453:epidemiology / Q000209:etiology; D006311:Hearing Disorders / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008579:Meningioma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016634:Radiosurgery / Q000009:adverse effects / Q000295:instrumentation*; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000473:pathology* / Q000601:surgery*; D015173:Supratentorial Neoplasms / Q000473:pathology / Q000601:surgery; D055815:Young Adult