title: Stereotactic radiosurgery for cerebellopontine angle meningiomas.
abstract: OBJECTIVE
  To assess the long-term outcomes of stereotactic radiosurgery (SRS) for cerebellopontine angle (CPA) meningiomas, the authors retrospectively reviewed data from a 20-year experience. They evaluated progression-free survival as well as improvement, stabilization, or deterioration in clinical symptoms.
  
  
  METHODS
  Seventy-four patients with CPA meningiomas underwent SRS involving various Gamma Knife technologies between 1990 and 2010. The most common presenting symptoms were dizziness or disequilibrium, hearing loss, facial sensory dysfunction, and headache. The median tumor volume was 3.0 cm(3) (range 0.3-17.1 cm(3)), and the median radiation dose to the tumor margin was 13 Gy (range 11-16 Gy). The median follow-up period was 40 months (range 4-147 months).
  
  
  RESULTS
  At last imaging follow-up, the tumor volume had decreased in 46 patients (62%), remained stable in 26 patients (35%), and increased in 2 patients (3%). The progression-free survival after SRS was 98% at 1 year, 98% at 3 years, and 95% at 5 years. At the last clinical follow-up, 23 patients (31%) showed neurological improvement, 43 patients (58%) showed no change in symptoms or signs, and 8 patients (11%) had worsening symptoms or signs. The neurological improvement rate after SRS was 16% at 1 year, 31% at 3 years, and 40% at 5 years. The post-SRS deterioration rate was 5% at 1 year, 10% at 3 years, and 16% at 5 years. A multivariate analysis demonstrated that trigeminal neuralgia was the symptom most likely to worsen after SRS (HR 0.08, 95% CI 0.02-0.31; p = 0.001). Asymptomatic peritumoral edema occurred in 4 patients (5%) after SRS, and symptomatic adverse radiation effects developed in 7 patients (9%).
  
  
  CONCLUSIONS
  Stereotactic radiosurgery for CPA meningiomas provided a high tumor control rate and relatively low risk of ARE. Tumor compression of the trigeminal nerve by a CPA meningioma resulted in an increased rate of facial pain worsening in this patient experience.
authors: Departments of Neurological Surgery and.
authors: Seong-Hyun
authors: SH
authors: Park
authors: Hideyuki
authors: H
authors: Kano
authors: Ajay
authors: A
authors: Niranjan
authors: John C
authors: JC
authors: Flickinger
authors: L Dade
authors: LD
authors: Lunsford
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002530:Cerebellopontine Angle / Q000601:surgery*; D018572:Disease-Free Survival; D005155:Facial Nerve Diseases / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006319:Hearing Loss, Sensorineural / Q000209:etiology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008579:Meningioma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D013997:Time Factors; D014277:Trigeminal Neuralgia / Q000209:etiology / Q000601:surgery