title: Surgery followed by radiosurgery: a deliberate valuable strategy in the treatment of intracranial meningioma.
abstract: OBJECTIVE
  The aim of our study is to show that surgery followed by Gamma Knife Radiosurgery is an effective and safe combined treatment for the control of intracranial meningiomas located close to critical structures.
  
  
  METHODS
  This retrospective study followed 31 patients with intracranial meningioma between 2005 and 2010. We included patients when initial therapeutic decision was deliberate subtotal surgical resection preparing a target for early postoperative GKR. Early MRI was performed to evaluate the tumor residual volume after surgical procedure. Annual MRI was performed to detect any tumor progression.
  
  
  RESULTS
  The mean follow-up was 4.5 years. The mean margin dose was 14.5 Gy and the mean target volume was 2.4 cm3. The mean progression free survival after combined treatment was 4.4 years in the irradiated target volume and 3.9 years on the limit or remotely of irradiated target volume. Of all patients, we recorded 5 tumor progressions after combined treatment, in-field in 1 case and out-of-field in 4 cases. All tumor progressions were high-grade meningiomas.
  
  
  CONCLUSIONS
  Surgery followed by radiosurgery is a safe and effective combined treatment for intracranial meningiomas. We recommend it in case of meningioma located close to critical structures for which it is safer to leave in place a tumor remnant to reduce morbidity.
authors.affiliation: Department of Neurosurgery, Lille University Hospital, rue Emile Laine, 59000 Lille, France. Electronic address: rabihdoc@hotmail.com.
authors.forename: Rabih
authors.initials: R
authors.lastname: Aboukais
authors.affiliation: Department of Neurosurgery, Lille University Hospital, rue Emile Laine, 59000 Lille, France.
authors.forename: Fahed
authors.initials: F
authors.lastname: Zairi
authors.affiliation: Department of Neurosurgery, Lille University Hospital, rue Emile Laine, 59000 Lille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Reyns
authors.affiliation: Department of Neurosurgery, Lille University Hospital, rue Emile Laine, 59000 Lille, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Le Rhun
authors.affiliation: Department of Neurosurgery, Lille University Hospital, rue Emile Laine, 59000 Lille, France.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Touzet
authors.affiliation: Department of Neurosurgery, Lille University Hospital, rue Emile Laine, 59000 Lille, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Blond
authors.affiliation: Department of Neurosurgery, Lille University Hospital, rue Emile Laine, 59000 Lille, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Lejeune
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods*; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Combined treatment; Meningioma; Progression free survival; Radiosurgery