title: Direct Comparison of Gamma Knife Radiosurgery and Microsurgery for Small Size Meningiomas.
abstract: BACKGROUND
  Patients with small (<3 cm) intracranial meningiomas can be either observed or treated. Treatment can be either radiosurgery or microsurgery if and when tumor progression occurs. We compared local tumor growth control and recurrence-free survival (RFS) of microsurgical resection and radiosurgery in small intracranial meningiomas and identified predictors of unfavorable outcome.
  
  
  METHODS
  A retrospective review (2005-2016) was performed of 90 consecutive patients with intracranial meningiomas who underwent either microsurgery (n = 31) or Gamma Knife radiosurgery (GKRS) (n = 59). The study population was evaluated clinically and radiographically after treatment.
  
  
  RESULTS
  GKRS in meningiomas showed a significantly higher percentage of local control of tumor growth compared with microsurgery (P = 0.02) 5 and 10 years (P = 0.003) after treatment. The median RFS was also significantly higher in the GKRS group compared with the microsurgery group (P = 0.04). There was no difference in RFS between Simpson grade I resection and GKRS (P = 0.69). In univariate analysis, RFS after procedures was significantly affected by tumor involvement of cranial nerves, presence of comorbidities, and preoperative Karnofsky performance scale score ≤70. In multivariate analysis, only preoperative Karnofsky performance scale score ≤70 was a predictor of unfavorable outcome.
  
  
  CONCLUSIONS
  GKRS offers a high rate of tumor control and longer RFS that is comparable to Simpson grade I resection. Subtotal resection is not a good choice for small meningiomas. The treatment procedure should be tailored according to the presence of comorbidities and the maximum benefit for the patient.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA.
authors.forename: Shyamal C
authors.initials: SC
authors.lastname: Bir
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA.
authors.forename: Devi Prasad
authors.initials: DP
authors.lastname: Patra
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA.
authors.forename: Tanmoy Kumar
authors.initials: TK
authors.lastname: Maiti
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA.
authors.forename: Papireddy
authors.initials: P
authors.lastname: Bollam
authors.affiliation: Department of Neurology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA.
authors.forename: Alireza
authors.initials: A
authors.lastname: Minagar
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA. Electronic address: ananda@lsuhsc.edu.
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery*; D008866:Microsurgery / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods / Q000592:standards*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Gamma Knife radiosurgery; Microsurgery; Outcomes and complications; Predictors