Clinical and radiologic outcomes after stereotactic radiosurgery for meningiomas in direct contact with the optic apparatus: an international multicenter study

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  • 1 Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;
  • | 2 Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt;
  • | 3 Neurosurgery Department, Benha University, Qalubya, Egypt;
  • | 4 Neurosurgery Department, Ain Shams University, Cairo, Egypt;
  • | 5 Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt;
  • | 6 Clinical Oncology Department, Ain Shams University, Cairo, Egypt;
  • | 7 Stereotactic and Radiation Neurosurgery Department, Na Homolce Hospital, Prague, Czech Republic;
  • | 8 Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada;
  • | 9 Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan;
  • | 10 School of Medicine, National Yang-Ming University, Taipei, Taiwan;
  • | 11 Department of Neurosurgery, Humanitas Clinical and Research Center—IRCCS, Rozzano, Italy;
  • | 12 Centro Gamma Knife Dominicano and CEDIMAT Radiology Department, Santo Domingo, Dominican Republic;
  • | 13 Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Canada;
  • | 14 Department of Neurosurgery, West Virginia University, Morgantown, West Virginia;
  • | 15 Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia;
  • | 16 Department of Neurosurgery, University of Southern California, Los Angeles, California;
  • | 17 Department of Radiation Oncology, University of Southern California, Los Angeles, California;
  • | 18 Department of Radiation Oncology, University of Colorado, Aurora, Colorado;
  • | 19 Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio; and
  • | 20 Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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OBJECTIVE

Resection of meningiomas in direct contact with the anterior optic apparatus carries risk of injury to the visual pathway. Stereotactic radiosurgery (SRS) offers a minimally invasive alternative. However, its use is limited owing to the risk of radiation-induced optic neuropathy. Few SRS studies have specifically assessed the risks and benefits of treating meningiomas in direct contact with the optic nerve, chiasm, or optic tract. The authors hypothesized that SRS is safe for select patients with meningiomas in direct contact with the anterior optic apparatus.

METHODS

The authors performed an international multicenter retrospective analysis of 328 patients across 11 institutions. All patients had meningiomas in direct contract with the optic apparatus. Patients were followed for a median duration of 56 months after SRS. Neurological examinations, including visual function evaluations, were performed at follow-up visits. Clinical and treatment variables were collected at each site according to protocol. Tumor volumes were assessed with serial MR imaging. Variables predictive of visual deficit were identified using univariable and multivariable logistic regression.

RESULTS

SRS was the initial treatment modality for 64.6% of patients, and 93% of patients received SRS as a single fraction. Visual information was available for 302 patients. Of these patients, visual decline occurred in 29 patients (9.6%), of whom 12 (41.4%) had evidence of tumor progression. Visual decline in the remaining 17 patients (5.6%) was not associated with tumor progression. Pre-SRS Karnofsky Performance Status predicted visual decline in adjusted analysis (adjusted OR 0.9, 95% CI 0.9–1.0, p < 0.01). Follow-up imaging data were available for 322 patients. Of these patients, 294 patients (91.3%) had radiographic evidence of stability or tumor regression at last follow up. Symptom duration was associated with tumor progression in adjusted analysis (adjusted OR 1.01, adjusted 95% CI 1.0–1.02, adjusted p = 0.02).

CONCLUSIONS

In this international multicenter study, the vast majority of patients exhibited tumor control and preservation of visual function when SRS was used to treat meningioma in direct contact with the anterior optic pathways. SRS is a relatively safe treatment modality for select patients with perioptic meningiomas in direct contact with the optic apparatus.

ABBREVIATIONS

KPS = Karnofsky Performance Status; SRS = stereotactic radiosurgery.

Supplementary Materials

    • Supplemental Tables S1-S3 (PDF 414 KB)

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  • 1

    Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neurooncol. 2010;99(3):307314.

  • 2

    Marchetti M, Conti A, Beltramo G, et al. Multisession radiosurgery for perioptic meningiomas: medium-to-long term results from a CyberKnife cooperative study. J Neurooncol. 2019;143(3):597604.

    • Search Google Scholar
    • Export Citation
  • 3

    Eddleman CS, Liu JK. Optic nerve sheath meningioma: current diagnosis and treatment. Neurosurg Focus. 2007;23(5):E4.

  • 4

    Taha ANM, Erkmen K, Dunn IF, et al. Meningiomas involving the optic canal: pattern of involvement and implications for surgical technique. Neurosurg Focus. 2011;30(5):E12.

    • Search Google Scholar
    • Export Citation
  • 5

    Schick U, Dott U, Hassler W. Surgical management of meningiomas involving the optic nerve sheath. J Neurosurg. 2004;101(6):951959.

  • 6

    Cohen-Inbar O, Lee CC, Schlesinger D, et al. Long-term results of stereotactic radiosurgery for skull base meningiomas. Neurosurgery. 2016;79(1):5868.

    • Search Google Scholar
    • Export Citation
  • 7

    Kondziolka D, Mathieu D, Lunsford LD, et al. Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery. 2008;62(1):5360.

    • Search Google Scholar
    • Export Citation
  • 8

    Dufour H, Muracciole X, Métellus P, et al. Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with or without previous surgery: is there an alternative to aggressive tumor removal?. Neurosurgery. 2001;48(2):285296.

    • Search Google Scholar
    • Export Citation
  • 9

    Adler JR Jr, Gibbs IC, Puataweepong P, Chang SD. Visual field preservation after multisession CyberKnife radiosurgery for perioptic lesions. Neurosurgery. 2006;59(2):244254.

    • Search Google Scholar
    • Export Citation
  • 10

    Danesh-Meyer HV. Radiation-induced optic neuropathy. J Clin Neurosci. 2008;15(2):95100.

  • 11

    Mihalcea O, Arnold AC. Side effect of head and neck radiotherapy: optic neuropathy. Oftalmologia. 2008;52(1):3640.

  • 12

    Whipple KM, Levi L, Lee MS. The delayed cost of treatment. Surv Ophthalmol. 2013;58(4):370376.

  • 13

    Milano MT, Grimm J, Soltys SG, et al. Single- and multi-fraction stereotactic radiosurgery dose tolerances of the optic pathways. Int J Radiat Oncol. 2021;110(1):8799.

    • Search Google Scholar
    • Export Citation
  • 14

    Minniti G, Amichetti M, Enrici RM. Radiotherapy and radiosurgery for benign skull base meningiomas. Radiat Oncol. 2009;4(1):42.

  • 15

    Stafford SL, Pollock BE, Leavitt JA, et al. A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2003;55(5):11771181.

    • Search Google Scholar
    • Export Citation
  • 16

    Conti A, Pontoriero A, Midili F, et al. CyberKnife multisession stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for perioptic meningiomas: intermediate-term results and radiobiological considerations. Springerplus. 2015;4(1):37.

    • Search Google Scholar
    • Export Citation
  • 17

    Bunevicius A, Anand RK, Suleiman M, et al. Stereotactic radiosurgery for perioptic meningiomas: an international, multicenter study. Neurosurgery. 2021;88(4):828837.

    • Search Google Scholar
    • Export Citation
  • 18

    Sheehan JP, Starke RM, Kano H, et al. Gamma Knife radiosurgery for sellar and parasellar meningiomas: a multicenter study. J Neurosurg. 2014;120(6):12681277.

    • Search Google Scholar
    • Export Citation
  • 19

    Vernimmen FJAI, Slabbert JP. Assessment of the α/β ratios for arteriovenous malformations, meningiomas, acoustic neuromas, and the optic chiasma. Int J Radiat Biol. 2010;86(6):486498.

    • Search Google Scholar
    • Export Citation
  • 20

    Shrieve DC, Hazard L, Boucher K, Jensen RL. Dose fractionation in stereotactic radiotherapy for parasellar meningiomas: radiobiological considerations of efficacy and optic nerve tolerance. J Neurosurg. 2004;101(suppl 3):390395.

    • Search Google Scholar
    • Export Citation
  • 21

    Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996;27(8):13041305.

  • 22

    Yang DY, Sheehan J, Liu YS, et al. Analysis of factors associated with volumetric data errors in gamma knife radiosurgery. Stereotact Funct Neurosurg. 2009;87(1):17.

    • Search Google Scholar
    • Export Citation
  • 23

    Chukwueke UN, Wen PY. Use of the Response Assessment in Neuro-Oncology (RANO) criteria in clinical trials and clinical practice. CNS Oncol. 2019;8(1):CNS28.

    • Search Google Scholar
    • Export Citation
  • 24

    Shaw E, Scott C, Souhami L, et al. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys. 2000;47(2):291298.

    • Search Google Scholar
    • Export Citation
  • 25

    Delgado-Fernández J, García-Pallero MA, Gil-Simoes R, et al. Validation of grading scores and outcome prognostic factors in intracranial meningiomas in elderly patients. World Neurosurg. 2018;114:e1057e1065.

    • Search Google Scholar
    • Export Citation
  • 26

    Ge Y, Liu D, Zhang Z, et al. Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients. Neurosurg Focus. 2019;46(6):E7.

    • Search Google Scholar
    • Export Citation
  • 27

    Theriault BC, Pazniokas J, Adkoli AS, et al. Frailty predicts worse outcomes after intracranial meningioma surgery irrespective of existing prognostic factors. Neurosurg Focus. 2020;49(4):E16.

    • Search Google Scholar
    • Export Citation

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