Abstract
Meningiomas are common intracranial tumors in the adult population. The management of intracranial meningiomas depends on specific patient factors and tumor characteristics. When treatment is deemed necessary, surgical resection remains the primary intervention, with gross total resection (GTR) representing the gold standard. When GTR cannot be safely achieved without a significant risk of neurological compromise, residual tumor can be treated with fractionated radiation therapy or stereotactic radiosurgery (SRS) depending on the location and volume of residual disease. The contemporary therapeutic landscape has paved way for SRS as an integral therapeutic modality for patients with meningioma. SRS was initially confined to the setting of recurrent or residual skull base meningiomas. With broadened experience and progressively successful outcomes for these types of meningiomas, the indications for SRS have gradually expanded to include parasagittal, parafalcine, and convexity meningiomas. SRS can also serve as an upfront treatment for patients presenting with clinical and radiographic features consistent with a benign (WHO grade I) meningioma. SRS has enjoyed particular efficacy as a primary or adjunctive treatment for grade I meningiomas, primarily those tumors located at the skull base, where the operative morbidity is particularly high with aggressive resection [1-3]. The majority of contemporary SRS series of patients with WHO grade I meningiomas report tumor control rates in excess of 85%. The role of SRS for WHO grade II and III meningiomas remains less established, with relatively sparse literature describing radiosurgical outcomes for these uncommon, aggressive tumors [4, 5]. Nevertheless, nascent reports suggest that SRS may play an important role in the management of residual or recurrent grade II and III meningiomas [6]. Futures studies will hopefully further delineate this role. As with any modern surgical technique, potential benefits are not devoid of complications. While complications can occur, neurological function is generally preserved. Longitudinal follow-up including neurologic and radiologic assessment is required for an effective radiosurgical therapeutic regimen. Single and multisession stereotactic radiosurgery will likely play an expanding role in the treatment of patients with meningiomas going forward. © 2016 Nova Science Publishers, Inc. All rights reserved.