gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Stereotactic radiosurgery for the treatment of meningiomas eligible for complete resection

Meeting Abstract

  • Juman Tutunji - University Hospital of Cologne, Cologne, Deutschland
  • Stefan Grau - Klinik und Poliklinik für Allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Uniklinik Köln, Köln, Deutschland
  • Daniel Ruess - Klinik für Stereotaxie und funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Uniklinik Köln, Köln, Deutschland
  • Martin Kocher - Uniklinik Köln, Strahlenklinik, Köln, Deutschland
  • Roland Goldbrunner - Klinikum der Universität zu Köln, Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Maximilian I. Ruge - Klinik für Stereotaxie und funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Uniklinik Köln, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.27.02

doi: 10.3205/17dgnc164, urn:nbn:de:0183-17dgnc1648

Published: June 9, 2017

© 2017 Tutunji et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Microsurgical resection is the first recommended treatment for meningiomas especially if sufficient resection can be achieved (Simpson Grade I&II). Stereotactic radiosurgery (SRS) is established as treatment option for meningiomas considered inoperable due to critical localisation or involvement of vulnerable structures. In this study, we evaluated the efficacy and safety of SRS in cases where a Simpson Grade I or II resection could be achieved but either patient´s wish or condition excluded surgery.

Methods: In this retrospective single-center analysis (1995-2014) we included all patients who underwent single fraction LINAC based SRS for microsurgically resectable (Simpson Grade I&II) cranial meningiomas with clinical follow-up of ≥6 months. Histologically confirmed WHO II&III tumors were excluded. We analyzed local tumor control by magnetic resonance imaging, early (first 6 month after SRS) and late treatment related complications, including symptomatic peritumoral edema requiring steroids (rated by the Common Terminology Criteria for Adverse Events; CTCAEv4.03). Local control was estimated by Kaplan-Meier method.

Results: 85 patients (f:m=65:20, mean age 60 years) were treated with LINAC-SRS for 92 supra- (67.4%) or infratentorial (32.6%) meningiomas localized in skull base (63.0%), convexity (20.7%), parafalcine (14.1%) or other areas (2.2%). Treatment indication was based on documented tumor growth in 71.7 % or recurrence after surgery in 28.3%. Mean follow-up was 68.7 ±48.8 months. Mean tumor volume was 4.1 ±3.6ml, mean radiation parameters were 13.2 ±2.2 Gy surface dose at 65.8 ±13.9% isodose level. The estimated 2-,5-, and 10-year tumor control rate was 99%, 93% and 93%, respectively. Local recurrence was observed in one case after 180.4 months (1.2%) and loco-regional (out of dose) recurrence in five patients after 17.7–155.7 months (5.9%). Minor early complications (headache, dizziness) occurred in 4.7%; one patient suffered from seizures. Late complications encompassed permanent deterioration of cranial nerve function in two cases (CTCAE:1;2) and transient seizures in one patient. Temporary steroid use due to symptomatic peritumoral edema was observed in 7.1%.

Conclusion: SRS can be considered as treatment alternative for patients with meningiomas eligible for Simpson Grade (I&II) resection either refusing or harboring contraindications to microsurgery. SRS treatment provides reasonable long term tumor control with low morbidity rates.