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Stereotactic radiosurgery for asymptomatic petroclival region meningiomas: a focused analysis from the IMPASSE study

  • Original Article - Tumor—Meningioma
  • Published:
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Abstract

Background

The optimal management of asymptomatic, petroclival meningiomas remains incompletely defined. The purpose of this study was to evaluate the safety and efficacy of upfront stereotactic radiosurgery (SRS) for patients with asymptomatic, petroclival region meningiomas.

Methods

This retrospective, international, multicenter study involved patients treated with SRS for an asymptomatic, petroclival region meningioma. Study endpoints included local tumor control rate, procedural complications, and the emergence of new neurological deficits.

Results

There were 72 patients (22 males, mean age 59.53 years (SD ± 11.9)) with an asymptomatic meningioma located in the petroclival region who were treated with upfront SRS. Mean margin dose and maximum dose were 13.26 (SD ± 2.72) Gy and 26.14 (SD ± 6.75) Gy respectively. Median radiological and clinical follow-up periods post-SRS were 52.5 (IQR 61.75) and 47.5 months (IQR 69.75) respectively. At last follow-up, tumor control was achieved in all patients. SRS-related complications occurred in 6 (8.33%) patients, with 3 of them (4.17%) exhibiting new neurological deficits.

Conclusions

Upfront SRS for asymptomatic, petroclival region meningiomas affords excellent local tumor control and does so with a relatively low risk of SRS-related complications. SRS can be considered at diagnosis of an asymptomatic petroclival region meningioma. If active surveillance is initially chosen, SRS should be recommended when growth is noted during radiological follow-up.

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Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA

    Georgios Mantziaris, Stylianos Pikis, Adomas Bunevicius & Jason Sheehan

  2. Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey

    Selcuk Peker & Yavuz Samanci

  3. Gamma Knife Center Cairo-Nasser Institute, Cairo, Egypt

    Ahmed M. Nabeel, Wael A. Reda, Sameh R. Tawadros, Amr M. N. El-Shehaby, Khaled Abdelkarim & Reem M. Emad

  4. Department of Neurosurgery, Benha University, Benha, Egypt

    Ahmed M. Nabeel

  5. Ain Shams University, Cairo, Egypt

    Wael A. Reda, Sameh R. Tawadros, Amr M. N. El-Shehaby & Khaled Abdelkarim

  6. Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt

    Reem M. Emad

  7. Division of Neurosurgery, Université de Sherbrooke, Centre de Recherché du CHUS, Sherbrooke, Québec, Canada

    Violaine Delabar & David Mathieu

  8. Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan

    Cheng-chia Lee & Huai-che Yang

  9. National Yang-Ming University, Taipei, Taiwan

    Cheng-chia Lee & Huai-che Yang

  10. Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic

    Roman Liscak & Jaromir Hanuska

  11. Department of Radiosurgery, Rúber International Hospital, Madrid, Spain

    Roberto Martinez Alvarez & Nuria Martinez Moreno

  12. Department of Neurosurgery and Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Manjul Tripathi

  13. Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic

    Herwin Speckter & Camilo Albert

  14. Department of Neurosurgery, University of Alberta, Edmonton, Canada

    Greg N. Bowden

  15. Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Ronald J. Benveniste

  16. Department of Neurosurgery, New York University, New York, NY, USA

    Dev N. Patel & Douglas Kondziolka

  17. Department of Radiation Oncology, New York University, New York, NY, USA

    Kenneth Bernstein

  18. Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA

    L. Dade Lunsford

Authors
  1. Georgios Mantziaris
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  2. Stylianos Pikis
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  3. Adomas Bunevicius
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  4. Selcuk Peker
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  5. Yavuz Samanci
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  6. Ahmed M. Nabeel
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  7. Wael A. Reda
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  8. Sameh R. Tawadros
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  9. Amr M. N. El-Shehaby
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  10. Khaled Abdelkarim
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  11. Reem M. Emad
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  12. Violaine Delabar
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  13. David Mathieu
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  14. Cheng-chia Lee
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  15. Huai-che Yang
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  16. Roman Liscak
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  17. Jaromir Hanuska
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  18. Roberto Martinez Alvarez
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  19. Nuria Martinez Moreno
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  20. Manjul Tripathi
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  21. Herwin Speckter
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  22. Camilo Albert
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  23. Greg N. Bowden
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  24. Ronald J. Benveniste
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  25. Dev N. Patel
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  26. Douglas Kondziolka
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  27. Kenneth Bernstein
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  28. L. Dade Lunsford
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  29. Jason Sheehan
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Corresponding author

Correspondence to Jason Sheehan.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of interest

L. Dade Lunsford is a shareholder in Elekta AB, the manufacturer of some radiosurgical devices. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

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Comments

This paper is by a group of experts of SRS and is a timely and important contribution to the pre-existing literature. For many years the dogma was to propose proactive neurosurgical management of meningiomas only in symptomatic patients with growth demonstration. In skull base meningiomas and specially those of the petroclival region (PCM) this attitude was completely justified by the significant risk of morbimortality and the high risk of uncomplete resection carried by microsurgical removal in this difficult anatomical area, even in the best hands (1). The achievement of radiosurgery came along (SRS) this strategy was, by default, applied to SRS. However in small middle size PCM SRS has demonstrated a very low rate of morbidity with no mortality and a high rate of tumor control (2) comparable to the one provided by complete tumor resection including the surrounding dura and bone (3). However, the best safety efficacy is obtained with the smaller tumors in SRS. Thus, numerous neurosurgeons have started to propose upfront radiosurgery in asymptomatic MPC, even in absence of growth demonstration, in order to give to the patient the higher probability of long term tumor control with the lowest risk.

The manuscript is putting under the magnifying glass a subset of patients of an earlier publication on upfront radiosurgery for meningiomas, with a patient selection completely different from the one of the papers (4,5).

This paper shows that upfront SRS in asymptomatic is a safe and efficient option in small and middle size Petroclival Meningiomas and is strongly advocating for upfront SRS in PCM without proof of growth.

Jean-Paul Regis

Marseille, France

This article is part of the Topical Collection on Tumor—Meningioma

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Mantziaris, G., Pikis, S., Bunevicius, A. et al. Stereotactic radiosurgery for asymptomatic petroclival region meningiomas: a focused analysis from the IMPASSE study. Acta Neurochir 164, 273–279 (2022). https://doi.org/10.1007/s00701-021-05056-y

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  • DOI: https://doi.org/10.1007/s00701-021-05056-y

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