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Skull Base Meningiomas

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CyberKnife NeuroRadiosurgery

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Abstract

Surgical excision is the treatment of choice for accessible skull base meningiomas. Nevertheless, a significant subset of complex tumors tightly attached to or encasing neurovascular structures cannot be removed safely. In such patients with residual or progressing disease after incomplete tumor resection, adjuvant external beam radiation therapy (RT) has been traditionally employed with a reported tumor local control up to 90% at 10 years. In the last decades, RT has evolved with the development of conformal and stereotactic techniques with dramatic technical advances in all aspects of treatment with better immobilization, imaging, planning, and treatment. Advanced radio-oncology techniques include intensity-modulated radiotherapy (IMRT), volumetric arc therapy (VMAT), and stereotactic radiotherapy (SRT) and radiosurgery (SRS) which allow for more precise dose delivery to the tumor while limiting the amount of radiation to the sensitive brain structures, i.e., the optic pathway and the brainstem. New radiation techniques, particularly SRS, have progressively emerged as an effective primary treatment of selected meningiomas of the skull base. Large series report local control rates of more than 90% at 5 years following SRS, which remain above 80% at 10–15 years. Although virtually noninvasive, SRS carries a risk of radiation-induced late toxicity, typically cranial nerve deficits causing impaired visual acuity and ocular motility. For patients with large skull base meningiomas or with tumors in close proximity to the optic pathway, fractionated SRS (2–5 fractions) has emerged as an alternative to single-fraction SRS with the hope of reducing the long-term consequences of treatment while maintaining its effectiveness. Currently, SRT and SRS are an essential part of the modern management of skull base meningiomas recurring after surgery or located at difficult accessibility.

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Authors and Affiliations

  1. Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Siena, Italy

    Giuseppe Minniti

  2. Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  3. IRCCS ISNB Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

    Alfredo Conti

  4. Department of Neurosurgery, Charité Faculty of Medicine, Berlin, Germany

    Alfredo Conti

  5. Department of Radiation Oncology, University of Messina, A.O.U. “G. Martino”—Cyberknife Centre of Messina, Messina, Italy

    Antonio Pontoriero

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  1. Giuseppe Minniti
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  2. Alfredo Conti
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  3. Antonio Pontoriero
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Correspondence to Alfredo Conti .

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Editors and Affiliations

  1. Associate Professor of Neurosurgery, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  2. Scientific Director, AB Medica, Milano, Italy

    Pantaleo Romanelli

  3. Assistant Professor, Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Evangelos Pantelis

  4. Associate Professor, Department of Radiation Oncology, Stanford University Cancer Center, Stanford, CA, USA

    Scott G. Soltys

  5. Associate Professor, Department of Neurosurgery and Radiosurgery Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea (Republic of)

    Young Hyun Cho

  6. Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael Lim

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Minniti, G., Conti, A., Pontoriero, A. (2020). Skull Base Meningiomas. In: Conti, A., Romanelli, P., Pantelis, E., Soltys, S., Cho, Y., Lim, M. (eds) CyberKnife NeuroRadiosurgery . Springer, Cham. https://doi.org/10.1007/978-3-030-50668-1_19

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