Stereotactic Radiosurgery for Cerebellopontine Meningiomas: A Systematic Review and Meta-analysis of Surgical Outcomes. (16th November 2020)

• Record Type: Journal Article
• Authors: Gendreau, Julian L; Sheaffer, Kristin; Macdonald, Nicholas; Kanwar, Ankita; Abraham, Mickey E; Patel, Nitesh V; Lindley, James G
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_891
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Cerebellopontine angle (CPA) meningiomas are often challenging to resect due to their close proximity to surrounding cranial nerves, vascular structures and the cerebellum. In the last 20 years, stereotactic radiosurgery (SRS) has emerged as an innovative modality in treating CPA meningiomas with less post-operative morbidity than microsurgery. METHODS: A systematic search was performed on PubMed, Medline, Emabse and the Cochrane Library. Studies measuring post-operative outcomes in patients undergoing SRS for CPA meningiomas were selected for inclusion. Two reviewers screened and assessed all literature in accordance with Cochrane systematic reviewing standards. After data extraction and Newcastle-Ottawa scale quality assessment, statistical analysis was performed with Review Manager 3.4.5. RESULTS: In total, 10 studies including 540 patients were included. Mean pooled data found an overall tumor control rate of 95.1%, hearing preservation rate of 94.4%, facial nerve preservation rate of 97.9%, trigeminal nerve preservation rate of 94.2%, and an adverse radiation effect (ARE) rate of 6.0% post-operatively. There was a statistically significant increase in post-operative hearing loss in studies with a median tumor volume ≥ 6 cm 3 (RR 2.37 [95% CI 1.08 - 5.21], P = .0322), and in studies with a median marginal dose > 13 Gy (RR 2.17 [95% CI 1.01 - 4.65], P = .0458). AREs were increased in studies with a median maximal dose ≥ 26 Gy (RR 2.67 [95% CI 1.08 - 5.21], P = .0437) and in studies with a median tumor volume < 6 cm 3 (RR 2.67 [95% CI 1.03 - 6.94], P = .0437). Tumor control was not adversely affected by decreased marginal dosing or maximal dosing. CONCLUSION: Radiosurgery is an effective modality for offering excellent tumor control while allowing for minimal morbidity when compared to microsurgery. Post-operative hearing loss is more likely in patients treated with higher marginal dosing (>13 Gy) and in patients that have larger tumor volumes pre-operatively (≥6 cm 3 ). Increased maximal dosing (≥26 Gy) appears to result in more AREs especially with lower tumor volumes. Neurosurgeons should conisder this data when deciding on appropriate dosing regimens for patients.