Radiosurgery for Meningiomas

Radiosurgery is a cornerstone of meningioma management and can be used for primary treatment, treatment of postoperative residual disease, and treatment of recurrences. Evidence over the last 30 years has demonstrated that radiosurgery is an effective and safe treatment with high tumor control rates and low side effect profiles. For patients with large or symptomatic meningiomas, surgery is still the mainstay of treatment, but there has been a paradigm shift in surgical care of this disease with a focus on functional preservation and complication avoidance, in part due to the impact radiosurgery has had as an effective adjuvant treatment. It should be noted that fractionated radiotherapy also remains an alternative strategy for achieving tumor control for diffuse recurrent tumors as well as to the resection cavities of higher-grade meningiomas. Recent implementation of DOTATATE positron emission tomography (PET) imaging can also help define meningioma boundaries, with a possible impact on radiosurgery treatment planning and gauging follow-up response. This chapter will review the current state of radiosurgery care for patients with meningiomas, including guidelines and key clinical studies that highlight the efficacy of this treatment strategy. Discussions mostly center around the impact of radiosurgery for WHO grade 1 or imaging-defined meningiomas.