• Dale Ding, Robert M Starke, Hideyuki Kano, Peter Nakaji, Gene H Barnett, David Mathieu, Veronica Chiang, Sacit B Omay, Judith Hess, Heyoung L McBride, Norissa Honea, John Y K Lee, Gazanfar Rahmathulla, Wendi A Evanoff, Michelle Alonso-Basanta, L Dade Lunsford, and Jason P Sheehan.
• *Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia; ‡Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; §Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona; ¶Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio; ‖Department of Surgery, Division of Neurosurgery, University of Sherbrooke, Sherbrooke, Quebec, Canada; #Department of Neurosurgery, Yale University, New Haven, Connecticut; and **Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania.
• Neurosurgery. 2014 Oct 1;75(4):398-408; quiz 408.

BackgroundResection of cerebellopontine angle (CPA) meningiomas may result in significant neurological morbidity. Radiosurgery offers a minimally invasive alternative to surgery.ObjectiveTo evaluate, in a multicenter cohort study, the outcomes of patients harboring CPA meningiomas who underwent Gamma Knife radiosurgery (GKRS).MethodsFrom 7 institutions participating in the North American Gamma Knife Consortium, 177 patients with benign CPA meningiomas treated with GKRS and at least 6 months radiologic follow-up were included for analysis. The mean age was 59 years and 84% were female. Dizziness or imbalance (48%) and cranial nerve (CN) VIII dysfunction (45%) were the most common presenting symptoms. The median tumor volume and prescription dose were 3.6 cc and 13 Gy, respectively. The mean radiologic and clinical follow-up durations were 47 and 46 months, respectively. Multivariate regression analyses were performed to identify the predictors of tumor progression and neurological deterioration.ResultsThe actuarial rates of progression-free survival at 5 and 10 years were 93% and 77%, respectively. Male sex (P = .014), prior fractionated radiation therapy (P = .010), and ataxia at presentation (P = .002) were independent predictors of tumor progression. Symptomatic adverse radiation effects and permanent neurological deterioration were observed in 1.1% and 9% of patients, respectively. Facial spasms at presentation (P = .007) and lower maximal dose (P = .011) were independently associated with neurological deterioration.ConclusionGKRS is an effective therapy for CPA meningiomas. Depending on the patient and tumor characteristics, radiosurgery can be an adjuvant treatment to initial surgical resection or a standalone procedure that obviates the need for resection in most patients.

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