• Youngbeom Seo, Dong Gyu Kim, Jin Wook Kim, Jung Ho Han, Hyun-Tai Chung, and Sun-Ha Paek.
• Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
• Neurosurgery. 2018 Nov 1; 83 (5): 1040-1049.

BackgroundGamma knife radiosurgery (GKRS) is recognized as an important treatment modality for meningioma.ObjectiveTo analyze the long-term outcomes in meningioma patients treated with GKRS to determine the risk factors related to treatment failure and peritumoral edema (PTE) development.MethodsBetween 1998 and 2010, 770 consecutive patients were treated with GKRS for intracranial meningioma. After the exclusion of patients with follow-up periods of less than 5 yr and those with neurofibromatosis, multiple meningiomas, nonbenign meningioma, or radiotherapy, a total of 424 patients were enrolled in this study. The median follow-up duration was 92 mo. The median tumor volume was 4.35 cm3, and the median marginal dose was 14 Gy.ResultsThe overall local tumor control rate was 84%. The actuarial tumor control rates were 91.7% and 78.9% at 5 and 10 yr, respectively. The tumor control rate of a radiologically diagnosed tumor was higher than that of a grade I tumor (82% vs 70.1% at 10 yr, P = .001). In multivariate analysis, factors associated with tumor progression were female sex (hazard ratio: 0.5, P = .025) and a previous history of craniotomy (hazard ratio: 1.9, P = .009). Symptomatic PTE was identified in 36 (8.5%) patients, and the factor associated with poor PTE was the presence of PTE before GKRS (odds ratio: 4.6, P < .001). Permanent complication rate was 4%.ConclusionGKRS appears to be an effective treatment modality for meningioma with long-term follow-up. However, the identification of delayed tumor progression in our study suggests that extended follow-up data should be collected after GKRS.

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