Surgery followed by radiosurgery: A deliberate valuable strategy in the treatment of intracranial meningioma

• Surgery remains the main treatment of intracranial meningiomas.
• Complete surgical resection is difficult when location of these tumors is close to critical structures.
• Surgery followed by radiosurgery is a safe and effective combined treatment in case of grade 1 meningioma located close to critical structures for which it is safer to leave in place a tumor residual in order to reduce morbidity.

ObjectiveThe aim of our study is to show that surgery followed by Gamma Knife Radiosurgery is an effective and safe combined treatment for the control of intracranial meningiomas located close to critical structures.Materials and methodsThis retrospective study followed 31 patients with intracranial meningioma between 2005 and 2010. We included patients when initial therapeutic decision was deliberate subtotal surgical resection preparing a target for early postoperative GKR. Early MRI was performed to evaluate the tumor residual volume after surgical procedure. Annual MRI was performed to detect any tumor progression.ResultsThe mean follow-up was 4.5 years. The mean margin dose was 14.5 Gy and the mean target volume was 2.4 cm3. The mean progression free survival after combined treatment was 4.4 years in the irradiated target volume and 3.9 years on the limit or remotely of irradiated target volume. Of all patients, we recorded 5 tumor progressions after combined treatment, in-field in 1 case and out-of-field in 4 cases. All tumor progressions were high-grade meningiomas.ConclusionSurgery followed by radiosurgery is a safe and effective combined treatment for intracranial meningiomas. We recommend it in case of meningioma located close to critical structures for which it is safer to leave in place a tumor remnant to reduce morbidity.