Stereotactic radiosurgery for cerebellopontine meningiomas: a systematic review and meta-analysis

• Published in: British journal of neurosurgery Vol. 37; no. 2; pp. 199 - 205
• Main Authors: Gendreau, Julian L., Sheaffer, Kristin, Macdonald, Nicholas, Craft-Hacherl, Caitlin, Abraham, Mickey, Patel, Nitesh V., Herschman, Yehuda, Lindley, James G.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.04.2023; Taylor & Francis Ltd
• Subjects: Brain cancer; Cerebellopontine angle; Follow-Up Studies; Hearing loss; Hearing Loss - complications; Hearing Loss - surgery; hearing preservation; Humans; marginal dose; maximal dose; Meningeal Neoplasms - complications; Meningeal Neoplasms - radiotherapy; Meningeal Neoplasms - surgery; meningioma; Meningioma - complications; Meningioma - radiotherapy; Meningioma - surgery; Meta-analysis; outcomes; postmeatal; premeatal; Radiosurgery; Radiosurgery - adverse effects; Radiosurgery - methods; Retrospective Studies; stereotactic radiosurgery; Surgical outcomes; Treatment Outcome; meningioma; premeatal; hearing preservation; postmeatal; outcomes; maximal dose; marginal dose; Cerebellopontine angle; stereotactic radiosurgery
• ISSN: 0268-8697; 1360-046X
• DOI: 10.1080/02688697.2022.2064425

To (1) measure surgical outcomes associated with stereotactic radiosurgery treatment of cerebellopontine angle meningiomas, and (2) determine if differences in radiation dosages or preoperative tumor volumes affect surgical outcomes. A systematic search was performed on the PubMed, Medline, Embase and Cochrane Library databases searching for patients under stereotactic radiosurgery for meningiomas of the cerebellopontine angle. After data extraction and Newcastle-Ottawa scale quality assessment, meta-analysis of the data was performed with Review Manager 3.4.5. In total, 6 studies including 406 patients were included. Postprocedure, patients had minimal cranial nerve complications while having an overall tumor control rate of 95.6%. Complications were minimal with facial nerve deficits occurring in 2.4%, sensation deficits of the trigeminal nerve in 4.0%, hearing loss in 5.9%, hydrocephalus in 2.0% and diplopia in 2.6% of all patients. Individuals with tumors extending into the internal auditory canal extension did not have significantly increases in hearing loss. There was a higher likelihood of tumor regression on postprocedure imaging in studies with a median prescription dose of >13 Gy (RR 1.27 [95% CI 1.04-1.56, p = 0.0225). There was no evidence of publication bias detected. Radiosurgery is an effective modality for offering excellent tumor control of CPA meningiomas while allowing for only minimal complications postprocedure. A higher prescription dose may achieve higher tumor regression at follow up. Future studies should aim at establishing and optimizing accurate dosimetric guidelines for this patient population.