• Adomas Bunevicius, Stylianos Pikis, Rithika Kormath Anand, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, Khaled Abdelkarim, El-ShehabyAmr M NAMNGamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.Neurosurgery Department, Ain Shams University, Cairo, Egypt., Reem M Emad, Tomas Chytka, Roman Liscak, Marco Perez Caceres, David Mathieu, Cheng-Chia Lee, Huai-Che Yang, Piero Picozzi, Andrea Franzini, Luca Attuati, Herwin Speckter, Jeremy Olivo, Samir Patel, Christopher P Cifarelli, Daniel T Cifarelli, Joshua D Hack, Ben A Strickland, Gabriel Zada, Eric L Chang, Kareem R Fakhoury, Chad G Rusthoven, Ronald E Warnick, and Jason Sheehan.
• Department of Neurosurgery, University of Virginia, Charlottesville, VA, 22908, USA.
• Acta Neurochir (Wien). 2021 Oct 1; 163 (10): 2861-2869.

PurposeResection of clinoid meningiomas can be associated with significant morbidity. Experience with stereotactic radiosurgery (SRS) for clinoid meningiomas remains limited. We studied the safety and effectiveness of SRS for clinoid meningiomas.MethodsFrom twelve institutions participating in the International Radiosurgery Research Foundation, we pooled patients treated with SRS for radiologically suspected or histologically confirmed WHO grade I clinoid meningiomas.ResultsTwo hundred seven patients (median age: 56 years) underwent SRS for clinoid meningiomas. Median treatment volume was 8.02 cm3, and 87% of tumors were immediately adjacent to the optic apparatus. The median tumor prescription dose was 12 Gy, and the median maximal dose to the anterior optic apparatus was 8.5 Gy. During a median post-SRS imaging follow-up of 51.1 months, 7% of patients experienced tumor progression. Greater margin SRS dose (HR = 0.700, p = 0.007) and pre-SRS radiotherapy (HR = 0.004, p < 0.001) were independent predictors of better tumor control. During median visual follow-up of 48 months, visual function declined in 8% of patients. Pre-SRS visual deficit (HR = 2.938, p = 0.048) and maximal radiation dose to the optic apparatus of ≥ 10 Gy (HR = 11.297, p = 0.02) independently predicted greater risk of post-SRS visual decline. Four patients experienced new post-SRS cranial nerve V neuropathy.ConclusionsSRS allows durable control of clinoid meningiomas and visual preservation in the majority of patients. Greater radiosurgical prescription dose is associated with better tumor control. Radiation dose to the optic apparatus of ≥ 10 Gy and visual impairment before the SRS increase risk of visual deterioration.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.

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