Stereotactic radiosurgery for anterior foramen magnum meningiomas

BACKGROUND Total microsurgical resection is the procedure of choice for gro wing and symptomatic foramen magnum meningiomas. We hypothesized that for p atients with advanced age, complicating medical conditions, or residual or recurrent meningiomas at the foramen magnum, stereotactic radiosurgery woul d be a useful adjunctive (n = 2) or alternative (n = 3) treatment. METHODS We report our experience in five elderly patients (23-84 years) who underwent gamma knife radiosurgery. The median tumor volume was 10.5 mi an d the tumor margin dose varied from 10 to 16 Gy. Because of the irregular t umor volumes along the inferior clivus, multiple isocenters of irradiation were required (range, 2-8; mean 4.4). RESULTS During the follow-up interval of 1-5 years (median, 3 years), one p atient died of an intercurrent illness, and all remaining patients were sta ble without any further deterioration in their clinical condition. Follow-u p imaging studies revealed a reduction in tumor volume in one patient and n o further growth in the remaining four. CONCLUSION We believe that stereotactic radiosurgery provides safe and effe ctive management for patients who are poor candidates for resection of thei r foramen magnum meningiomas. (C) 1999 by Elsevier Science Inc.