Long-term outcomes after meningioma radiosurgery: physician and patient perspectives

Object. Stereotactic radiosurgery is a primary or adjuvant management appro ach used to treat patients with intracranial meningiomas. The goal of radio surgery is long-term prevention of tumor growth, maintenance or the patient 's neurological function, and prevention of new neurological deficits. The object of this study is to report long-term patient outcomes. Methods. The authors evaluated 99 consecutive patients who underwent radios urgery for meningioma between 1987 and 1992. Evaluation was performed using serial imaging tests, clinical evaluations, and a patient survey that was administered between 5 and 10 years after radiosurgery. Four patients under went two radiosurgery procedures for separate meningiomas. The average tumo r margin dose was 16 Gy and the median tumor volume was 4.7 ml (range 0.24- 24 ml). Fifty-seven patients (57%) had undergone prior resection. of which 12 procedures were considered "total." Five patients received fractionated radiation therapy before radiosurgery. Eighty-nine patients (89%) had skull base tumors. The clinical tumor control rate (no resection required) was 93%. Sixty-one (63%) of 97 tumors became smaller, 31 (32%,) remained unchanged in size, an d five (5%) were enlarged. Resection was performed in seven patients (7%), six of whom had undergone prior resection. New neurological deficits develo ped in five patients (5%) 3 to 31 months after radiosurgery. Twenty-seven ( 42%) of 65 responding patients were employed at the time of radiosurgery an d 70 (74%) of these remained so. Radiosurgery was believed to have been "su ccessful" by 67 of 70 patients who completed an outcomes questionnaire 5 to 10 years later. At least one complication was described by nine patients ( 14%) and in foul patients the complications resolved. Conclusions. Five to 10 years after radiosurgery. 96% of surveyed patients believed that radiosurgery provided a satisfactory outcome for their mening ioma. Overall, 93% of patients required no other tumor surgery. Incidences of morbidity in this early experience were usually transitory and relativel y mild. Radiosurgery provided long-term tumor control associated with high rates of neurological function preservation and patient satisfaction.