Stereotactic Radiosurgery for the Treatment of Central Nervous System Meningiomas

Foreword
Preface
Contents
1: Introduction
	References
2: Physics and Radiation Dosage Issues in Neuroradiosurgical Treatment of Meningiomas
	2.1	 Materials and Methods: Evidence Collection
	2.2	 Introduction
	2.3	 Equipment and Technology
		2.3.1	 Linear Accelerator
		2.3.2	 CyberKnife
		2.3.3	 Tomotherapy
		2.3.4	 Gamma Knife
	2.4	 Planning Stereotactic Radiosurgery
		2.4.1	 Defining Volumes
		2.4.2	 Prescription and Treatment Plan Assessment
	2.5	 Radiobiology
		2.5.1	 Hypoxia and Reoxygenation
		2.5.2	 Dose Rate
		2.5.3	 Uneven Dose Distribution
		2.5.4	 Irradiated Volume-Associated Complications
	References
3: Imaging Approaches for Radiosurgical Treatment of Meningiomas
	3.1	 Lesions in Specific Locations
	3.2	 Anaplastic and Atypical Meningiomas
	References
4: Medical Management of Meningiomas
	4.1	 Chemotherapy
	4.2	 Growth Factor Receptor Inhibitor Treatment
	4.3	 Hormone Therapy
	4.4	 Target Therapy
	4.5	 Immunotherapy
	4.6	 Combined Drug Therapy
	4.7	 Anti-oedemogenic Treatment
	4.8	 Treatment of Meningioma-Related Seizures
	References
5: Systemic Treatments for Grade II and III Meningiomas (WHO)
	References
6: Gamma Knife Radiosurgery for Posterior Cranial Fossa Meningioma
	6.1	 Introduction
	6.2	 Overview of Posterior Fossa Meningiomas Gamma Knife Treatment
		6.2.1	 Outcomes
		6.2.2	 GK Treatment Planning and Response Assessment
		6.2.3	 Radiobiology, Side Effects and Complications
	6.3	 Conclusions
	References
7: Stereotactic Radiosurgery for Cavernous Sinus Meningiomas
	7.1	 Introduction
	7.2	 Materials and Methods
	7.3	 Results
	7.4	 Discussion
		7.4.1	 Epidemiology, Anatomy and Clinical Data
		7.4.2	 Imaging
		7.4.3	 Surgical Treatment
		7.4.4	 SRS and Its Advantages
		7.4.5	 Comparison of Different Cases
		7.4.6	 Long-Term Complications
			7.4.6.1	 Stroke Risk
			7.4.6.2	 Tumorigenesis and Malignant Transformation
	7.5	 Conclusions
	References
8: Hypofractionated Radiosurgery for Perioptic Meningiomas: Current Practice, Principles, and Treatment Quandary
	8.1	 Introduction
	8.2	 Results of Hypofractionated Radiosurgery for Perioptic Meningiomas
	8.3	 Radiation Tolerance of the Optic Apparatus During Radiosurgery
	8.4	 Alternatives to Hypofractionated Radiosurgery for Perioptic Meningiomas
	8.5	 Conclusions
	References
9: Single- Versus Multiple-Fraction Stereotactic Radiotherapy
	9.1	 Introduction
		9.1.1	 Advanced Fractionated Radiation Techniques
		9.1.2	 Stereotactic Radiosurgery (SRS)
		9.1.3	 Outcomes of Single-Fraction SRS
		9.1.4	 Outcomes of Fractionated SRS
	9.2	 Comparison of Radiotherapy Techniques
	9.3	 Conclusions
	References
10: Atypical and Anaplastic Meningiomas: Is There a Role for Stereotactic Radiosurgery?
	10.1	 Who Grade I Meningiomas
	10.2	 WHO Grade II Meningiomas
	10.3	 WHO Grade III Meningiomas
		10.3.1	 Clinical Case
	10.4	 Conclusions
	References
11: CyberKnife Treatment of Atypical Meningiomas (GII)
	11.1	 Introduction
		11.1.1	 Stereotactic Radiosurgery and the CyberKnife
		11.1.2	 Meningiomas
	11.2	 Materials and Methods
	11.3	 Results
	11.4	 Discussion
	11.5	 Conclusions
	References
12: SRS and Microsurgery: Antagonistic or Complementary in the Treatment of Meningiomas?
	12.1	 Surgical Removal vs. Gamma Knife in Meningiomas
	12.2	 Aim
	12.3	 Materials and Methods
		12.3.1	 Falcine/Parasagittal Meningiomas
		12.3.2	 Symptoms
		12.3.3	 GK Procedures
		12.3.4	 Results of GK
		12.3.5	 Microsurgery Procedures
		12.3.6	 Stereotaxic Procedures
		12.3.7	 Results of Surgery
		12.3.8	 Olfactory Groove Meningiomas
		12.3.9	 Symptoms
		12.3.10 GK Procedures
		12.3.11 Results of GK
		12.3.12 Microsurgical Procedures (15)
		12.3.13 Results After Surgical Removal
		12.3.14 Wait-and-See
	12.4	 Conclusion
	12.5	 Discussion
	References
13: Combined Microsurgical and Radiosurgical Treatment in Intracranial Meningiomas
	13.1	 Treatment of Intracranial Meningiomas: Indications and Different Management Strategies
	13.2	 Combined Microsurgical and Radiosurgical Treatment
		13.2.1	 Key Points for Radiosurgery
		13.2.2	 Clinical Case of Combined Microsurgery and Radiosurgery for Meningioma with Vascular Encasement
	13.3	 Skull Base Meningiomas
		13.3.1	 Cavernous Sinus Meningiomas
		13.3.2	 Petroclival Meningiomas
			13.3.2.1	 Clinical Case of Combined Microsurgical and Radiosurgical Approach in Petroclival Meningioma
	13.4	 Meningiomas Extending into Dural Venous Sinuses
		13.4.1	 Clinical Case: Combined Microsurgical and Radiosurgical Approach in Parasagittal Meningioma
	References
14: SRS in Incidental Meningioma: Whether to Treat and When
	14.1	 Definition
		14.1.1	 Natural History
	14.2	 Management
	14.3	 Conclusions
	References
15: Side Effects of SRS Treatment of Low-Grade Meningioma: Types, Frequency and Management
	15.1	 Introduction
	15.2	 Aims
	15.3	 Materials and Methods
	15.4	 Discussion
		15.4.1	 Pathophysiology of Cerebral Oedema
		15.4.2	 Pathophysiology of Radionecrosis
		15.4.3	 Acute Side Effects
		15.4.4	 Subacute Side Effects
		15.4.5	 Late Side Effects
			15.4.5.1	 Cranial Nerve Deficits
			15.4.5.2	 Malignant Transformation
	15.5	 Conclusions
	References
16: Spinal Meningioma Radiosurgery
	16.1	 Introduction
	16.2	 Presentation and Diagnosis
	16.3	 Treatment Strategies
		16.3.1	 The Problem of Spinal Cord Tolerance
	16.4	 Clinical Experiences
	16.5	 Conclusions
	References
17: Guidelines and Evidence-Based Recommendations for the Radiosurgical Treatment of CNS Meningiomas
	17.1	 Introduction
	17.2	 Available Guidelines
	17.3	 Summary of Findings
	17.4	 Conclusions
	References