Stereotactic radiosurgery for clinoid meningiomas: a multi-institutional study

Adomas Bunevicius, Stylianos Pikis, Rithika Kormath Anand, Ahmed M. Nabeel, Wael A. Reda, Sameh R. Tawadros, Khaled Abdelkarim, Amr M.N. El-Shehaby, 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 OlivoSamir 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, Jason Sheehan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: Resection 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. Methods: From 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. Results: Two 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. Conclusions: SRS 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.

Original languageEnglish
Pages (from-to)2861-2869
Number of pages9
JournalActa Neurochirurgica
Issue number10
StatePublished - Oct 2021


  • Local control
  • Meningioma
  • Stereotactic radiosurgery
  • Visual outcomes


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