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Email Dr. Jeffery Williams. The decisions related to treatment for the atypical meningiomas depend upon the complete understanding of the competing risks vs. benefits for the different treatments for atypical meningiomas. Options for skull base, olfactory groove, cavernous sinus and clivus atypical meningioma treatments may include surgery or radiosurgery. The FSR (fractionated stereotactic radiosurgery) for atypical meningiomas is an important option for treatment. The important considerations include the size and rate of growth of the atypical meningioma as well as the progression of any symptoms.

Click Here for Dr. Williams C.V. Curriculum Vitae: Dr. Jeffery Williams
Director, Brain Tumor Radiosurgery
The Johns Hopkins Hospital
Board Certified: Neurological Surgery
Board Certified: Radiation Oncology
Email Dr. Jeffery Williams.

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Phone: 410-614-2886
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Atypical Meningiomas

Atypical meningiomas are often successfully treated with radiosurgery.
The atypical variant of meningioma is characterized by a papillary pattern of epithelioid cells or sheeting of polyhedral, round, and fusiform cells with abundant mitoses and possible brain infiltration. There may be a poor long-term prognosis of these atypical meningiomas. The prognosis for this group is less favorable than for the group with benign meningiomas, but is better than that for patients in a subsequent group classified with malignant meningioma, who had a mean survival time of 2.5 years. It was subsequently suggested by other authors that the malignant meningiomas could be further (WHO) in its first and recently revised second edition classifications of meningiomas, with two grades of malignancy termed atypical (Grade 2) and anaplastic (Grade 3). Unfortunately, the WHO classification gives mostly qualitative criteria in defining atypical and anaplastic meningiomas, and does not suggest more precise quantitative indications such as numerical scoring systems. As a consequence, detailed correlative clinicopathological studies on this subject are difficult to perform and it is not possible to compare data from different centers. In particular, the clinical behavior of atypical meningiomas, regarded as less severe than malignant tumors and intermediate between benign and malignant forms, must still be precisely defined by further clinicopathological studies. Moreover, the prognostic influence of radical surgery on outcome has not been discussed.
Radiosurgery delivers high dose to the meningioma with sparing of the surrounding normal structures.

Radiosurgery allows deposition of high doses of radiation in the meningioma with sparing of the surrounding normal structures including the optic nerves and optic chiasm. Although the carotid arteries may in some cases receive radiation, the arteries have not occluded after radiosurgery. The tolerance (ability to absorb radiation and keep functioning) of the cranial nerves that subserve motion of the eye and sensation to the eye and face is very high. The tolerance of the optic nerves and chiasm is more limited. Thus, the fractionation (dividing the treatment into multiple smaller treatment) allows safe treatment. Not only is the treatment safer with fractionation, but the total dose may be escalated when compared to single fraction techniques, resulting in potentially higher rates of tumor control.

The radiosurgery can be divided into single session (one big "shot" of radiation as given via the "gamma knife") and the fractionated stereotactic radiosurgery(FSR). The gamma knife and any single session treatment may have higher risk for the cranial nerves (REFERENCE). The risk to the cranial nerves after single "shot" radiosurgery may be as high as 13% (REFERENCE).

Consult Johns Hopkins Radiosurgery for the Atypical Meningiomas.

Johns Hopkins Radiosurgery offers considerable experience and success in the treatment of the atypical meningiomas. The results of the fractionated stereotactic radiosurgery treatments for our first patients have been published in The Journal of Radiosurgery. This manuscript may be viewed by clicking here. The results show that for meningiomas of disparate locations including the skull base, cavernous sinus and clivus and including both the benign and the atypical or malignant meningiomas, the results of treatment are very favorable. Only one patient (with atypical meningioma) required surgery for growth after radiosurgery. Importantly none of the patients sustained new neurological deficit after the radiosurgery. Radiosurgery is an important option for treatment for these meningiomas.

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