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What is Radiosurgery?

Email Dr. Jeffery Williams ( The decisions related to treatment for the meningiomas depend upon the complete understanding of the competing risks vs. benefits for the different treatments. Options for meningioma treatment may include surgery or radiosurgery. The FSR (fractionated stereotactic radiosurgery) for meningiomas is an important option for treatment. The important considerations include the size, location and rate of growth of the 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
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Phone: 410-614-2886
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Meningioma Introduction

Any discussion of radiosurgery for meningiomas must compare the results to the results reported for surgical treatment and conventional radiotherapy. This is difficult because different patient groups are typically selected for each modality.

Location of Meningioma

In the past surgery was used for meningiomas in more readily accessible areas of the brain (superficially located, near the surface). Radiosurgery was used in more ''high risk'' surgical locations. Now, however, the radiosurgery (single shot) and the fractionated stereotactic radiosurgery (FSR) (consecutive daily treatments, one per day) are used for both groups of patients.

Comparison of Meningioma Treatments

Comparison of the outcomes between radiosurgery and surgery for treatments of meningiomas are difficult because of the absence of controlled, prospective trials that evenly divide patients and treatments according to age, size of the meningioma and location of the meningioma as well as the symptoms. Measurements of size of the meningioma after treatment is important. In all published radiosurgical series for meningiomas, patients were closely monitored with MRI or CT at relatively frequent intervals after treatment. However, many of the large surgical series for meningiomas were carried out, at least partially, in the pre-CT and -MRI era, it is doubtful whether small increases in tumor size were reliably detected. Additionally, recurrence of meningiomas has been defined differently and/or documented poorly in numerous surgical studies. The same constraints apply to many of the conventional radiotherapy reports on meningiomas.

Meningioma Surgery

Because of the benign histology of most meningiomas, surgery can be curative, and therefore remains the standard with which all other forms of therapy must be compared. Long-term symptom-free survival can be expected after ''complete'' resection, with most series reporting a recurrence rate of approximately 5 to 10%. Subtotal resection alone of meningiomas affords much worse control, with 5-year recurrence rates of approximately 60%.

Meningioma Radiosurgery

Stereotactic Radiosurgery offers non-invasive treatment for many meningiomas. Until recently the single session or "shot" radiosurgery was employed. Based upon the principles of "radiobiology" the single "shot" is more likely to result in complications for the normal brain surrounding the meningioma or the cranial nerves that may travel through the meningioma.

Fractionation of Stereotactic Radiosurgery

For this reason the "fractionation" of radiosurgery was developed to both improve the safety and to increase the dose to the meningioma. The fractionated stereotactic radiosurgery (FSR) has proven safe has effectively controlled (killed) the treated meningiomas in our experience.

FSR For Meningioma

The FSR for meningioma is an outpatient experience. The first step is the "simulation" or special scan in our department. This allows creation of the special "mask" for that allows the precise, repeat fixation for the daily meningioma treatments. Once this scan is obtained, I perform the treatment planning on the computer. This allows a beam profile that will treat the meningioma and spare the surrounding normal tissues. On the day of the first treatment, the patient lies on the treatment "couch" and the mask is positioned. Plain x-rays are taken to verify the correct positioning. I verify these films. Treatment for that day's "fraction" then begins. The FSR for meningioma is tolerated very well. There is no nausea, red skin and usually no hair loss.

  • Below is the Johns Hopkins Radiosurgery Meningioma Questionnaire.

  • If helpful to you, please complete the form and press the "Send Form" button at the bottom of the page.

  • The questions below discuss issues that can help determine the suitability of different treatments for meningiomas:

    • surgery

    • radiosurgery

    • observation

      Meningioma Information Page

      Your email address (if response is desired):

      Date of MENINGIOMA Diagnosis

      What is the DATE of the diagnosis of the first meningioma (If a meningioma was diagnosed in the past before the current meningioma)?

      Method of MENINGIOMA Diagnosis

      How was the first meningioma diagnosed?

      Stereotactic Biopsy


      Only radiographically

      MENINGIOMA: Histology Please enter the MENINGIOMA histology:




      Other (not listed above):

      MENINGIOMA Location

      What was the location of the meningioma? (Please ask your doctor for clarification of the location.)

      Skull Base (Middle of skull, deep)

      Supratentorial (Above tentorium: e.g. sphenoid wing, convexity)

      Posterior Fossa (Cerebellar)


      Number of MENINGIOMAS

      How many meningiomas were there initially prior to any treatment, right after the first diagnosis?

      One (solitary)





      More than Five

      First treatment(s)for MENINGIOMA prior to current treatment (if applicable)

      How was the first meningioma (or group of meningioma treated)?

      Stereotactic Biopsy only

      Craniotomy only

      Stereotactic Biopsy and Radiation

      Craniotomy and Radiation

      No Treatment: Observation only

      Date of initial treatment for MENINGIOMA after first diagnosis (if applicable)

      What was the DATE of the treatment for the FIRST meningioma?

      Current Meningioma

      What is the DATE of the DIAGNOSIS of the CURRENT meningioma (or meningiomas if more than one)? (This (these) meningioma(s) are for consideration for the CURRENT radiosurgery or surgical resection).

      Number of Tumors now

      How many meningiomas are there now?
      One (solitary)





      More than Five

      Size of tumor now

      What is the largest dimension (in centimeters) of the meningioma (or largest meningioma if more than one)? One

      Two Centimeters

      Three Centimeters

      Four Centimeters

      Five Centimeters

      More than Five Centimeters

      Current Treatment other than Radiosurgery

      Prior to Radiosurgery (if applicable), how is the CURRENT meningioma (or group of meningiomas) treated?

      Stereotactic Biopsy only

      Craniotomy and removal of as much tumor as possible

      No Surgery

      Craniotomy and external beam irradiation (regular radiation)

      Stereotactic Biopsy and external beam irradiation (regular radiation)



    • This completes the Meningioma Information Form.

    • Please press the "Send Form" button below.

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