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What is Radiosurgery?

Brain Tumor "Pop Up" Glossary

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Click on the BOLD (REFERENCE) to view the "Pop Up Reference" in a new, separate window (you will not leave this page).

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

Email Address: jw@jhu.edu
Phone: 410-614-2886
Fax: 410-614-2982


Malignant Meningiomas

Malignant meningiomas can be treated with radiosurgery.
Meningiomas constitute 15% to 20% of all primary brain tumors and 10% to 15% of all meningiomas are considered malignant.

Malignant meningiomas are defined by several criteria including: 1) invasion of adjacent brain parenchyma or skull; 2) numerous mitoses (. 5/high-powered field); 3) elevated proliferative indices (. 3%) as assessed by either 5-bromo-deoxyuridine labeling or Ki-67 staining; 4) necrosis; 5) increased cellularity; 6) nuclear pleomorphism; and 7) metastases. The optimum treatment of malignant meningiomas has not been well defined and survival following gross-total tumor resection without adjuvant radiotherapy is less than 2 years.

The World Health Organization (WHO) classifies meningiomas into four types: 1) classic (meningotheliomatous, fibroblastic, and transitional subtypes); 2) angioblastic (hemangiopericytoma); 3) aggressive (papillary subtype); and 4) malignant. Malignant meningiomas are defined by the WHO as tumors demonstrating histo- Very limited information is available on the best approach for treatment of malignant meningiomas. Notwithstanding the controversy regarding the role of radiotherapy for classic meningiomas, there is universal agreement as to its application in malignant meningiomas irrespective of the extent of surgery.

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 Malignant Meningiomas of the skull base, cavernous sinus and clivus.

Johns Hopkins Radiosurgery offers considerable experience and success in the treatment of the malignant 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 malignant or malignant meningiomas, the results of treatment are very favorable. Only one patient (with malignant 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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