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Brain Tumor "Pop Up" Glossary

For the meningioma terms, click on the BOLD BLUE words and terms below to view the "Pop Up Glossary" in a new, separate window (you will not leave this page).

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 treatments for the meningioma including radiosurgery and surgery depend upon the complete understanding of the competing risks vs. benefits. Options for meningioma treatment may include surgery or radiosurgery. The FSR (fractionated stereotactic radiosurgery) for parasellar (adjacent to the pituitary and the sella turcica) meningioma is an important option for treatment. The important considerations for meningioma radiosurgery include the size and rate of growth of the meningioma as well as the progression of any symptoms.

Johns Hopkins Meningioma Radiosurgery: 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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Parasellar Meningiomas

The Parasellar Meningioma is often successfully treated with radiosurgery.

The parasellar meningioma is located in the middle of the base of the skull. The parasellar meningioma can result in the worsening vision. Surgical removal of this meningioma is an option for relief of symptoms. Radiosurgery is an important option for treatment of the parasellar meningioma as well. Radiosurgery should also be considered in an asymptomatic patient if there is a likely probability of future visual symptoms. When a large meningioma involves the optic apparatus, internal carotid, or anterior cerebral arteries with dense adherence surgery can have higher risks.

The management of the parasellar meningioma remains a challenge because of their poor surgical accessibility and proximity to critical neurovascular structures. Although advances in cranial base surgical techniques have lowered surgical mortality rates dramatically, postoperative morbidity, especially in terms of new cranial neuropathies, remains significant (REFERENCE). Early postoperative functional deterioration occurred in 45 patients (60%) and ranged from mild (30 patients) to severe (three patients). Permanent functional deterioration afer surgery for the meningioma can be associated with the following: blood supply from the basilar artery, difficulty of dissection and incomplete tumor resection.

Radiosurgery for the meningioma is recommended when there has been a subtotal removal with an inadequate decompression, or there is evidence of recurrence on MRI after radical subtotal removal. The radiosurgery of the parasellar meningioma allows the safe escalation of the dose to the tumor via fractionation. Fractionation spares the optic apparatus while resulting in killing of the meningiomas.

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. Finally, it is important to note that in no instance of conventional radiotherapy is a large single fraction of treatment given for the treatment of any tumor anywhere in the body. Fractionation is the principle for successful treatment of tumors by radiation.

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).

Surgery may be feasible to resect as much tumor as possible.

Surgery allows removal of as much tumor as is safely possible:

Consult Johns Hopkins Radiosurgery for the Parasellar Meningiomas.

Johns Hopkins Radiosurgery offers considerable experience and success in the treatment of the parasellar meningiomas. The results of the radiosurgery for our first patients has 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 and including both the benign and the atypical or malignant meningiomas, the results of treatment are very favorable. Only one patient treated (with atypical meningioma) required surgery for growth after radiosurgery. Importantly none of the patients sustained new neurological deficit after the radiosurgery.

Radiosurgery remains an important option in the multi-disciplinary treatment of the meningiomas. Surgery and radiosurgery are often complementary.

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