Radiological Response Assessment of Intracranial Meningioma after Cyberknife Stereotactic Radiosurgery.

Abstract

Objective: To evaluate the impact of stereotactic radiosurgery (SRS) with a cyberknife system on intracranial meningioma in terms of disease control / clinical outcome and radiological assessment according to the site and histological grading.

Study design: Observational study. Place and Duration of the Study: Cyberknife Department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from March 2023 to May 2024.

Methodology: The study comprised 196 patients, out of which 138 were preoperative and 58 were postoperative patients. Inclusion criteria were biopsy-proven patients or those confirmed via imaging having lesions either unsuitable for surgery or having residual disease after surgery. Patients with atypical features of meningioma / asymptomatic were excluded from the study. The 3D T1 contrast and FLAIR sequence were used for preoperative planning; BTFE sequence was also used in cases of CP angle meningioma. Mean radiation dosage 24.3 ± 23.0 Gy was used in 3-5 fractions. Following radiosurgery, all patients underwent six months of clinical and radiological follow-up with contrast-enhanced MRI of brain.

Results: The mean age of patients was found to be 47.25 ± 13.91 years (10-81 years). Female gender was more frequently reported (n = 126, 64.29%) as compared to males (n = 70, 35.71%). The right side of the brain was more involved than the left. The most common sites were cerebellopontine angles in 61 (31.1%). The most common symptom was headache in 84 (42.85%) patients. About 32 (16.32%) cases were biopsy-proven Grade I and 14 (7.14%) cases were Grade II, while the rest 150 (76.53%) were selected on imaging. On follow-up imaging, radiological findings on MRI showed that the disease was stable in 126 (65.0%) patients and reduced in 64 (33.0%) patients with no oedema.

Conclusion: This study concluded that radiosurgery is a safe option for treating intracranial meningioma with a satisfactory radiological response and clinical improvement.

Key words: Intracranial meningioma, Radiosurgery, Magnetic resonance imaging.