Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA.
Department of Neurosurgery, Atrium Health, Charlotte, NC, USA.
Neurosurg Rev. 2023 Oct 28;46(1):287. doi: 10.1007/s10143-023-02197-9.
Perioptic meningiomas, defined as those that are less than 3 mm from the optic apparatus, are challenging to treat with stereotactic radiosurgery (SRS). Tumor control must be weighed against the risk of radiation-induced optic neuropathy (RION), as both tumor progression and RION can lead to visual decline. We performed a systematic review and meta-analysis of single fraction SRS and hypofractionated radiosurgery (hfRS) for perioptic meningiomas, evaluating tumor control and visual preservation rates. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed articles published between 1968 and December 8, 2022. We retained 5 studies reporting 865 patients, 438 cases treated in single fraction, while 427 with hfRS. For single fraction SRS, the overall rate of tumor control was 95.1%, with actuarial rates at 5 and 10 years of 96% and 89%, respectively; tumor progression was 7.7%. The rate of visual stability was 90.4%, including visual improvement in 29.3%. The rate of visual decline was 9.6%, including blindness in 1.2%. For hfRS, the overall rate of tumor control was 95.6% (range 92.1-99.1, p < 0.001); tumor progression was 4.4% (range 0.9-7.9, p = 0.01). Overall rate of visual stability was 94.9% (range 90.9-98.9, p < 0.001), including visual improvement in 22.7% (range 5.0-40.3, p = 0.01); visual decline was 5.1% (range 1.1-9.1, p = 0.013). SRS is an effective and safe treatment option for perioptic meningiomas. Both hypofractionated regimens and single fraction SRS can be considered.
眶周脑膜瘤定义为距离视神经小于 3 毫米的脑膜瘤，采用立体定向放射外科（SRS）治疗具有挑战性。必须权衡肿瘤控制与放射性视神经病变（RION）的风险，因为肿瘤进展和 RION 都可能导致视力下降。我们对眶周脑膜瘤单次分割 SRS 和分次放射外科治疗（hfRS）进行了系统回顾和荟萃分析，评估了肿瘤控制和视力保存率。我们使用系统评价和荟萃分析的首选报告项目（PRISMA）指南，回顾了 1968 年至 2022 年 12 月 8 日期间发表的文章。我们保留了 5 项报告 865 例患者的研究，其中 438 例接受单次分割治疗，427 例接受 hfRS。对于单次分割 SRS，肿瘤控制的总体率为 95.1%，5 年和 10 年的累积率分别为 96%和 89%；肿瘤进展率为 7.7%。视力稳定率为 90.4%，包括 29.3%的视力改善。视力下降率为 9.6%，包括 1.2%的失明。对于 hfRS，肿瘤控制的总体率为 95.6%（范围为 92.1-99.1，p<0.001）；肿瘤进展率为 4.4%（范围为 0.9-7.9，p=0.01）。总体视力稳定率为 94.9%（范围为 90.9-98.9，p<0.001），包括 22.7%的视力改善（范围为 5.0-40.3，p=0.01）；视力下降率为 5.1%（范围为 1.1-9.1，p=0.013）。SRS 是治疗眶周脑膜瘤的有效且安全的治疗选择。可以考虑使用分次治疗方案和单次分割 SRS。
