De Nigris Vasconcellos Fernando, Pichardo-Rojas Pavel, Fieldler Augusto Muller, Mashiach Elad, Santhumayor Brandon, Gorbachev Jowah, Fountain Hayes, Bandopadhay Josh, Almeida Timoteo, Sheehan Jason
Vivian L Smith, Department of Neurosurgery, Texas Institute for Restorative Neurotechnologies, UTHealth Houston, 6431 Fannin St, Houston, TX, 77030, USA.
Department of Neurosurgery, University of Miami, Miami, USA.
Neurosurg Rev. 2024 Mar 22;47(1):127. doi: 10.1007/s10143-024-02360-w.
Parafalcine and parasagittal (PFPS) are common locations for meningiomas. Surgical resection for these tumors, the first-line treatment, poses challenges due to their proximity to critical structures. This systematic review investigates the use of stereotactic radiosurgery (SRS) as a treatment for PFPS meningiomas, aiming to elucidate its safety and efficacy. The review adhered to PRISMA guidelines. Searches were conducted on MEDLINE, Embase, and Cochrane. Inclusion criteria involved studies on SRS for PFPS meningiomas, reporting procedure outcomes and complications. Tumors were presumed or confirmed to be WHO grade 1. Data was systematically extracted. Meta-analysis was performed where applicable. The review included data from eight studies, 821 patients with 878 lesions. Tumor control was achieved in greater than 80% of cases. Adverse radiation effects were reported in 7.3% of them. Recurrence and further surgical approach were observed in 17.1% and 9.2% of cases, respectively. Symptom improvement was noted in 33.2% of patients. Edema occurred in approximately 25.1% of patients. A subgroup of 283 patients had upfront SRS, achieving tumor control in approximately 97% of such cases. SRS is a safe and effective treatment for PFPS meningiomas, both as an adjuvant therapy and as an upfront treatment for often smaller tumors. Post-SRS edema can typically be managed medically and usually does not require further surgical intervention. Further studies should provide more specific data on PFPS meningiomas. The use of single and hypofractionated SRS for larger volume PFPS meningiomas should be more explored to better define the risks and benefits.
大脑镰旁和矢状窦旁（PFPS）是脑膜瘤的常见发病部位。这些肿瘤的一线治疗方法是手术切除，但由于其靠近关键结构，手术切除面临挑战。本系统评价研究了立体定向放射外科（SRS）作为PFPS脑膜瘤治疗方法的应用，旨在阐明其安全性和有效性。该评价遵循PRISMA指南。检索了MEDLINE、Embase和Cochrane数据库。纳入标准包括关于PFPS脑膜瘤SRS治疗的研究，报告手术结果和并发症。肿瘤被假定或确认为世界卫生组织1级。数据进行了系统提取。在适用的情况下进行了荟萃分析。该评价纳入了八项研究的数据，821例患者有878个病灶。超过80%的病例实现了肿瘤控制。其中7.3%报告有放射性不良反应。分别有17.1%和9.2%的病例观察到复发和进一步的手术治疗。33.2%的患者症状得到改善。约25.1%的患者出现水肿。283例患者接受了 upfront SRS治疗，其中约97%的病例实现了肿瘤控制。SRS作为一种辅助治疗以及对于通常较小肿瘤的 upfront 治疗，是治疗PFPS脑膜瘤的一种安全有效的方法。SRS术后水肿通常可以通过药物治疗，通常不需要进一步的手术干预。进一步的研究应提供关于PFPS脑膜瘤更具体的数据。对于更大体积的PFPS脑膜瘤，应更多地探索使用单次分割和低分割SRS，以更好地明确风险和益处。
