Clinical and radiologic outcomes after stereotactic radiosurgery for meningiomas in direct contact with the optic apparatus: an international multicenter study
Authors: Asuzu David T. , Bunevicius Adomas , Kormath Anand Rithika , Suleiman Mohanad , Nabeel Ahmed M. , Reda Wael A. , Tawadros Sameh R. , Abdel Karim Khaled , El-Shehaby Amr M. N. , Emad Eldin Reem M. , Chytka Tomas , Liščák Roman , Sheehan Kimball , Sheehan Darrah , Perez Caceres Marco , Mathieu David , Lee Cheng-chia , Yang Huai-che , Picozzi Piero , Franzini Andrea , Attuati Luca , Speckter Herwin , Olivo Jeremy , Patel Samir , Cifarelli Christopher P. , Cifarelli Daniel T. , Hack Joshua D. , Strickland Ben A. , Zada Gabriel , Chang Eric L. , Fakhoury Kareem R. , Rusthoven Chad G. , Warnick Ronald E. , Sheehan Jason P. 
Published: September 2021

OBJECTIVE
Resection of meningiomas in direct contact with the anterior optic apparatus carries risk of injury to the visual pathway. Stereotactic radiosurgery (SRS) offers a minimally invasive alternative. However, its use is limited owing to the risk of radiation-induced optic neuropathy. Few SRS studies have specifically assessed the risks and benefits of treating meningiomas in direct contact with the optic nerve, chiasm, or optic tract. The authors hypothesized that SRS is safe for select patients with meningiomas in direct contact with the anterior optic apparatus.

METHODS
The authors performed an international multicenter retrospective analysis of 328 patients across 11 institutions. All patients had meningiomas in direct contract with the optic apparatus. Patients were followed for a median duration of 56 months after SRS. Neurological examinations, including visual function evaluations, were performed at follow-up visits. Clinical and treatment variables were collected at each site according to protocol. Tumor volumes were assessed with serial MR imaging. Variables predictive of visual deficit were identified using univariable and multivariable logistic regression.

RESULTS
SRS was the initial treatment modality for 64.6% of patients, and 93% of patients received SRS as a single fraction. Visual information was available for 302 patients. Of these patients, visual decline occurred in 29 patients (9.6%), of whom 12 (41.4%) had evidence of tumor progression. Visual decline in the remaining 17 patients (5.6%) was not associated with tumor progression. Pre-SRS Karnofsky Performance Status predicted visual decline in adjusted analysis (adjusted OR 0.9, 95% CI 0.9–1.0, p < 0.01). Follow-up imaging data were available for 322 patients. Of these patients, 294 patients (91.3%) had radiographic evidence of stability or tumor regression at last follow up. Symptom duration was associated with tumor progression in adjusted analysis (adjusted OR 1.01, adjusted 95% CI 1.0–1.02, adjusted p = 0.02).

CONCLUSIONS
In this international multicenter study, the vast majority of patients exhibited tumor control and preservation of visual function when SRS was used to treat meningioma in direct contact with the anterior optic pathways. SRS is a relatively safe treatment modality for select patients with perioptic meningiomas in direct contact with the optic apparatus.