Skull Base Meningiomas in Patients with Neurofibromatosis Type 2: An International Multicenter Study Evaluating Stereotactic Radiosurgery

Henry Ruiz-Garcia, Daniel M. Trifiletti, Nasser Mohammed, Yi Chieh Hung, Zhiyuan Xu, Tomas Chytka, Roman Liscak, Manjul Tripathi, David Arsanious, Christopher P. Cifarelli, Marco Perez Caceres, David Mathieu, Herwin Speckter, Gautam U. Mehta, Gregory P. Lekovic, Jason P. Sheehan

Research output: Contribution to journalArticlepeer-review


Objective: Meningiomas are the second most common tumors in neurofibromatosis type 2 (NF-2). Microsurgery is challenging in NF-2 patients presenting with skull base meningiomas due to the intrinsic risks and need for multiple interventions over time. We analyzed treatment outcomes and complications after primary Gamma Knife radiosurgery (GKRS) to delineate its role in the management of these tumors. Methods: An international multicenter retrospective study approved by the International Radiosurgery Research Foundation was performed. NF-2 patients with at least one growing and/or symptomatic skull base meningioma and 6-month follow-up after primary GKRS were included. Clinical and radiosurgical parameters were recorded for analysis. Results: In total, 22 NF-2 patients with 54 skull base meningiomas receiving GKRS as primary treatment met inclusion criteria. Median age at GKRS was 38 years (10-79 years). Most lesions were located in the posterior fossa (55.6%). Actuarial progression free survival (PFS) rates were 98.1% at 2 years and 90.0% at 5 and 10 years. The median follow-up time after initial GKRS was 5.0 years (0.6-25.5 years). Tumor volume at GKRS was a predictor of tumor control. Lesions >5.5 cc presented higher chances to progress after radiosurgery (p = 0.043). Three patients (13.64%) developed adverse radiation effects. No malignant transformation or death due to meningioma or radiosurgery was reported. Conclusions: GKRS is effective and safe in the management of skull base meningiomas in NF-2 patients. Tumor volume deserve greater relevance during clinical decision-making regarding the most appropriate time to treat. GKRS offers a minimally invasive approach of particular interest in this specific group of patients.

Original languageEnglish (US)
Pages (from-to)E173-E180
JournalJournal of Neurological Surgery, Part B: Skull Base
StatePublished - Jun 1 2022


  • gamma knife radiosurgery
  • meningioma
  • neurofibromatosis type 2
  • skull base

ASJC Scopus subject areas

  • Clinical Neurology


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