Good afternoon. My name is Andrew Farman. I'm a postdoc research fellow at the Center of Image-Guided Neurosurgery at the University of Pittsburgh, and I thank you first for allowing me to present my work. I will be talking about cranial nerve outcomes after stereotactic radiosurgery for skull-based meningiomas. So first, I don't have any disclosures. So we know that complete surgical resection of skull-based meningiomas is difficult and is often associated with high risk of morbidity and mortality. And stereotactic radiosurgery have been used either as a primary management option or as an adjuvant following incomplete surgical resection. The optimal outcomes of stereotactic radiosurgery are achieving tumor control as well as maintaining neurological function. So in this retrospective study, we wanted to look at cranial nerve outcomes after stereotactic radiosurgery, look at tumor control rates, and identify any factors that may be associated with better or worse outcomes. So we reviewed our charts of 2022 patients who underwent stereotactic radiosurgery starting in 1987 up until 2016. We included patients who had at least one cranial nerve deficit at the time of radiosurgery, as well as patients who had at least 12 months of clinical and imaging follow-up. And we excluded patients who had multiple meningiomas, meningiomas related to previous radiation therapy, neurofibromatosis type 2, or patients with high-grade meningiomas. So we ended up with 395 patients with radiosurgery being performed as a primary management option in 245, and 150 patients had adjuvant radiosurgery following incomplete resection. This is a bit of a slide. I just want to show that 98 patients had petrochloric meningiomas, 242 had cavernous sinus meningiomas, and 55 patients had CP angular meningiomas. In the petrochloric meningioma group, the most common presentation was related to adrenal neurology or neuropathy. In the cavernous sinus, the most common was diplopia, and in the CP angular meningiomas, they often had hearing loss or tinnitus. So the technique involved, the patient comes in early in the morning, under local anesthesia and mild sedation, they get the head frame attached, then they get high-resolution images. The images are then transferred to the dose planning software, and then the volume is targeted and the margin doses are set. There was no difference between the different types of meningiomas in terms of margin dose or number of isolated, but the main difference was that CP angular meningiomas were significantly smaller than petrochloric cavernous sinus meningiomas. So then we followed up patients, first every six months until one year, and then every two years. Patients' subjective sense of symptom change, as well as any changes on physical examination were what we considered for determining symptom improvement. To start with the results, tumor control was achieved in almost 91% of patients at a median follow-up of 57 months. 35 patients had tumor progression on imaging, 24 of which underwent a second radiosurgical procedure, 10 underwent surgery, and one underwent an IMRT. For the 24 patients who had a second radiosurgical procedure, all 27 of the 24 achieved tumor control on final imaging. Tumor volume, margin dose, location, as well as period resection were not found to be associated with better or worse progression-free survival. And this is a survival plot, so a 10-year progression-free survival was 90%, which is similar to a Simpson grade 1 resection. In terms of cranial nerve outcomes, overall 36% of patients reported improvement in their cranial nerve deficits, and 10.6% of patients developed new or worsening or preexisting symptoms. And then dividing based on whether they had period resection or not, we found that 46% of patients who did not have a period resection reported improvement, compared to 19% of patients who did have period improvement, and that difference was found to be statistically significant. This is just showing the no surgery group versus the surgery group, and we found that the five-year progression-free survival in terms of cranial nerve deficits, 45%, and the no surgery group, and 14% in the person who had resection. And then comparing based on tumor location, so we found that patients who had FCAvernous Sinus and Petrocholivin meningiomas were more likely to report symptom improvement, compared to patients who had CP Angle meningiomas, and that was found to be clinically significant. In terms of deterioration rates, so 10.6% of patients had worsening or new onset cranial nerve deficits, and 15% of them, that was due to tumor progression, in eight patients that was due to adverse radiation effects, and in the remaining patients, no cause and imaging was identified as the cause of the worsening symptoms. So this is a retrospective study, and such is limited by the limitations of such a study, such as referral bias. We didn't look at cranial nerve outcomes in patients who did not undergo radiosurgery and only had surgical resection. In addition, we lacked quantifiable measures to be able to better demonstrate the degree of improvement, and in addition, we often know that tumors that are treated by surgical resection are often larger than those treated by radiosurgery, and as such, their outcomes might be possibly worse due to that effect. So in conclusion, radiosurgery provides high tumor control rates. The likelihood of symptom improvement is higher in patients who had no prior resection, and patients with Petrocholivin and Cavernous Sinus meningiomas demonstrated significantly higher rates of symptom improvement compared to CPI meningiomas. Thank you.

cranial nerve outcomes

stereotactic radiosurgery

skull-based meningiomas

tumor control rates

symptom improvement