Small recurrent / residual meningioma need to be treated with radiosurgery. There is regression of tumour after high dose radiosurgery. Usual dose for radiosurgery is 12-15 Gy in single fraction.

1. Meningioma / craniopharyngioma/Meningioma / craniopharyngioma/
High grade gliomaHigh grade gliomaMeningioma
- Small recurrent / residual meningioma need to be treated with radiosurgery
- There is regression of tumour after high dose radiosurgery
- Usual dose for radiosurgery is 12-15 Gy in single fraction
Craniopharyngioma
- Small craniopharyngioma > 4mm away from chiasm need radiosurgery
- Small para-sellar residual disease need radiosurgery
High grade glioma
- Small residual / recurrent disease in well preserved patients may be treated with
radiosurgery
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2. Fractionated radiosurgeryFractionated radiosurgery
Extended Indications for multiple fraction treatment
- Larger meningiomas (>3 cm)
- Larger acuastic schwannoma (>3 cm)
- Large solitary / oligo brain metastasis with controlled primary
- Larger residual LGG
- AVMs (>3 cm)
- Chordomas
- Rec HCC
- Craniopharyngioma
- Pituitary tumour
Short term data with robotic radiosurgery
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3. New experiences with fSRSNew experiences with fSRS
Post-TreatmentPre-Treatment
- More necrosis with CK than SRT (25Gy/5# Vs 54Gy/30#)
- Difficult to have radiological interpretation
- Require longer duration of steroid
- Associated with more oedema
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4. Meningiomas: SRSMeningiomas: SRS
- SRS is an option for small meningiomas (Incidental findings or symptomatic )
- Dose: 10-15 Gy; single Fr
- Local control rate: 80-90% at 10 yrs
- However, now emerging data, larger lesions (para-sagital) / Recurrent meningiomas may
be treated with fractionated approach
CK Society website 2010
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5. Atypical/ anaplastic meningiomas: SRSAtypical/ anaplastic meningiomas: SRS
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6. CraniopharyngiomaCraniopharyngioma
• Epithelial tumou rising from rathkes pouch remnantsEpithelial tumou rising from rathkes pouch remnants
• 2-5% of all primary intracranial tumours2-5% of all primary intracranial tumours
• Common age of presentation <20 yrsCommon age of presentation <20 yrs
• 5-15% of primary tumour in children5-15% of primary tumour in children
Two histopathological types:Two histopathological types:
1) Aadamantinomatous type-1) Aadamantinomatous type-
mainly occurs in childrenmainly occurs in children
2) papillary type- occurs exclusively in adults.2) papillary type- occurs exclusively in adults.
• Increasingly treated with conservative surgery + RTIncreasingly treated with conservative surgery + RT
• Good results with RT; 70-85% long term controlGood results with RT; 70-85% long term control
• Relatively high risk of treatment related effectsRelatively high risk of treatment related effects
Age & Sex distribution Review of 144 published data; Adamson & Yasargil 2008

7. AuthorAuthor yryr nn RecurrenceRecurrence FU (yrs)FU (yrs)
CarbezudoCarbezudo 19811981 1414 1212 5-305-30
CarmelCarmel 19821982 1414 1010 6.16.1
DjordjevicDjordjevic 18791879 1515 88 --
HoffHoff 19721972 1818 1616 1010
HoffmanHoffman 19771977 1515 88 2-162-16
LichterLichter 19771977 99 77 1-201-20
McMurraryMcMurrary 19771977 99 77 1-141-14
ShapiroShapiro 19791979 99 77 7.87.8
StahnkeStahnke 19841984 1212 66 6.96.9
SweetSweet 19761976 55 44 1-211-21
ThomsettThomsett 19801980 1111 1010 8.28.2
131131 93 (71%)93 (71%)
Recurrence rate 71% after only partial excision
Recurrence rate after only partial excisionRecurrence rate after only partial excision

8. Surgery alone vs Sur+ RTSurgery alone vs Sur+ RT
Subtotal resection + RT: higher PFS
Stripp et al IJROBP 2004
(n=76)

9. Veeravagu et al, Neurosurg Focus 2010
SRS/fSRS: Craniopharyngioma

10. Craniopharyngioma: SCRT- IQ assessment (n=18)
VQ: Verbal Quotient
PQ: Performance Quotient
MQ: Memory Quotient
FSIQ: Full Scale IQ
• Mean IQ Scores are maintained at post-RT follow up.Mean IQ Scores are maintained at post-RT follow up.
• State anxiety had reduced after RT.State anxiety had reduced after RT.
Dutta, Jalali et al WFNO 2009

11. Recurrent HGG: SRS studiesRecurrent HGG: SRS studies
Romanelli, Neurosurg focus 2009

12. Recurrent GBM: SRS
Conti 2010
SRS/fSRS SRS+TMZ
MS (mo) 6.5 12
6-mo PFS (%) 20 60
Radionecrosis - 10%
Corticosteroid 60% 80%
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13. Conti 2010
Recurrent GBM: Survival function
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14. New Indications for RadiosurgeryNew Indications for Radiosurgery
-Temporal lobe epilepsy
- Resistant seizure disorder
- Behavioral disorders
- Mood disorder
- Obesity
- Child hood attention deficit disorder / absence seizure
- Skull base tumour
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15. Meningioma / craniopharyngioma/Meningioma / craniopharyngioma/
High grade gliomaHigh grade gliomaMeningioma
- Small recurrent / residual meningioma need to be treated with radiosurgery
- There is regression of tumour after high dose radiosurgery
- Usual dose for radiosurgery is 12-15 Gy in single fraction
Craniopharyngioma
- Small craniopharyngioma > 4mm away from chiasm need radiosurgery
- Small para-sellar residual disease need radiosurgery
High grade glioma
- Small residual / recurrent disease in well preserved patients may be treated with
radiosurgery
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