Turkish Neurosurgery
Stereotactic radiosurgery versus observation for treating incidental imaging-diagnosed intracranial meningioma: a systematic review and meta-analysis
Zhang Changfu1, Zhang Hengzhu2
1the First Clinical College of Dalian Medical University, Department of Neurosurgery, DaLian,
2Clinical Medical College of Yangzhou University, Department of Neurosurgery, DaLian,
DOI: 10.5137/1019-5149.JTN.31405-20.2

Aim: The treatment of IM remains controversial. Many studies recommend that IM should be managed with observation, and microsurgery or SRS is considered as further treatment until radiological or symptomatic progression. Recent studies have revealed that SRS provides a higher level of tumor control and acceptable complications compared with observation. The aim of this review is to evaluate the clinical outcomes of IM treated with SRS or observation.Methods:The PubMed, Cochrane Library and MEDLINE (Ovid) databases were comprehensively searched for eligible studies about IM that were managed with observation or SRS. We performed a systematic review and meta-analysis of the tumor progression rate between these two groups. The SRS-related morbidity was qualitatively analyzed. To predict potential tumor growth, the correlation between rapid tumor growth and the following factors,T2 hyperintensity, initial tumor diameter and age were also analyzed by meta-analysis.Results:Sixteen studies were included. The SRS treatment group had significantly higher tumor control than the observation group in a mean follow-up of more than 3 years (pooled OR: 0.06, 95% CI: 0.01-0.20, P<0.0001; random effects model). Additionally, there was an acceptable level of SRS-associated morbidity. Tumor progression was positively associated with MRI T2 hyperintensity (pooled OR: 1.93, 95% CI: 1.30-2.87, P<0.05, fixed effects model), initial large tumor diameter (pooled OR: 3.19, 95% CI: 0.94-5.44, P<0.05, fixed effects model) and younger age to some extent (pooled OR: -3.80, 95% CI: -9.13-1.53, P>0.05, random effects model). Absence of calcification was consistently shown to be a risk factor for progressive IM based on the existing literature.Conclusions: SRS is a rational treatment for incidental meningioma in consideration of the higher tumor control rate and acceptable complications compared with treatment via observation. The integration of risk factors such as absence of calcification, T2 hyperintensity and initial large tumor size may contribute to accurately predicting rapid tumor growth

Corresponding author : Zhang Hengzhu