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BioMed Research International
Volume 2014, Article ID 107526, 8 pages
http://dx.doi.org/10.1155/2014/107526
Review Article

The Evolving Role of Radiosurgery in the Management of Radiation-Induced Meningiomas: A Review of Current Advances and Future Directions

1Division of Neurosurgery, University of Toronto, Toronto, Canada M5T 2S8
2Department of Neurosurgery, Toronto Western Hospital, University Health Network, 4W-436, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8

Received 7 June 2014; Accepted 30 June 2014; Published 17 July 2014

Academic Editor: Cheng-Shie Wuu

Copyright © 2014 Alireza Mansouri et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Meningiomas are among the most common primary adult brain tumors, which arise either spontaneously or secondary to environmental factors such as ionizing radiation. The latter are referred to as radiation-induced meningiomas (RIMs) which, while much less common than their spontaneous counterparts, are challenging from a management point of view. Similar to spontaneous meningiomas, the optimal management of RIMs is complete surgical resection. However, given their high grade, multiplicity, tendency to invade bone and venous sinuses, and high recurrence rate, this cannot always be accomplished safely. Therefore, other therapeutic modalities, such as stereotactic radiosurgery, have emerged. In the current review, we provide an overview of the historical outcomes achieved for RIMs through radiosurgery and microsurgical resection. Furthermore, we provide a discussion of clinical and radiological parameters that affect the decision-making process with regard to the management of RIMs. We also provide an outline of recent changes in our understanding of RIMs, based on molecular and genetic markers, and how these will change our management perspective. We conclude the review by summarizing some of the current obstacles in the management of RIMs with SRS and how current and future research can address these challenges.