{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:05:26Z","timestamp":1780131926358,"version":"3.54.0"},"reference-count":76,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,6]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Complications from radiotherapy (RT), in a primary or adjuvant setting, have overall been described as uncommon, with few detailed descriptions of major complications. The authors present two cases involving significant complications and their management in their review of patients undergoing RT for treatment of atypical meningioma.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors conducted a retrospective review of all patients with pathologically confirmed atypical meningioma (WHO grade II) treated with primary or adjuvant RT from February 2011 through February 2019. They identified two patients with long-term, grade 3 toxicity. The cases of these patients are described in detail.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Two patients had major complications associated with postoperative RT. Patients 1 and 2 both were treated with postoperative RT for pathologically confirmed atypical meningioma. Patient 1 experienced worsening behavioral changes, cognitive decline, and hydrocephalus following treatment. This required cerebrospinal fluid diversion. Patient 2 developed radiation necrosis with mass effect and cognitive decline. Neither patient returned to his\/her initial post-RT status after steroid therapy, and each remained in need of supportive care. Both patients remained free of tumor progression at 52 and 38 months following treatment.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The postoperative management of patients with atypical meningioma continues to be defined, with questions remaining regarding timing of RT, dose, target delineation, and fractionation. Both of the patients in this study received fractionated RT, which included a greater volume of normal brain than more focal treatment options such as would be required by stereotactic radiosurgery (SRS). Further research is needed to compare SRS and fractionated RT for the management of patients with grade II meningiomas. The more focused nature of SRS may make this a preferred option in certain cases of focal recurrence.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2019.3.focus1930","type":"journal-article","created":{"date-parts":[[2019,6,7]],"date-time":"2019-06-07T19:09:58Z","timestamp":1559934598000},"page":"E5","source":"Crossref","is-referenced-by-count":6,"title":["Major complications from radiotherapy following treatment for atypical meningiomas"],"prefix":"10.3171","volume":"46","author":[{"given":"Troy","family":"Dawley","sequence":"first","affiliation":[{"name":"Section of Neurosurgery, Department of Surgery, Ascension Providence Hospitals, Michigan State University, College of Human Medicine, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaker","family":"Rana","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussam","family":"Abou-Al-Shaar","sequence":"additional","affiliation":[{"name":"Neurosurgery, Zucker School of Medicine at Hofstra\/Northwell, Lake Success, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuj","family":"Goenka","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Schulder","sequence":"additional","affiliation":[{"name":"Neurosurgery, Zucker School of Medicine at Hofstra\/Northwell, Lake Success, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Neuro Oncol","article-title":"Non-malignant and malignant meningioma incidence and survival in the elderly from 2005-2015 using the Central Brain Tumor Registry of the United States","author":"Achey RL","unstructured":"Achey RL, Gittleman H, Schroer J, Khanna V, Kruchko C, Barnholtz-Sloan JS: Non-malignant and malignant meningioma incidence and survival in the elderly from 2005-2015 using the Central Brain Tumor Registry of the United States. Neuro Oncol [epub ahead of print], 201830295804"},{"key":"b2","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1227\/01.NEU.0000330399.55586.63","article-title":"Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation","volume":"64","author":"Aghi MK","year":"2009","unstructured":"Aghi MK, Carter BS, Cosgrove GR, Ojemann RG, Amin-Hanjani S, Martuza RL, : Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery 64:56\u201360, 200910.1227\/01.NEU.0000330399.55586.6319145156"},{"key":"b3","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s11060-012-0828-1","article-title":"Patterns of failure after treatment of atypical meningioma with gamma knife radiosurgery","volume":"108","author":"Attia A","year":"2012","unstructured":"Attia A, Chan MD, Mott RT, Russell GB, Seif D, Daniel Bourland J, : Patterns of failure after treatment of atypical meningioma with gamma knife radiosurgery. J Neurooncol 108:179\u2013185, 20122235923110.1007\/s11060-012-0828-1"},{"key":"b4","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1822","DOI":"10.3171\/2016.5.JNS152809","article-title":"Adjuvant radiotherapy for atypical meningiomas","volume":"126","author":"Bagshaw HP","year":"2017","unstructured":"Bagshaw HP, Burt LM, Jensen RL, Suneja G, Palmer CA, Couldwell WT, : Adjuvant radiotherapy for atypical meningiomas. J Neurosurg 126:1822\u20131828, 20172761120110.3171\/2016.5.JNS152809"},{"key":"b5","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.ijrobp.2018.09.019","article-title":"Pathologic predictors of local recurrence in atypical meningiomas following gross total resection","volume":"103","author":"Barrett OC","year":"2019","unstructured":"Barrett OC, Hackney JR, McDonald AM, Willey CD, Bredel M, Fiveash JB: Pathologic predictors of local recurrence in atypical meningiomas following gross total resection. Int J Radiat Oncol Biol Phys 103:453\u2013459, 201910.1016\/j.ijrobp.2018.09.01930253235"},{"key":"b6","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.ijrobp.2008.10.053","article-title":"Combined proton and photon conformal radiotherapy for intracranial atypical and malignant meningioma","volume":"75","author":"Boskos C","year":"2009","unstructured":"Boskos C, Feuvret L, Noel G, Habrand JL, Pommier P, Alapetite C, : Combined proton and photon conformal radiotherapy for intracranial atypical and malignant meningioma. Int J Radiat Oncol Biol Phys 75:399\u2013406, 20091920384410.1016\/j.ijrobp.2008.10.053"},{"key":"b7","series-title":"J Cancer Res Ther","doi-asserted-by":"publisher","first-page":"52","DOI":"10.4103\/0973-1482.80462","article-title":"Fractionated stereotactic radiosurgery for the treatment of meningiomas","volume":"7","author":"Bria C","year":"2011","unstructured":"Bria C, Wegner RE, Clump DA, Vargo JA, Mintz AH, Heron DE, : Fractionated stereotactic radiosurgery for the treatment of meningiomas. J Cancer Res Ther 7:52\u201357, 20112154674310.4103\/0973-1482.80462"},{"key":"b8","series-title":"Future Oncol","doi-asserted-by":"publisher","first-page":"2161","DOI":"10.2217\/fon-2018-0006","article-title":"An overview of meningiomas","volume":"14","author":"Buerki RA","year":"2018","unstructured":"Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV: An overview of meningiomas. Future Oncol 14:2161\u20132177, 20183008426510.2217\/fon-2018-0006"},{"key":"b9","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1227\/NEU.0b013e3181f2f427","article-title":"Cyberknife stereotactic radiosurgery for treatment of atypical (WHO grade II) cranial meningiomas","volume":"67","author":"Choi CYH","year":"2010","unstructured":"Choi CYH, Soltys SG, Gibbs IC, Harsh GR, Jackson PS, Lieberson RE, : Cyberknife stereotactic radiosurgery for treatment of atypical (WHO grade II) cranial meningiomas. Neurosurgery 67:1180\u20131188, 201010.1227\/NEU.0b013e3181f2f42720871435"},{"key":"b10","series-title":"J Clin Oncol","doi-asserted-by":"publisher","first-page":"3547","DOI":"10.1200\/JCO.2001.19.15.3547","article-title":"High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results","volume":"19","author":"Debus J","year":"2001","unstructured":"Debus J, Wuendrich M, Pirzkall A, Hoess A, Schlegel W, Zuna I, : High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results. J Clin Oncol 19:3547\u20133553, 200110.1200\/JCO.2001.19.15.354711481362"},{"key":"b11","series-title":"Lancet Oncol","doi-asserted-by":"publisher","first-page":"e383","DOI":"10.1016\/S1470-2045(16)30321-7","article-title":"EANO guidelines for the diagnosis and treatment of meningiomas","volume":"17","author":"Goldbrunner R","year":"2016","unstructured":"Goldbrunner R, Minniti G, Preusser M, Jenkinson MD, Sallabanda K, Houdart E, : EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol 17:e383\u2013e391, 201610.1016\/S1470-2045(16)30321-7"},{"key":"b12","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/S0360-3016(99)00349-1","article-title":"Local control and overall survival in atypical meningioma: a retrospective study","volume":"46","author":"Goyal LK","year":"2000","unstructured":"Goyal LK, Suh JH, Mohan DS, Prayson RA, Lee J, Barnett GH: Local control and overall survival in atypical meningioma: a retrospective study. Int J Radiat Oncol Biol Phys 46:57\u201361, 20001065637310.1016\/S0360-3016(99)00349-1"},{"issue":"Suppl","key":"b13","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"283","DOI":"10.3171\/sup.2005.102.s_supplement.0283","article-title":"Gamma knife surgery for atypical meningiomas","volume":"102","author":"Huffmann BC","year":"2005","unstructured":"Huffmann BC, Reinacher PC, Gilsbach JM: Gamma knife surgery for atypical meningiomas. J Neurosurg 102 (Suppl):283\u2013286, 200510.3171\/sup.2005.102.s_supplement.028315662826"},{"key":"b14","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1023\/A:1006434124794","article-title":"Management of atypical and malignant meningiomas: role of high-dose, 3D-conformal radiation therapy","volume":"48","author":"Hug EB","year":"2000","unstructured":"Hug EB, Devries A, Thornton AF, Munzenride JE, Pardo FS, Hedley-Whyte ET, : Management of atypical and malignant meningiomas: role of high-dose, 3D-conformal radiation therapy. J Neurooncol 48:151\u2013160, 200010.1023\/A:100643412479411083080"},{"key":"b15","series-title":"Trials","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1186\/s13063-015-1040-3","article-title":"The ROAM\/EORTC-1308 trial: Radiation versus Observation following surgical resection of Atypical Meningioma: study protocol for a randomised controlled trial","volume":"16","author":"Jenkinson MD","year":"2015","unstructured":"Jenkinson MD, Javadpour M, Haylock BJ, Young B, Gillard H, Vinten J, : The ROAM\/EORTC-1308 trial: Radiation versus Observation following surgical resection of Atypical Meningioma: study protocol for a randomised controlled trial. Trials 16:519, 20152657653310.1186\/s13063-015-1040-3"},{"key":"b16","series-title":"Neuro Oncol","first-page":"453","article-title":"Atypical meningioma\u2013is it time to standardize surgical sampling techniques?","volume":"19","author":"Jenkinson MD","year":"2017","unstructured":"Jenkinson MD, Santarius T, Zadeh G, Aldape KD: Atypical meningioma\u2013is it time to standardize surgical sampling techniques? Neuro Oncol 19:453\u2013454, 201728391316"},{"key":"b17","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1007\/s11060-007-9338-y","article-title":"Stereotactic radiosurgery for atypical and anaplastic meningiomas","volume":"84","author":"Kano H","year":"2007","unstructured":"Kano H, Takahashi JA, Katsuki T, Araki N, Oya N, Hiraoka M, : Stereotactic radiosurgery for atypical and anaplastic meningiomas. J Neurooncol 84:41\u201347, 200710.1007\/s11060-007-9338-y17361335"},{"key":"b18","series-title":"Neuro Oncol","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1093\/neuonc\/nou025","article-title":"Adjuvant radiotherapy for atypical and malignant meningiomas: a systematic review","volume":"16","author":"Kaur G","year":"2014","unstructured":"Kaur G, Sayegh ET, Larson A, Bloch O, Madden M, Sun MZ, : Adjuvant radiotherapy for atypical and malignant meningiomas: a systematic review. Neuro Oncol 16:628\u2013636, 20142469649910.1093\/neuonc\/nou025"},{"key":"b19","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"679","DOI":"10.3171\/2012.7.JNS112113","article-title":"The role of radiotherapy following gross-total resection of atypical meningiomas","volume":"117","author":"Komotar RJ","year":"2012","unstructured":"Komotar RJ, Iorgulescu JB, Raper DMS, Holland EC, Beal K, Bilsky MH, : The role of radiotherapy following gross-total resection of atypical meningiomas. J Neurosurg 117:679\u2013686, 20122292095510.3171\/2012.7.JNS112113"},{"key":"b20","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1227\/NEU.0000000000000519","article-title":"Is there a tumor volume threshold for postradiosurgical symptoms? A single-institution analysis","volume":"75","author":"Kuhn EN","year":"2014","unstructured":"Kuhn EN, Taksler GB, Dayton O, Loganathan A, Bourland D, Tatter SB, : Is there a tumor volume threshold for postradiosurgical symptoms? A single-institution analysis. Neurosurgery 75:536\u2013545, 201410.1227\/NEU.0000000000000519"},{"key":"b21","series-title":"J Craniofac Surg","doi-asserted-by":"publisher","first-page":"e569","DOI":"10.1097\/SCS.0000000000003874","article-title":"Bevacizumab for the treatment of Gammaknife radiosurgery-induced brain radiation necrosis","volume":"28","author":"Ma Y","year":"2017","unstructured":"Ma Y, Zheng C, Feng Y, Xu Q: Bevacizumab for the treatment of Gammaknife radiosurgery-induced brain radiation necrosis. J Craniofac Surg 28:e569\u2013e571, 201710.1097\/SCS.0000000000003874"},{"key":"b22","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1007\/BF01476410","article-title":"Intracranial meningiomas: analysis of recurrence after surgical treatment","volume":"126","author":"Mahmood A","year":"1994","unstructured":"Mahmood A, Qureshi NH, Malik GM: Intracranial meningiomas: analysis of recurrence after surgical treatment. Acta Neurochir (Wien) 126:53\u201358, 199410.1007\/BF014764108042555"},{"key":"b23","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"811","DOI":"10.3171\/2011.5.JNS11112","article-title":"Radiotherapy for atypical meningiomas","volume":"115","author":"Mair R","year":"2011","unstructured":"Mair R, Morris K, Scott I, Carroll TA: Radiotherapy for atypical meningiomas. J Neurosurg 115:811\u2013819, 201110.3171\/2011.5.JNS1111221699480"},{"key":"b24","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/S0090-3019(03)00377-X","article-title":"Potential complications following radiotherapy for meningiomas","volume":"60","author":"Mathiesen T","year":"2003","unstructured":"Mathiesen T, Kihlstr\u00f6m L, Karlsson B, Lindquist C: Potential complications following radiotherapy for meningiomas. Surg Neurol 60:193\u2013200, 200310.1016\/S0090-3019(03)00377-X12922028"},{"key":"b25","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.clineuro.2018.07.010","article-title":"Long-term stroke risk of single-fraction photon-based stereotactic radiosurgery for meningioma","volume":"173","author":"McClelland S III","year":"2018","unstructured":"McClelland S III, Ciporen JN, Mitin T, Jaboin JJ: Long-term stroke risk of single-fraction photon-based stereotactic radiosurgery for meningioma. Clin Neurol Neurosurg 173:169\u2013172, 20183014552610.1016\/j.clineuro.2018.07.010"},{"key":"b26","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1016\/0360-3016(95)02166-3","article-title":"Radiotherapy for atypical or malignant intracranial meningioma","volume":"34","author":"Milosevic MF","year":"1996","unstructured":"Milosevic MF, Frost PJ, Laperriere NJ, Wong CS, Simpson WJ: Radiotherapy for atypical or malignant intracranial meningioma. Int J Radiat Oncol Biol Phys 34:817\u2013822, 1996859835810.1016\/0360-3016(95)02166-3"},{"key":"b27","article-title":"NCCN Guidelines: Central Nervous System Cancers","author":"National Comprehensive Cancer Network","unstructured":"National Comprehensive Cancer Network: NCCN Guidelines: Central Nervous System Cancers. NCCN.org (http:\/\/www.nccn.org\/) [Accessed April 4, 2019]"},{"issue":"suppl_5","key":"b28","series-title":"Neuro Oncol","doi-asserted-by":"publisher","first-page":"v1","DOI":"10.1093\/neuonc\/now207","article-title":"CBTRUS Statistical Report: Primary brain and other central nervous system tumors diagnosed in the United States in 2009\u20132013","volume":"18","author":"Ostrom QT","year":"2016","unstructured":"Ostrom QT, Gittleman H, Xu J, Kromer C, Wolinsky Y, Kruchko C, : CBTRUS Statistical Report: Primary brain and other central nervous system tumors diagnosed in the United States in 2009\u20132013. Neuro Oncol 18 (suppl_5):v1\u2013v75, 201610.1093\/neuonc\/now207"},{"key":"b29","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1016\/j.ijrobp.2007.12.020","article-title":"Atypical and malignant meningioma: outcome and prognostic factors in 119 irradiated patients. A multicenter, retrospective study of the Rare Cancer Network","volume":"71","author":"Pasquier D","year":"2008","unstructured":"Pasquier D, Bijmolt S, Veninga T, Rezvoy N, Villa S, Krengli M, : Atypical and malignant meningioma: outcome and prognostic factors in 119 irradiated patients. A multicenter, retrospective study of the Rare Cancer Network. Int J Radiat Oncol Biol Phys 71:1388\u20131393, 200810.1016\/j.ijrobp.2007.12.02018294779"},{"key":"b30","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"4","DOI":"10.3171\/2014.7.JNS131644","article-title":"Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review","volume":"122","author":"Rogers L","year":"2015","unstructured":"Rogers L, Barani I, Chamberlain M, Kaley TJ, McDermott M, Raizer J, : Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review. J Neurosurg 122:4\u201323, 201510.3171\/2014.7.JNS13164425343186"},{"issue":"Suppl 6","key":"b31","series-title":"Neuro Oncol","doi-asserted-by":"publisher","first-page":"vi133","DOI":"10.1093\/neuonc\/nox168.546","article-title":"MNGI-08. High-risk meningioma: initial outcomes from NRG Oncology\/RTOG-0539","volume":"19","author":"Rogers L","year":"2017","unstructured":"Rogers L, Zhang P, Vogelbaum M, Perry A, Ashby LS, Modi J, : MNGI-08. High-risk meningioma: initial outcomes from NRG Oncology\/RTOG-0539. Neuro Oncol 19 (Suppl 6):vi133, 201710.1093\/neuonc\/nox168.546"},{"key":"b32","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"35","DOI":"10.3171\/2016.11.JNS161170","article-title":"Intermediate-risk meningioma: initial outcomes from NRG Oncology RTOG 0539","volume":"129","author":"Rogers L","year":"2018","unstructured":"Rogers L, Zhang P, Vogelbaum MA, Perry A, Ashby LS, Modi JM, : Intermediate-risk meningioma: initial outcomes from NRG Oncology RTOG 0539. J Neurosurg 129:35\u201347, 20182898451710.3171\/2016.11.JNS161170"},{"key":"b33","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/j.ijrobp.2008.08.018","article-title":"Long-term experience with World Health Organization grade III (malignant) meningiomas at a single institution","volume":"74","author":"Rosenberg LA","year":"2009","unstructured":"Rosenberg LA, Prayson RA, Lee J, Reddy C, Chao ST, Barnett GH, : Long-term experience with World Health Organization grade III (malignant) meningiomas at a single institution. Int J Radiat Oncol Biol Phys 74:427\u2013432, 200910.1016\/j.ijrobp.2008.08.018"},{"key":"b34","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1136\/jnnp.20.1.22","article-title":"The recurrence of intracranial meningiomas after surgical treatment","volume":"20","author":"Simpson D","year":"1957","unstructured":"Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22\u201339, 195710.1136\/jnnp.20.1.2213406590"},{"key":"b35","series-title":"Neurosurgery","first-page":"1029","article-title":"Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients","volume":"49","author":"Stafford SL","year":"2001","unstructured":"Stafford SL, Pollock BE, Foote RL, Link MJ, Gorman DA, Schomberg PJ, : Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients. Neurosurgery 49:1029\u20131038, 200111846894"},{"key":"b36","series-title":"Front Oncol","doi-asserted-by":"publisher","first-page":"227","DOI":"10.3389\/fonc.2013.00227","article-title":"Radiation treatment for WHO grade II and III meningiomas","volume":"3","author":"Walcott BP","year":"2013","unstructured":"Walcott BP, Nahed BV, Brastianos PK, Loeffler JS: Radiation treatment for WHO grade II and III meningiomas. Front Oncol 3:227, 20132403210710.3389\/fonc.2013.00227"},{"key":"b37","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1136\/jnnp.2007.121582","article-title":"Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features","volume":"79","author":"Yang SY","year":"2008","unstructured":"Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW: Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry 79:574\u2013580, 20081776643010.1136\/jnnp.2007.121582"},{"key":"b38","series-title":"Recent Patents Anticancer Drug Discov","doi-asserted-by":"publisher","first-page":"272","DOI":"10.2174\/1574892812666170425124430","article-title":"Indication of bevacizumab for cerebral radiation necrosis","volume":"12","author":"Zhuang H","year":"2017","unstructured":"Zhuang H, Yuan X, Yuan Z, Wang P: Indication of bevacizumab for cerebral radiation necrosis. Recent Patents Anticancer Drug Discov 12:272\u2013277, 201710.2174\/1574892812666170425124430"},{"key":"b1","series-title":"Neuro Oncol","article-title":"Non-malignant and malignant meningioma incidence and survival in the elderly from 2005-2015 using the Central Brain Tumor Registry of the United States","author":"Achey RL","unstructured":"Achey RL, Gittleman H, Schroer J, Khanna V, Kruchko C, Barnholtz-Sloan JS: Non-malignant and malignant meningioma incidence and survival in the elderly from 2005-2015 using the Central Brain Tumor Registry of the United States. Neuro Oncol [epub ahead of print], 201830295804"},{"key":"b2","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1227\/01.NEU.0000330399.55586.63","article-title":"Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation","volume":"64","author":"Aghi MK","year":"2009","unstructured":"Aghi MK, Carter BS, Cosgrove GR, Ojemann RG, Amin-Hanjani S, Martuza RL, : Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery 64:56\u201360, 200910.1227\/01.NEU.0000330399.55586.6319145156"},{"key":"b3","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s11060-012-0828-1","article-title":"Patterns of failure after treatment of atypical meningioma with gamma knife radiosurgery","volume":"108","author":"Attia A","year":"2012","unstructured":"Attia A, Chan MD, Mott RT, Russell GB, Seif D, Daniel Bourland J, : Patterns of failure after treatment of atypical meningioma with gamma knife radiosurgery. J Neurooncol 108:179\u2013185, 20122235923110.1007\/s11060-012-0828-1"},{"key":"b4","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1822","DOI":"10.3171\/2016.5.JNS152809","article-title":"Adjuvant radiotherapy for atypical meningiomas","volume":"126","author":"Bagshaw HP","year":"2017","unstructured":"Bagshaw HP, Burt LM, Jensen RL, Suneja G, Palmer CA, Couldwell WT, : Adjuvant radiotherapy for atypical meningiomas. J Neurosurg 126:1822\u20131828, 20172761120110.3171\/2016.5.JNS152809"},{"key":"b5","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.ijrobp.2018.09.019","article-title":"Pathologic predictors of local recurrence in atypical meningiomas following gross total resection","volume":"103","author":"Barrett OC","year":"2019","unstructured":"Barrett OC, Hackney JR, McDonald AM, Willey CD, Bredel M, Fiveash JB: Pathologic predictors of local recurrence in atypical meningiomas following gross total resection. Int J Radiat Oncol Biol Phys 103:453\u2013459, 201910.1016\/j.ijrobp.2018.09.01930253235"},{"key":"b6","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.ijrobp.2008.10.053","article-title":"Combined proton and photon conformal radiotherapy for intracranial atypical and malignant meningioma","volume":"75","author":"Boskos C","year":"2009","unstructured":"Boskos C, Feuvret L, Noel G, Habrand JL, Pommier P, Alapetite C, : Combined proton and photon conformal radiotherapy for intracranial atypical and malignant meningioma. Int J Radiat Oncol Biol Phys 75:399\u2013406, 20091920384410.1016\/j.ijrobp.2008.10.053"},{"key":"b7","series-title":"J Cancer Res Ther","doi-asserted-by":"publisher","first-page":"52","DOI":"10.4103\/0973-1482.80462","article-title":"Fractionated stereotactic radiosurgery for the treatment of meningiomas","volume":"7","author":"Bria C","year":"2011","unstructured":"Bria C, Wegner RE, Clump DA, Vargo JA, Mintz AH, Heron DE, : Fractionated stereotactic radiosurgery for the treatment of meningiomas. J Cancer Res Ther 7:52\u201357, 20112154674310.4103\/0973-1482.80462"},{"key":"b8","series-title":"Future Oncol","doi-asserted-by":"publisher","first-page":"2161","DOI":"10.2217\/fon-2018-0006","article-title":"An overview of meningiomas","volume":"14","author":"Buerki RA","year":"2018","unstructured":"Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV: An overview of meningiomas. Future Oncol 14:2161\u20132177, 20183008426510.2217\/fon-2018-0006"},{"key":"b9","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1227\/NEU.0b013e3181f2f427","article-title":"Cyberknife stereotactic radiosurgery for treatment of atypical (WHO grade II) cranial meningiomas","volume":"67","author":"Choi CYH","year":"2010","unstructured":"Choi CYH, Soltys SG, Gibbs IC, Harsh GR, Jackson PS, Lieberson RE, : Cyberknife stereotactic radiosurgery for treatment of atypical (WHO grade II) cranial meningiomas. Neurosurgery 67:1180\u20131188, 201010.1227\/NEU.0b013e3181f2f42720871435"},{"key":"b10","series-title":"J Clin Oncol","doi-asserted-by":"publisher","first-page":"3547","DOI":"10.1200\/JCO.2001.19.15.3547","article-title":"High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results","volume":"19","author":"Debus J","year":"2001","unstructured":"Debus J, Wuendrich M, Pirzkall A, Hoess A, Schlegel W, Zuna I, : High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results. J Clin Oncol 19:3547\u20133553, 200110.1200\/JCO.2001.19.15.354711481362"},{"key":"b11","series-title":"Lancet Oncol","doi-asserted-by":"publisher","first-page":"e383","DOI":"10.1016\/S1470-2045(16)30321-7","article-title":"EANO guidelines for the diagnosis and treatment of meningiomas","volume":"17","author":"Goldbrunner R","year":"2016","unstructured":"Goldbrunner R, Minniti G, Preusser M, Jenkinson MD, Sallabanda K, Houdart E, : EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol 17:e383\u2013e391, 201610.1016\/S1470-2045(16)30321-7"},{"key":"b12","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/S0360-3016(99)00349-1","article-title":"Local control and overall survival in atypical meningioma: a retrospective study","volume":"46","author":"Goyal LK","year":"2000","unstructured":"Goyal LK, Suh JH, Mohan DS, Prayson RA, Lee J, Barnett GH: Local control and overall survival in atypical meningioma: a retrospective study. Int J Radiat Oncol Biol Phys 46:57\u201361, 20001065637310.1016\/S0360-3016(99)00349-1"},{"issue":"Suppl","key":"b13","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"283","DOI":"10.3171\/sup.2005.102.s_supplement.0283","article-title":"Gamma knife surgery for atypical meningiomas","volume":"102","author":"Huffmann BC","year":"2005","unstructured":"Huffmann BC, Reinacher PC, Gilsbach JM: Gamma knife surgery for atypical meningiomas. J Neurosurg 102 (Suppl):283\u2013286, 200510.3171\/sup.2005.102.s_supplement.028315662826"},{"key":"b14","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1023\/A:1006434124794","article-title":"Management of atypical and malignant meningiomas: role of high-dose, 3D-conformal radiation therapy","volume":"48","author":"Hug EB","year":"2000","unstructured":"Hug EB, Devries A, Thornton AF, Munzenride JE, Pardo FS, Hedley-Whyte ET, : Management of atypical and malignant meningiomas: role of high-dose, 3D-conformal radiation therapy. J Neurooncol 48:151\u2013160, 200010.1023\/A:100643412479411083080"},{"key":"b15","series-title":"Trials","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1186\/s13063-015-1040-3","article-title":"The ROAM\/EORTC-1308 trial: Radiation versus Observation following surgical resection of Atypical Meningioma: study protocol for a randomised controlled trial","volume":"16","author":"Jenkinson MD","year":"2015","unstructured":"Jenkinson MD, Javadpour M, Haylock BJ, Young B, Gillard H, Vinten J, : The ROAM\/EORTC-1308 trial: Radiation versus Observation following surgical resection of Atypical Meningioma: study protocol for a randomised controlled trial. Trials 16:519, 20152657653310.1186\/s13063-015-1040-3"},{"key":"b16","series-title":"Neuro Oncol","first-page":"453","article-title":"Atypical meningioma\u2013is it time to standardize surgical sampling techniques?","volume":"19","author":"Jenkinson MD","year":"2017","unstructured":"Jenkinson MD, Santarius T, Zadeh G, Aldape KD: Atypical meningioma\u2013is it time to standardize surgical sampling techniques? Neuro Oncol 19:453\u2013454, 201728391316"},{"key":"b17","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1007\/s11060-007-9338-y","article-title":"Stereotactic radiosurgery for atypical and anaplastic meningiomas","volume":"84","author":"Kano H","year":"2007","unstructured":"Kano H, Takahashi JA, Katsuki T, Araki N, Oya N, Hiraoka M, : Stereotactic radiosurgery for atypical and anaplastic meningiomas. J Neurooncol 84:41\u201347, 200710.1007\/s11060-007-9338-y17361335"},{"key":"b18","series-title":"Neuro Oncol","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1093\/neuonc\/nou025","article-title":"Adjuvant radiotherapy for atypical and malignant meningiomas: a systematic review","volume":"16","author":"Kaur G","year":"2014","unstructured":"Kaur G, Sayegh ET, Larson A, Bloch O, Madden M, Sun MZ, : Adjuvant radiotherapy for atypical and malignant meningiomas: a systematic review. Neuro Oncol 16:628\u2013636, 20142469649910.1093\/neuonc\/nou025"},{"key":"b19","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"679","DOI":"10.3171\/2012.7.JNS112113","article-title":"The role of radiotherapy following gross-total resection of atypical meningiomas","volume":"117","author":"Komotar RJ","year":"2012","unstructured":"Komotar RJ, Iorgulescu JB, Raper DMS, Holland EC, Beal K, Bilsky MH, : The role of radiotherapy following gross-total resection of atypical meningiomas. J Neurosurg 117:679\u2013686, 20122292095510.3171\/2012.7.JNS112113"},{"key":"b20","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1227\/NEU.0000000000000519","article-title":"Is there a tumor volume threshold for postradiosurgical symptoms? A single-institution analysis","volume":"75","author":"Kuhn EN","year":"2014","unstructured":"Kuhn EN, Taksler GB, Dayton O, Loganathan A, Bourland D, Tatter SB, : Is there a tumor volume threshold for postradiosurgical symptoms? A single-institution analysis. Neurosurgery 75:536\u2013545, 201410.1227\/NEU.0000000000000519"},{"key":"b21","series-title":"J Craniofac Surg","doi-asserted-by":"publisher","first-page":"e569","DOI":"10.1097\/SCS.0000000000003874","article-title":"Bevacizumab for the treatment of Gammaknife radiosurgery-induced brain radiation necrosis","volume":"28","author":"Ma Y","year":"2017","unstructured":"Ma Y, Zheng C, Feng Y, Xu Q: Bevacizumab for the treatment of Gammaknife radiosurgery-induced brain radiation necrosis. J Craniofac Surg 28:e569\u2013e571, 201710.1097\/SCS.0000000000003874"},{"key":"b22","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1007\/BF01476410","article-title":"Intracranial meningiomas: analysis of recurrence after surgical treatment","volume":"126","author":"Mahmood A","year":"1994","unstructured":"Mahmood A, Qureshi NH, Malik GM: Intracranial meningiomas: analysis of recurrence after surgical treatment. Acta Neurochir (Wien) 126:53\u201358, 199410.1007\/BF014764108042555"},{"key":"b23","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"811","DOI":"10.3171\/2011.5.JNS11112","article-title":"Radiotherapy for atypical meningiomas","volume":"115","author":"Mair R","year":"2011","unstructured":"Mair R, Morris K, Scott I, Carroll TA: Radiotherapy for atypical meningiomas. J Neurosurg 115:811\u2013819, 201110.3171\/2011.5.JNS1111221699480"},{"key":"b24","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/S0090-3019(03)00377-X","article-title":"Potential complications following radiotherapy for meningiomas","volume":"60","author":"Mathiesen T","year":"2003","unstructured":"Mathiesen T, Kihlstr\u00f6m L, Karlsson B, Lindquist C: Potential complications following radiotherapy for meningiomas. Surg Neurol 60:193\u2013200, 200310.1016\/S0090-3019(03)00377-X12922028"},{"key":"b25","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.clineuro.2018.07.010","article-title":"Long-term stroke risk of single-fraction photon-based stereotactic radiosurgery for meningioma","volume":"173","author":"McClelland S III","year":"2018","unstructured":"McClelland S III, Ciporen JN, Mitin T, Jaboin JJ: Long-term stroke risk of single-fraction photon-based stereotactic radiosurgery for meningioma. Clin Neurol Neurosurg 173:169\u2013172, 20183014552610.1016\/j.clineuro.2018.07.010"},{"key":"b26","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1016\/0360-3016(95)02166-3","article-title":"Radiotherapy for atypical or malignant intracranial meningioma","volume":"34","author":"Milosevic MF","year":"1996","unstructured":"Milosevic MF, Frost PJ, Laperriere NJ, Wong CS, Simpson WJ: Radiotherapy for atypical or malignant intracranial meningioma. Int J Radiat Oncol Biol Phys 34:817\u2013822, 1996859835810.1016\/0360-3016(95)02166-3"},{"key":"b27","article-title":"NCCN Guidelines: Central Nervous System Cancers","author":"National Comprehensive Cancer Network","unstructured":"National Comprehensive Cancer Network: NCCN Guidelines: Central Nervous System Cancers. NCCN.org (http:\/\/www.nccn.org\/) [Accessed April 4, 2019]"},{"issue":"suppl_5","key":"b28","series-title":"Neuro Oncol","doi-asserted-by":"publisher","first-page":"v1","DOI":"10.1093\/neuonc\/now207","article-title":"CBTRUS Statistical Report: Primary brain and other central nervous system tumors diagnosed in the United States in 2009\u20132013","volume":"18","author":"Ostrom QT","year":"2016","unstructured":"Ostrom QT, Gittleman H, Xu J, Kromer C, Wolinsky Y, Kruchko C, : CBTRUS Statistical Report: Primary brain and other central nervous system tumors diagnosed in the United States in 2009\u20132013. Neuro Oncol 18 (suppl_5):v1\u2013v75, 201610.1093\/neuonc\/now207"},{"key":"b29","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1016\/j.ijrobp.2007.12.020","article-title":"Atypical and malignant meningioma: outcome and prognostic factors in 119 irradiated patients. A multicenter, retrospective study of the Rare Cancer Network","volume":"71","author":"Pasquier D","year":"2008","unstructured":"Pasquier D, Bijmolt S, Veninga T, Rezvoy N, Villa S, Krengli M, : Atypical and malignant meningioma: outcome and prognostic factors in 119 irradiated patients. A multicenter, retrospective study of the Rare Cancer Network. Int J Radiat Oncol Biol Phys 71:1388\u20131393, 200810.1016\/j.ijrobp.2007.12.02018294779"},{"key":"b30","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"4","DOI":"10.3171\/2014.7.JNS131644","article-title":"Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review","volume":"122","author":"Rogers L","year":"2015","unstructured":"Rogers L, Barani I, Chamberlain M, Kaley TJ, McDermott M, Raizer J, : Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review. J Neurosurg 122:4\u201323, 201510.3171\/2014.7.JNS13164425343186"},{"issue":"Suppl 6","key":"b31","series-title":"Neuro Oncol","doi-asserted-by":"publisher","first-page":"vi133","DOI":"10.1093\/neuonc\/nox168.546","article-title":"MNGI-08. High-risk meningioma: initial outcomes from NRG Oncology\/RTOG-0539","volume":"19","author":"Rogers L","year":"2017","unstructured":"Rogers L, Zhang P, Vogelbaum M, Perry A, Ashby LS, Modi J, : MNGI-08. High-risk meningioma: initial outcomes from NRG Oncology\/RTOG-0539. Neuro Oncol 19 (Suppl 6):vi133, 201710.1093\/neuonc\/nox168.546"},{"key":"b32","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"35","DOI":"10.3171\/2016.11.JNS161170","article-title":"Intermediate-risk meningioma: initial outcomes from NRG Oncology RTOG 0539","volume":"129","author":"Rogers L","year":"2018","unstructured":"Rogers L, Zhang P, Vogelbaum MA, Perry A, Ashby LS, Modi JM, : Intermediate-risk meningioma: initial outcomes from NRG Oncology RTOG 0539. J Neurosurg 129:35\u201347, 20182898451710.3171\/2016.11.JNS161170"},{"key":"b33","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/j.ijrobp.2008.08.018","article-title":"Long-term experience with World Health Organization grade III (malignant) meningiomas at a single institution","volume":"74","author":"Rosenberg LA","year":"2009","unstructured":"Rosenberg LA, Prayson RA, Lee J, Reddy C, Chao ST, Barnett GH, : Long-term experience with World Health Organization grade III (malignant) meningiomas at a single institution. Int J Radiat Oncol Biol Phys 74:427\u2013432, 200910.1016\/j.ijrobp.2008.08.018"},{"key":"b34","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1136\/jnnp.20.1.22","article-title":"The recurrence of intracranial meningiomas after surgical treatment","volume":"20","author":"Simpson D","year":"1957","unstructured":"Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22\u201339, 195710.1136\/jnnp.20.1.2213406590"},{"key":"b35","series-title":"Neurosurgery","first-page":"1029","article-title":"Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients","volume":"49","author":"Stafford SL","year":"2001","unstructured":"Stafford SL, Pollock BE, Foote RL, Link MJ, Gorman DA, Schomberg PJ, : Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients. Neurosurgery 49:1029\u20131038, 200111846894"},{"key":"b36","series-title":"Front Oncol","doi-asserted-by":"publisher","first-page":"227","DOI":"10.3389\/fonc.2013.00227","article-title":"Radiation treatment for WHO grade II and III meningiomas","volume":"3","author":"Walcott BP","year":"2013","unstructured":"Walcott BP, Nahed BV, Brastianos PK, Loeffler JS: Radiation treatment for WHO grade II and III meningiomas. Front Oncol 3:227, 20132403210710.3389\/fonc.2013.00227"},{"key":"b37","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1136\/jnnp.2007.121582","article-title":"Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features","volume":"79","author":"Yang SY","year":"2008","unstructured":"Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW: Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry 79:574\u2013580, 20081776643010.1136\/jnnp.2007.121582"},{"key":"b38","series-title":"Recent Patents Anticancer Drug Discov","doi-asserted-by":"publisher","first-page":"272","DOI":"10.2174\/1574892812666170425124430","article-title":"Indication of bevacizumab for cerebral radiation necrosis","volume":"12","author":"Zhuang H","year":"2017","unstructured":"Zhuang H, Yuan X, Yuan Z, Wang P: Indication of bevacizumab for cerebral radiation necrosis. Recent Patents Anticancer Drug Discov 12:272\u2013277, 201710.2174\/1574892812666170425124430"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/46\/6\/article-pE5.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/46\/6\/article-pE5.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/46\/6\/article-pE5.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T08:44:06Z","timestamp":1780130646000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/46\/6\/article-pE5.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6]]},"references-count":76,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2019.3.focus1930","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6]]}}}