Gamma knife radiosurgery for posterior cranial fossa meningioma

Treatment of meningioma in the posterior cranial fossa represents a formidable challenge for the neurosurgeon. Although surgical resection is the primary treatment option for posterior fossa meningiomas, there is an important risk of injury to neurovascular structures adjacent to the brainstem. Furthermore, residual or recurrent tumours following resection are not rare, in spite of recent advances in microsurgery and anaesthesiology, including intraoperative neurophysiological monitoring. Gamma Knife (Elekta AB, Sweden) Stereotactic Radiosurgery (SRS) has been used to treat meningiomas in the posterior fossa (after surgery or as a primary treatment), with a good rate of local control and a low incidence of collateral effects. A large amount of data over long follow-up periods shows that Gamma Knife SRS is an effective complementary tool in a new patient-centred approach to the management of posterior cranial fossa meningiomas, in which the neurosurgeon needs to reach an acceptable compromise between tumour removal and function preservation. In this chapter, we analyse data from the most important WHO grade I posterior fossa meningioma case series reported in the literature and discuss their relevance in the paradigm shift towards achieving a good quality of life rather than gross total resection done with "blood, sweat and tears" (Leksell and Lunsford, The origins and birth of the Leksell Gamma Knife. In: Lunsford LD, et al. editors. Intracranial stereotactic radiosurgery. Thieme Medical Publishers, 2016. pp. 1-10).