Radiation therapy of meningioma of the anterior visual pathway

Radiotherapy is an established alternative to surgery in the treatment of meningiomas. Particularly in cases of symptomatic tumors of the optical pathways, irradiation is the treatment of choice when the functional risks of surgery are high. Because histological findings are often lacking an interdisciplinary discussion is important to determine neuroradiological and neuro-ophthalmological patterns of the tumor. As a general benefit for immediate irradiation after subtotal resection could not yet be shown and the risk for side effects is increased, a postoperative radiotherapy has to be discussed in each individual patient. The choice of the special irradiation schedule depends on tumor size and its localization in the proximity of critical structures. Three-dimensional treatment planning with magnetic resonance imaging (MRI) information on the tumor and its surroundings is mandatory. A precise immobilization of the patient is necessary for treatment in the area of the anterior visual pathways.