Hypofractionated Gamma Knife Icon Radiosurgery for Perioptic Meningiomas: Clinical and Radiological Outcomes in a Series of 100 Patients

Perioptic meningiomas pose a therapeutic challenge due to their proximity to critical visual structures. Single-fraction stereotactic radiosurgery is known to effectively control the growth of meningiomas, but this subgroup carries the risk of optic neuropathy, which is minimized with the introduction of dose hypofractionation. The Leksell Gamma Knife Icon has perfected fractionated stereotactic radiosurgery, maintaining submillimeter accuracy in each dose fraction without the need for an invasive frame. This study analyzes the feasibility, safety, and efficacy of multi-fraction Gamma Knife Icon radiosurgery for perioptic meningiomas, taking into account tumor control rates, visual preservation, and treatment-related toxicity. We conducted a retrospective analysis of 100 patients with a perioptic meningioma treated with fractionated Gamma Knife Icon radiosurgery between September 2017 and December 2022. A total of 80 Patients were female, and 20 were male; the mean age was 61.7 years (range 35–84). The most frequent anatomical locations included: cavernous sinus (35 pts), anterior clinoid (17 pts), sphenoid wing (14 pts) and olfactory groove (11 pts). The median tumor volume was 5.6 mL (range 0.12–31.7 mL). Most patients (89%) received 25 Gy in five fractions. Tumor control was achieved in 98% of cases, with a mean radiological follow-up of 41.2 months. Tumor volume did not predict radiological shrinkage (p = 0.639). Tumor shrinkage was observed more frequently in the no prior surgery group (p = 0.035). The mean clinical follow-up was 45.3 months. Among symptomatic patients (35 pts) at baseline, symptoms remained stable in 27 (77%) cases, improved in 5 (14%), and worsened in 3 (9%). No new symptoms were observed in asymptomatic patients. Overall clinical deterioration occurred in three (3%) patients—one because of tumor progression; although, without statistical evidence (p = 0.217), worsened patients had notable larger mean tumor volumes (12.6 mL vs. 6.8 mL). The dosimetric advantages of Gamma Knife technology are empowered by the biological benefits of fractionation and the convenience of non-invasive immobilization. Excellent tumor control rates and positive visual outcomes favor its routine application in properly selected patients.