Meningioma is a common incidental finding, and clinical course varies based on anatomical location. The aim of this sub-analysis of the IMPASSE study was to compare the outcomes of patients with an incidental frontobasal meningioma who underwent active surveillance to those who underwent upfront stereotactic radiosurgery (SRS). Data were retrospectively collected from 14 centres. The active surveillance (n = 28) and SRS (n = 84) cohorts were compared unmatched and matched for age, sex, and duration of follow-up (n = 25 each). The study endpoints included tumor progression, new symptom development, and need for further intervention. Tumor progression occurred in 52.0% and 0% of the matched active surveillance and SRS cohorts, respectively (p < 0.001). Five patients (6.0%) treated with SRS developed treatment related symptoms compared to none in the active monitoring cohort (p = 0.329). No patients in the matched cohorts developed symptoms attributable to treatment. Three patients managed with active surveillance (10.7%, unmatched; 12.0%, matched) underwent an intervention for tumor growth with no persistent side effects after treatment. No patients subject to SRS underwent further treatment. Active monitoring and SRS confer a similarly low risk of symptom development. Upfront treatment with SRS improves imaging-defined tumor control. Active surveillance and SRS are acceptable treatment options for incidental frontobasal meningioma.

Centre de Recherche du CHUS Université de Sherbrooke Sherbrooke QC J1H 5N4 Canada

Department of Neurological Surgery University of Virginia Charlottesville VA 22903 USA

Department of Neurosurgery 2D1 02 Mackenzie Health Sciences Centre University of Alberta Edmonton AB T6G 2B7 Canada

Department of Neurosurgery Ain Shams University Cairo 11566 Egypt

Department of Neurosurgery and Radiation Oncology New York University New York NY 10016 USA

Department of Neurosurgery and Radiotherapy Nehru Hospital Sector 12 Postgraduate Institute of Medical Education and Research Chandigarh 160012 Punjab India

Department of Neurosurgery Benha University Benha 13512 Egypt

Department of Neurosurgery Koc University School of Medicine Istanbul 34010 Turkey

Department of Neurosurgery National Yang Ming University Beitou District Taipei City 11221 Taiwan

Department of Neurosurgery New York University New York NY 10016 USA

Department of Neurosurgery School of Medicine Neurological Institute Taipei Veteran General Hospital Taipei City 11217 Taiwan

Department of Neurosurgery The Walton Centre NHS Foundation Trust Liverpool L9 7LJ UK

Department of Neurosurgery University of Miami Miller School of Medicine Miami FL 33136 USA

Department of Neurosurgery University of Pittsburgh Pittsburgh PA 15260 USA

Department of Radiation and Stereotactic Neurosurgery Na Homolce Hospital 150 00 Prague Czech Republic

Department of Radiation Oncology National Cancer Institute Cairo University Cairo 12613 Egypt

Department of Radiology Dominican Gamma Knife Center and CEDIMAT Santo Domingo 10514 Dominican Republic

Department of Radiosurgery Rúber International Hospital 28034 Madrid Spain

Gamma Knife Center Cairo Nasser Institute Cairo 11796 Egypt

Institute of Systems Molecular and Integrative Biology University of Liverpool Liverpool L69 7BE UK

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Morris Z., Whiteley W.N., Longstreth W.T., Weber F., Lee Y.-C., Tsushima Y., Alphs H., Ladd S.C., Warlow C., Wardlaw J.M., et al. Incidental findings on brain magnetic resonance imaging: Systematic review and meta-analysis. BMJ. 2009;339:b3016. doi: 10.1136/bmj.b3016. PubMed DOI PMC

Bos D., Poels M.M.F., Adams H.H.H., Akoudad S., Cremers L.G.M., Zonneveld H.I., Hoogendam Y.Y., Verhaaren B., Verlinden V.J.A., Verbruggen J.G.J., et al. Prevalence, Clinical Management, and Natural Course of Incidental Findings on Brain MR Images: The Population-based Rotterdam Scan Study. Radiology. 2016;281:507–515. doi: 10.1148/radiol.2016160218. PubMed DOI

EANO Guideline on the Diagnosis and Management of Meningiomas|Neuro-Oncology|Oxford Academic. [(accessed on 15 October 2021)]. Available online: https://academic.oup.com/neuro-oncology/advance-article-abstract/doi/10.1093/neuonc/noab150/6310843?redirectedFrom=fulltext. PubMed DOI PMC

Behbahani M., Skeie G.O., Eide G.E., Hausken A., Lund-Johansen M., Skeie B.S. A prospective study of the natural history of incidental meningioma—Hold your horses! Neuro-Oncol. Pract. 2019;6:438–450. doi: 10.1093/nop/npz011. PubMed DOI PMC

Brugada-Bellsolà F., Teixidor Rodríguez P., Rodríguez-Hernández A., Garcia-Armengol R., Tardáguila M., González-Crespo A., Domínguez C.J., Rimbau J.M. Growth prediction in asymptomatic meningiomas: The utility of the AIMSS score. Acta Neurochir. 2019;161:2233–2240. doi: 10.1007/s00701-019-04056-3. PubMed DOI

Islim A.I., Kolamunnage-Dona R., Mohan M., Moon R.D.C., Crofton A., Haylock B.J., Rathi N., Brodbelt A.R., Mills S.J., Jenkinson M.D. A prognostic model to personalize monitoring regimes for patients with incidental asymptomatic meningiomas. Neuro-Oncology. 2020;22:278–289. doi: 10.1093/neuonc/noz160. PubMed DOI PMC

Clark V.E., Erson-Omay E.Z., Serin A., Yin J., Cotney J., Ozduman K., Avşar T., Li J., Murray P.B., Henegariu O., et al. Genomic analysis of non-NF2 meningiomas reveals mutations in TRAF7, KLF4, AKT1, and SMO. Science. 2013;339:1077–1080. doi: 10.1126/science.1233009. PubMed DOI PMC

Meling T.R., Da Broi M., Scheie D., Helseth E. Meningiomas: Skull base versus non-skull base. Neurosurg. Rev. 2019;42:163–173. doi: 10.1007/s10143-018-0976-7. PubMed DOI

Islim A.I., Mohan M., Moon R.D.C., Srikandarajah N., Mills S.J., Brodbelt A.R., Jenkinson M.D. Incidental intracranial meningiomas: A systematic review and meta-analysis of prognostic factors and outcomes. J. Neurooncol. 2019;142:211–221. doi: 10.1007/s11060-019-03104-3. PubMed DOI PMC

Pinzi V., Biagioli E., Roberto A., Galli F., Rizzi M., Chiappa F., Brenna G., Fariselli L., Floriani I. Radiosurgery for intracranial meningiomas: A systematic review and meta-analysis. Crit. Rev. Oncol. Hematol. 2017;113:122–134. doi: 10.1016/j.critrevonc.2017.03.005. PubMed DOI

Sheehan J.P., Starke R.M., Kano H., Kaufmann A.M., Mathieu D., Zeiler F.A., West M., Chao S.T., Varma G., Chiang V.L.S., et al. Gamma Knife radiosurgery for sellar and parasellar meningiomas: A multicenter study: Clinical article. J. Neurosurg. 2014;120:1268–1277. doi: 10.3171/2014.2.JNS13139. PubMed DOI

Gande A., Kano H., Bowden G., Mousavi S.H., Niranjan A., Flickinger J.C., Lunsford L.D. Gamma Knife radiosurgery of olfactory groove meningiomas provides a method to preserve subjective olfactory function. J. Neurooncol. 2014;116:577–583. doi: 10.1007/s11060-013-1335-8. PubMed DOI

Sheehan J., Pikis S., Islim A.I., Chen C.-J., Bunevicius A., Peker S., Samanci Y., Nabeel A.M., Reda W.A., Tawadros S.R., et al. An International Multicenter Matched Cohort Analysis of Incidental Meningioma Progression during Active Surveillance or after Stereotactic Radiosurgery: The IMPASSE Study. Neuro-Oncology. 2021;24:116–124. doi: 10.1093/neuonc/noab132. PubMed DOI PMC

Proposed Response Assessment and Endpoints for Meningioma Clinical Trials: Report from the Response Assessment in Neuro-Oncology Working Group|Neuro-Oncology|Oxford Academic. [(accessed on 15 October 2021)]. Available online: https://academic.oup.com/neuro-oncology/article/21/1/26/5076187. PubMed PMC

Yao X., Wei T., Zhang H., Li J., Tang A., Ren K. The Natural Growth Rate of Skull Base Meningiomas Compared with Non-Skull Base Meningiomas. J. Craniofac. Surg. 2019;30:1231–1233. doi: 10.1097/SCS.0000000000005468. PubMed DOI

Slower growth of skull base meningiomas compared with non–skull base meningiomas based on volumetric and biological studies in. [(accessed on 15 October 2021)];J. Neurosurg. 2012 116:574–580. doi: 10.3171/2011.11.JNS11999. Available online: https://thejns.org/view/journals/j-neurosurg/116/3/article-p574.xml. PubMed DOI

Kreßner M., Arlt F., Riepl W., Meixensberger J. Prognostic factors of microsurgical treatment of intracranial meningiomas—A multivariate analysis. PLoS ONE. 2018;13:e0202520. doi: 10.1371/journal.pone.0202520. PubMed DOI PMC