gross total resection may not require adjuvant radiation. Patients with benign meningiomas who undergo complete resection do not benefit from radiation.

The Gamma Knife Meningioma Study Group evaluated 203 patients with histologically benign parasagittal meningiomas [36]. Based on their results, the authors recommended that patients should receive radiosurgery soon after surgical resection if the procedure leaves behind a residual tumor nodule or neoplastic dural remnant. No prospective, randomized trial has evaluated the timing (immediate vs delayed) of radiation therapy for meningiomas.

In conclusion, radiation therapy seems to play an important role in the overall management of patients with meningiomas. Its use as an adjunctive or primary therapy has thus far been valuable in the multi-modality approach for these patients. Innovative approaches with stereotactic radiosurgery, intensity-modulated radiation therapy, fractionated radiosurgery, and brachytherapy represent promising options. However, because some of these treatments do not have mature results, long-term follow-up is needed before we can make any definitive statements about their effectiveness.

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