颅内壳膜瘤靠近视路通常是显微手术减压的常见手术对象，尤其是如果是大尺寸的带视神经周围的蛛网膜瘤。但是，显微手术本身会对视力造成风险，肿瘤越大，风险越高，术后视力恢复的可能性越低。分段立体定向放射治疗通常用于此类情况。本研究的目的是评估单次立体定向放射治疗对大型（≥ 10 cm³）带视神经周围颅内良性蛛网膜瘤的长期疗效和安全性。 本回顾性研究纳入了175例患有大型带视神经周围良性蛛网膜瘤（≥ 10 cm³）的患者，采用单次立体定向放射治疗。带视神经周围的蛛网膜瘤被定义为接触、压迫或距视路不到3毫米的蛛网膜瘤。肿瘤的中位体积为15 cm³（范围10-57.3 cm³，四分位距8.4 cm³），中位处方剂量为12 Gy（范围9-14 Gy，IQR 1 Gy）。中位的随访时间为72个月（范围13-217个月，四分位距65个月）。肿瘤控制率为92%。5年和10年无进展生存率分别为97%和80%。169名患者（97%）报告了良好（更好/稳定）的视力结果，六名患者（3%）报告了不良（更差）的结果。21名患者（12%）观察到了暂时的不良影响，但只有7名患者（4%）有症状。根据治疗前的视野检查，63名患者有失明/无用的眼睛。17名患者（27%）失明/无用的眼睛有视力改善，而46名患者（73%）视力保持不变。36名患者的眼神经麻痹得到了改善。肿瘤缩小并不是颅神经改善的先决条件。 单次立体定向放射治疗为大型带视神经周围蛛网膜瘤提供了有效且安全的治疗选择。

Meningiomas close to the optic pathway are commonly candidates for microsurgical decompression, more so if they are large perioptic meningiomas. However, microsurgery itself imposes risk to vision, and the larger the tumor, the more the risk and the lower the possibility of postoperative visual recovery. Fractionated stereotactic radiotherapy is usually reserved for such cases. The purpose of this study was to assess the long-term efficacy and safety of single-session stereotactic radiosurgery (SRS) for large (≥ 10 cm3) perioptic intracranial benign meningiomas.This retrospective study included 175 patients with large perioptic benign meningiomas (≥ 10 cm3) who were treated by single-session SRS. Perioptic meningiomas were defined as meningiomas touching, compressing, or within 3 mm of the optic pathway. The median tumor volume was 15 cm3 (range 10-57.3 cm3, IQR 8.4 cm3). The median prescription dose was 12 Gy (range 9-14 Gy, IQR 1 Gy).The median follow-up period was 72 months (range 13-217 months, IQR 65 months). The tumor control rate was 92%. The progression-free survival rates at 5 and 10 years were 97% and 80%, respectively. Favorable (better/stable) visual outcome was reported in 169 patients (97%) and unfavorable (worse) outcome in 6 patients (3%). Temporary adverse radiation effects were observed in 21 patients (12%), but only 7 patients (4%) were symptomatic. Sixty-three patients had a blind/nonuseful eye according to the pretreatment visual field examination. Visual improvement was observed in the blind/nonuseful eye in 17 patients (27%), while vision remained unchanged in 46 patients (73%). Ocular nerve palsy improved in 36 patients (61%). Tumor shrinkage was not a prerequisite for cranial nerve improvement.SRS provides an effective and safe treatment option for large perioptic meningiomas.