PURPOSE: To compare tumor control rates after surgical resection or stereotactic 
radiosurgery for patients with small- to medium-size intracranial meningiomas.
MATERIALS AND METHODS: Between 1990 and 1997, 198 adult meningioma patients 
treated at our center underwent either surgical resection (n = 136) or 
radiosurgery (n = 62) as primary management for benign meningiomas <35 mm in 
average diameter. Tumor recurrence or progression rates were calculated by the 
Kaplan-Meier method according to an independent radiographic review. The mean 
follow-up was 64 months.
RESULTS: The tumor resections were Simpson Grade 1 in 57 (42%), Grade 2 in 57 
(42%), and Grade 3-4 in 22 (16%). The mean margin and maximal radiation dose at 
radiosurgery was 17.7 Gy and 34.9 Gy, respectively. Tumor recurrence/progression 
was more frequent in the surgical resection group (12%) than in the 
radiosurgical group (2%; p = 0.04). No statistically significant difference was 
detected in the 3- and 7-year actuarial progression-free survival (PFS) rate 
between patients with Simpson Grade 1 resections (100% and 96%, respectively) 
and patients who underwent radiosurgery (100% and 95%, respectively; p = 0.94). 
Radiosurgery provided a higher PFS rate compared with patients with Simpson 
Grade 2 (3- and 7-year PFS rate, 91% and 82%, respectively; p <0.05) and Grade 
3-4 (3- and 7-year PFS rate, 68% and 34%, respectively; p <0.001) resections. 
Subsequent tumor treatments were more common after surgical resection (15% vs. 
3%, p = 0.02). Complications occurred in 10% of patients after radiosurgery 
compared with 22% of patients after surgical resection (p = 0.06).
CONCLUSIONS: The PFS rate after radiosurgery was equivalent to that after 
resection of a Simpson Grade 1 tumor and was superior to Grade 2 and 3-4 
resections in our study. If long-term follow-up confirms the high tumor control 
rate and low morbidity of radiosurgery, this technique will likely become the 
preferred treatment for most patients with small- to moderate-size meningiomas 
without symptomatic mass effect.