BACKGROUND: Managing petroclival meningiomas (PCMs) is challenging due to their deep-seated location and proximity to critical anatomical structures. Resection aimed at achieving gross total resection (GTR) has been the primary therapeutic approach for PCMs
however, GTR is associated with considerable complications. Stereotactic radiosurgery (SRS) has emerged as an effective and safe minimally invasive option for managing petroclival meningiomas. This study evaluated the role of primary or adjuvant SRS in the treatment of petroclival meningiomas. METHODS: Following a comprehensive literature search, studies evaluating the role of primary or adjuvant SRS in petroclival meningiomas were included. The meta-analysis calculated the pooled estimates for local tumor control (LTC), progression-free survival (PFS), and adverse radiation effect (ARE). RESULTS: A total of 10 studies involving 605 patients were included. The meta-analysis revealed a pooled LTC rate of 94% (95% CI: 88-98%), a 5-year PFS rate of 94% (95% CI: 81-100%), and a 10-year PFS rate of 87% (95% CI: 69-98%). The meta-analysis for the SRS indication demonstrated that both primary and adjuvant SRS were associated with substantial LTC rates, and the difference was not significant (Primary: 95% [95% CI: 83-100%] vs. Adjuvant: 92% [95% CI: 69-100%], P = 0.65). The meta-analysis for the ARE indicated a pooled rate of 5% (95% CI: 0-12%). CONCLUSION: Our findings suggest that primary and adjuvant SRS are associated with significant LTC and PFS rates, along with minimal complications. Primary SRS may be considered for individuals with small or asymptomatic lesions, while adjuvant SRS is advised for larger or recurrent lesions.