Stereotactic radiosurgery for skull-base meningiomas: location-specific treatment strategies and outcomes

Skull-base meningiomas are challenging because of their proximity to critical neurovascular structures.This systematic review evaluated the location-specific role of stereotactic radiosurgery (SRS), focusing on patient selection, treatment strategy, tumor control, functional outcomes, and complications.PubMed/ MEDLINE was searched from inception through July 11, 2026.Eligible studies included adults with skull-base meningiomas treated with SRS, hypofractionated or multisession radiosurgery, staged radiosurgery, or stereotactic radiotherapy and reporting location-specific outcomes.Study selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance.Methodological quality was assessed with design-appropriate tools, and findings were synthesized narratively because of substantial heterogeneity.Of 771 identified records, 275 underwent detailed eligibility assessment and 28 were included.Evidence was strongest for cavernous sinus meningiomas, supporting primary or postoperative SRS.Favorable outcomes were also reported for selected petroclival, cerebellopontine angle, posterior fossa, tentorial, olfactory groove, and foramen magnum meningiomas.For perioptic, tuberculum sellae, and anterior clinoidal tumors, suitability depended on respecting optic pathway tolerance.Hypofractionated or fractionated treatment expanded applicability to selected larger tumors or tumors contacting critical structures.SRS provides durable tumor control with acceptable morbidity when individualized according to location, tumor volume, neurological status, and proximity to critical structures.