Treatment of Symptomatic Spinal Cord Meningioma in Patients with Poor Clinical Condition or Contraindication for Surgery

This protocol addresses symptomatic spinal cord meningioma in patients who are not suitable surgical candidates — whether due to poor overall clinical condition, significant comorbidities, or a relative or absolute contraindication to operative intervention.

For patients where surgical resection carries unacceptable risk — including elderly or critically ill individuals — established non-surgical alternatives exist. Radiosurgery has been validated as an alternative therapy in well-defined cases involving small tumors in such patients. It may also be considered when surgery is relatively or absolutely contraindicated and the tumor does not exert significant mass effect, provided appropriate patient selection criteria are met.

Management involves a radiation-based strategy; the applicable technique and fractionation depend on individual tumor characteristics and clinical context. The full selection algorithm and approach are detailed in the structured protocol.

Reduction of tumor size on imaging — a finding shown to be predictive of long-term tumor control.