Single session radiosurgery has established itself as an effective therapeutic modality in the primary or postoperative treatment of intracranial meningiomas. However, the treatment of lesions located less than 3 mm from the anterior optic pathway, represents a radiosurgical challenge due to the poor tolerance of these structures to high doses of radiation. In our study 42 patients with perioptic meningiomas were retrospectively treated with radiosurgery using Cyberknife in 1, 3 and 5 sessions, between April 2011 and April 2019. 3 patients (7%) had received previous radiotherapy and 25 patients (60%) had undergone surgery. In 62% of the cases, the lesions surrounded the anterior optic pathway, with no separation distance. 27 patients (64%) had visual impairment prior to treatment and 11 patients (26%) had involvement of other cranial nerves. 37 patients (88%) were treated in 5 sessions with a median tumor volume of 11.5 cc (0.14-37 cc). 34 of these patients received 25 Gy (5x5Gy) and one patient diagnosed with grade II meningioma received 30 Gy (5x6Gy). The other two patients, previously radiated, received 23Gy (5x4.6 Gy) and 20 Gy (5x4 Gy), respectively. 3 patients (7%) were treated in 3 sessions of 7 Gy (21 Gy) and 2 patients (5%) in a single session of 14 Gy with a median tumor volume of 6.2 cc (0.8-7.6 cc). The median tumor coverage with the prescription isodose was 98% and the median homogeneity and conformity index was 1.2 in both cases. The maximum dose in the optic pathway did not exceed 25 Gy in 5 sessions, 13 Gy in 3 sessions, and 7.7 Gy in a single session. The median clinical followup after treatment was 35 months (6-84 months) with MRI and campimetry. 18 patients (43%) experienced tumoral reduction and 23 patients (55%) presented stability. Only one patient had marginal progression and was surgically rescued. 19 patients (45%) had visual improvement after treatment, 21 patients (50%) remained clinically stable and two patients experienced worsening, one of them in the context of progression and the other already had previous symptoms and a bulky lesion compressing the optic pathway. Conclusions: This study shows that hypofractionated radiosurgery is a safe alternative, with excellent local control results and very low toxicity in the treatment of meningiomas whose proximity to the anterior optic pathway prevents single-dose treatments. However, a longer follow-up is necessary to fully validate these results. [ABSTRACT FROM AUTHOR]