Clinical and Radiological Response Following Single-Session Gamma Knife Radiosurgery in Cavernous Sinus Hemangiomas

Abstract

Purpose: Cavernous sinus hemangiomas (CSH) represent 2-3% of lesions occupying the cavernous sinus. The optimal management strategy for CSH in not established, with microsurgical resection and radiosurgery employed alone or in combination. Therefore, we aimed to analyse the efficacy and safety of Gamma Knife Radiosurgery(GKRS) for CSH in a cohort of primary and residual CSH. Methods: A retrospective analysis of 33 patients(26 primary and 7 residual CSH) that underwent single-session GKRS between 2012 and 2021 for CSH was performed. Demographic, clinical, radiological and follow-up data were acquired, and clinicoradiological response following GKRS was assessed. Results: The mean age of the cohort was 4313.5 years(range 10–77). There were 9 males (27.3%) and 24 females(72.7%). The median lesion volume was 6.9cc, ranging 1.46 to 19.06cc. The mean dose administered to the tumor margin was 13.501.5Gy(Range 12 to 15Gy). The median duration of clinical follow-up was 41 months, over which period the mean reduction in tumor volume was 87.6%. Complete response, defined as absence of tumor on follow-up imaging occurred in 23 patients(69.7%). Twenty-three patients(69.7%) showed clinical improvement following GKRS. There were no radiation-induced complications. Conclusions: CSH have a distinct radiological appearance and a predictable response to radiosurgery. When used primarily in radiologically diagnosed CSH and as adjunctive therapy supplementing a subtotal excision, GKRS produces a high rate of volume reduction with improvement of neurological function and minimal cranial nerve morbidity. Therefore, GKRS presents a viable alternative to surgery without the morbidity associated with surgical resection.