Linear Accelerator Radiosurgery for Meningiomas in and around the Cavernous Sinus

Spiegelmann, Roberto; Nissim, Ouzi; Menhel, J.; Alezra, D.; Pfeffer, M. Raphael

doi:10.1227/01.neu.0000309113.24711.00

Cited by 48 publications

(13 citation statements)

References 22 publications

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“…However, there are certain restrictions associated with this technique. It is not possible to treat lesions with a diameter > 3.5 cm (21,22); in addition, treatment delivery in a single dose presents a risk of further deterioration in neuropathy (6,7,(22)(23)(24)(25)(26) that can result in loss of the optic nerve. Although the functional results of the various studies published show significant postoperative improvement, this is nevertheless not as impressive as the potential improvement offered by FSR.…”

Section: Discussionmentioning

confidence: 99%

Fractionated Stereotactic Radiotherapy Treatment of Cavernous Sinus Meningiomas: A Study of 100 Cases

Litré

Colin

Noudel

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

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Purpose: We discuss our experiences with fractionated stereotactic radiotherapy (FSR) in the treatment of cavernous sinus meningiomas. Methods and Materials: From 1995 to 2006, we monitored 100 patients diagnosed with cavernous sinus meningiomas; 84 female and 16 male patients were included. The mean patient age was 56 years. The most common symptoms were a reduction in visual acuity (57%), diplopia (50%), exophthalmy (30%), and trigeminal neuralgia (34%). Surgery was initially performed on 26 patients. All patients were treated with FSR. A total of 45 Gy was administered to the lesion, with 5 fractions of 1.8 Gy completed each week. Patient treatment was performed using a Varian Clinac linear accelerator used for cranial treatments and a micro-multileaf collimator. Results: No side effects were reported. Mean follow-up period was 33 months, with 20% of patients undergoing follow-up evaluation of more than 4 years later. The tumor control rate at 3 years was 94%. Three patients required microsurgical intervention because FSR proved ineffective. In terms of functional symptoms, an 81% improvement was observed in patients suffering from exophthalmy, with 46% of these patients being restored to full health. A 52% improvement was observed in diplopia, together with a 67% improvement in visual acuity and a 50% improvement in type V neuropathy. Conclusions: FSR facilitates tumor control, either as an initial treatment option or in combination with microsurgery. In addition to being a safe procedure with few side effects, FSR offers the significant benefit of superior functional outcomes. Ó 2009 Elsevier Inc.

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Section: Discussionmentioning

confidence: 99%

Fractionated Stereotactic Radiotherapy Treatment of Cavernous Sinus Meningiomas: A Study of 100 Cases

Litré

Colin

Noudel

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

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“…External-beam radiation therapy 2,11,32,35,36,38,53,55 as well as stereotactic radiosurgery [3][4][5][6]12,14,[16][17][18][19][20]22,26,27,30,31,33,34,37,40,41,[43][44][45][46]48,54,58,60,61,63,64 have become viable adjuvant treatment as well as primary treatment modalities for many meningiomas. Their use is supported by high rates of tumor control and a low incidence of complications.…”

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confidence: 99%

Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival

Williams¹,

Yen²,

Starke³

et al. 2011

JNS

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Object. Stereotactic radiosurgery serves as an important primary and adjuvant treatment option for patients with many types of intracranial meningiomas. This is particularly true for patients with parasellar meningiomas. In this study, the authors evaluated the outcomes of Gamma Knife surgery (GKS) used to treat parasellar meningiomas.Methods. The study is a retrospective review of the outcomes in 138 patients with meningiomas treated at the University of Virginia from 1989 to 2006; all patients had a minimum follow-up of 24 months. There were 31 men and 107 women whose mean age was 54 years (range 19-85 years). Eighty-four patients had previously undergone resection. The mean pre-GKS tumor volume was 7.5 ml (range 0.2-54.8 ml). Clinical and radiographic evaluations were performed, and factors related to favorable outcomes in each case were assessed.Results. The mean follow-up duration was 84 months (median 75.5 months, range 24-216 months). In 118 patients (86%), the tumor volume was unchanged or had decreased at last follow-up. Kaplan-Meier analysis demonstrated radiographic progression-free survival at 5 and 10 years to be 95.4% and 69%, respectively. Fourteen patients (10%) developed new cranial nerve palsies following GKS. Factors associated with tumor control included younger age, a higher isodose, and smaller tumor volume. A longer follow-up duration was associated with either a decrease or increase in tumor volume. Fourteen patients (10%) experienced new or worsening cranial nerve deficits after treatment. Factors associated with this occurrence were larger pretreatment tumor volume, lower peripheral radiation dose, lower maximum dose, tumor progression, and longer follow-up.Conclusions. Gamma Knife surgery offers an acceptable rate of tumor control for parasellar meningiomas and accomplishes this with a low incidence of neurological deficits. Radiological control after radiosurgery is more likely in those patients with a smaller tumor volume and a higher prescription dose. (DOI: 10.3171/2011.1.JNS091939) keY WorDs • stereotactic radiosurgery • parasellar meningioma • skull base • cavernous sinus 1571Abbreviations used in this paper: GKS = Gamma Knife surgery; PFS = progression-free survival.

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“…Yazarlar 14-16 Gy dozlarla kraniyal defisitlerin %8 oranında görülebileceğini belirtmişlerdir. [8,[23][24][25] Beyin ödemi SRT sonrası oldukça yüksek oranlarda görülebilmektedir. Basal menenjiom, parasagittal yerleşim, fraksiyon dozunun 15 Gy ve üzerinde olması, tümör çapının 3 cm üzeri olması veya hacminin 4 cm 3 üzeri olması ve tedavi sonrası ödem riskini artırmaktadır.…”

Section: Discussionunclassified

“…The patients were administered an average dose of 20 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) Gy with a CyberKnife machine using an average of 3 (1-5) fractions.…”

Section: Methodsmentioning

confidence: 99%

Stereotactic radiotherapy results of menengiomas with a CyberKnife: a single center experience

Isik¹

2014

TJ Oncol

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Linear Accelerator Radiosurgery for Meningiomas in and around the Cavernous Sinus

Abstract: This study indicates that linear accelerator radiosurgery can achieve a high control rate of meningiomas involving the cavernous sinus with no mortality and a low incidence of morbidity.

Cited by 48 publications

References 22 publications

Fractionated Stereotactic Radiotherapy Treatment of Cavernous Sinus Meningiomas: A Study of 100 Cases

Fractionated Stereotactic Radiotherapy Treatment of Cavernous Sinus Meningiomas: A Study of 100 Cases

Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival

Stereotactic radiotherapy results of menengiomas with a CyberKnife: a single center experience

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