Stereotactic Gamma Knife surgery safety and efficacy in the management of symptomatic benign confined cavernous sinus meningioma

Hafez, Raef F.A.; Morgan, Magad S.; Fahmy, Osama M.

doi:10.1007/s00701-015-2509-2

Cited by 31 publications

(17 citation statements)

References 17 publications

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“…For the predictors of tumor recurrence or progression, some studies revealed that increasing tumor volume was an independent predictor, which was also proved in our study. 10,16,29 In this study, many patients with intracranial meningiomas had low subjective acceptance of craniotomy; even though there were significant mass effect or neurological symptoms or signs, they preferred GKRS instead of craniotomy, which resulted in a high rate of large tumor (≥ 10 cm 3 ) in proportion at the time of GKRS, and reduced the treatment effect of GKRS in the cohort. In addition, a GKRS dose-plan defect may also influence local tumor control.…”

Section: Discussionmentioning

confidence: 76%

Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients

Ge¹,

Liu²,

Zhang³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe authors retrospectively analyzed the follow-up data in 130 patients with intracranial benign meningiomas after Gamma Knife radiosurgery (GKRS), evaluated the tumor progression-free survival (PFS) rate and neurological function preservation rate, and determined the predictors by univariate and multivariate survival analysis.METHODSThis cohort of 130 patients with intracranial benign meningiomas underwent GKRS between May 2012 and May 2015 at the Second Hospital of Tianjin Medical University. The median age was 54.5 years (range 25–81 years), and women outnumbered men at a ratio of 4.65:1. All clinical and radiological data were obtained for analysis. No patient had undergone prior traditional radiotherapy or chemotherapy. The median tumor volume was 3.68 cm3 (range 0.23–45.78 cm3). A median margin dose of 12.0 Gy (range 10.0–16.0 Gy) was delivered to the tumor with a median isodose line of 50% (range 50%–60%).RESULTSDuring a median follow-up of 36.5 months (range 12–80 months), tumor volume regressed in 37 patients (28.5%), was unchanged in 86 patients (66.2%), and increased in 7 patients (5.4%). The actuarial tumor progression-free survival (PFS) rate was 98%, 94%, and 87% at 1, 3, and 5 years, respectively, after GKRS. Tumor recurred in 7 patients at a median follow-up of 32 months (range 12–56 months). Tumor volume ≥ 10 cm3 (p = 0.012, hazard ratio [HR] 8.25, 95% CI 1.60–42.65) and pre-GKRS Karnofsky Performance Scale score < 90 (p = 0.006, HR 9.31, 95% CI 1.88–46.22) were independent unfavorable predictors of PFS rate after GKRS. Of the 130 patients, 101 (77.7%) presented with one or more neurological symptoms or signs before GKRS. Neurological symptoms or signs improved in 40 (30.8%) patients, remained stable in 83 (63.8%), and deteriorated in 7 (5.4%) after GKRS. Two (1.5%) patients developed new cranial nerve (CN) deficit. Tumor volume ≥ 10 cm3 (p = 0.042, HR = 4.73, 95% CI 1.06–21.17) and pre-GKRS CN deficit (p = 0.045, HR = 4.35, 95% CI 0.84–22.48) were independent unfavorable predictors for improvement in neurological symptoms or signs. Six (4.6%) patients developed new or worsening peritumoral edema with a median follow-up of 4.5 months (range 2–7 months).CONCLUSIONSGKRS provided good local tumor control and high neurological function preservation in patients with intracranial benign meningiomas. Patients with tumor volume < 10 cm3, pre-GKRS Karnofsky Performance Scale score ≥ 90, and no pre-GKRS CN deficit (I–VIII) can benefit from stereotactic radiosurgery. It can be considered as the primary or adjuvant management of intracranial benign meningiomas.

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Section: Discussionmentioning

confidence: 76%

Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients

Ge¹,

Liu²,

Zhang³

et al. 2019

Neurosurgical Focus

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“…15,17 More recently, other studies have reported a control of growth in 60%-96% of lesions at 2 years, 9,11 a decrease in volume by 20%, 5 and radiological progression after radiotherapy in 5%-11% of lesions. 5,7,15 In the present study, only 1 of 5 patients undergoing radiation therapy had a meningioma whose volume decreased (by 30%). The efficacy of radiotherapy on growth of these meningiomas must be consistent with the natural history of this entity, which has an unpredictable and irregular development.…”

Section: Radiotherapy Treatmentmentioning

confidence: 96%

“…12,21 It is noteworthy that the efficacy of radiotherapy on neuralgia may be explained not only by its oncological effects; radiation could directly act on CN V as thermocoagulation, thus resulting in partial denervation. 5,6,21,24,25 Survival without tumor progression (PFS) is variable according to studies, and ranges from 87% to 99% at 5 years and from 70% to 90% at 10 years. 15,17 More recently, other studies have reported a control of growth in 60%-96% of lesions at 2 years, 9,11 a decrease in volume by 20%, 5 and radiological progression after radiotherapy in 5%-11% of lesions.…”

Section: Radiotherapy Treatmentmentioning

confidence: 99%

“…5,6,21,24,25 Survival without tumor progression (PFS) is variable according to studies, and ranges from 87% to 99% at 5 years and from 70% to 90% at 10 years. 15,17 More recently, other studies have reported a control of growth in 60%-96% of lesions at 2 years, 9,11 a decrease in volume by 20%, 5 and radiological progression after radiotherapy in 5%-11% of lesions. 5,7,15 In the present study, only 1 of 5 patients undergoing radiation therapy had a meningioma whose volume decreased (by 30%).…”

Section: Radiotherapy Treatmentmentioning

confidence: 99%

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Natural history of cavernous sinus meningiomas

Amelot

Kalamaridès

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Meningiomas confined to the cavernous sinus (MCSs) are benign tumors. Due to the high risk of severe complications, the intracavernous surgical procedure was abandoned in favor of radiotherapy. However, the choice of treatment remains complicated due to the fact that the natural history of this lesion has not yet been described. METHODS The authors studied the natural history of this lesion using a prospective series of 53 consecutive patients suffering from MCSs. The median follow-up duration was 10.2 years (range 2-25 years), from 1990 to 2016. RESULTS Patients ranged in age from 30 to 72 years (mean 53 years). The meningiomas were diagnosed by major symptoms (mainly oculomotor palsy and neuralgia experienced in 28 patients), minor symptoms (headache, intermittent diplopia in 15 patients), or incidental findings (10 patients). Simple symptomatic treatment (short courses of corticosteroids and carbamazepine) allowed patients to become asymptomatic in 19 (67.9%) of 28 cases experiencing major symptoms, and for 12 (80%) of 15 patients with initial minor symptoms (p < 0.0001). All patients with incidental findings remained asymptomatic. Forty four (83%) of 53 MCSs did not show any significant growth and 42 (80%) of 53 patients were not symptomatic at the end of follow-up (p < 0.001). The radiographic progression-free survival rates (± SD) at 5, 10, and 20 years were 90% ± 4.2%, 82% ± 5.7%, and 70% ± 10.2%, respectively. Five patients (9.4%) with no evidence of any effect of the initial medical treatment desired additional conventional radiation therapy. CONCLUSIONS Because of the capricious, unpredictable, and slow growth of MCSs, together with high growth variability from one patient to the next, the symptomatic medical treatment of these tumors is a highly effective method. This series shows that these lesions are naturally, clinically, and radiologically indolent.

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“…6,20,24,26,30,31,35 Hafez et al evaluated the results of stereotactic Gamma Knife radiosurgery in symptomatic benign CSMs and showed a tumor control rate of 96% at the 3-year follow-up period with a mean pretreatment tumor volume of 5.7 cm 3 (range 1.8-12.4 cm 3 ). 12 Maruyama et al treated their patients with radiosurgery alone when there was distance between tumors and the optic pathway or brainstem. They used a combination of surgery and radiosurgery for CSMs when the tumors were attached to or compressing the optic pathway and brainstem, were larger than 3 cm in diameter, and extended into the multiple cranial fossae.…”

Section: Treatment Strategy Of Primary Csmsmentioning

confidence: 99%

Safe maximal resection of primary cavernous sinus meningiomas via a minimal anterior and posterior combined transpetrosal approach

Morisako¹,

Goto²,

Ohata³

et al. 2018

Neurosurgical Focus

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OBJECTIVEMeningiomas arising from the cavernous sinus (CS) continue to be a significant technical challenge, and resection continues to carry a relatively higher risk of neurological morbidity in patients with these lesions because of the tumor’s proximity to neurovascular structures. The authors report the surgical outcomes of 9 patients with primary CS meningiomas (CSMs) that were surgically treated using a minimal anterior and posterior combined (MAPC) transpetrosal approach, and they emphasize the usefulness of the approach.METHODSThis retrospective study included 9 patients who underwent surgery for CSM treatment between 2015 and 2016 via the MAPC transpetrosal approach. Two patients were men and 7 were women, with a mean age of 58.5 years (39–72 years). Five patients (55.5%) had undergone previous treatment. The surgical technique consisted of a temporo-occipito-suboccipital craniotomy and exposure of the posterolateral part of the CS via the presigmoidal MAPC approach. After opening Meckel’s cave and identifying the 3rd–5th cranial nerves in the prepontine cistern, Parkinson’s triangle and supratrochlear triangles were opened. Finally, the tumor occupying the posterolateral part of the CS was removed.RESULTSAll lesions were safely and maximally removed, with preservation of external ocular movements and preoperative Karnofsky Performance Scale scores. The mean extent of resection was 77.0% (range 58.7%–95.4%). Six patients underwent adjuvant therapy in the form of stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) during the follow-up period; none of these patients experienced recurrence.CONCLUSIONThe authors conclude that the MAPC transpetrosal approach could be superior to other approaches for CSMs, as it provides direct visual access to the posterolateral portion of the CS. In their experience, this approach is an alternative and better option for safe maximal resection of CSMs.

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Stereotactic Gamma Knife surgery safety and efficacy in the management of symptomatic benign confined cavernous sinus meningioma

Abstract: Gamma Knife surgery is a safe and effective option for the treatment of cavernous sinus meningioma not only as an adjuvant to surgery but also as an alternative to surgical removal in tumors confined mainly to the cavernous sinus.

Cited by 31 publications

References 17 publications

Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients

Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients

Natural history of cavernous sinus meningiomas

Safe maximal resection of primary cavernous sinus meningiomas via a minimal anterior and posterior combined transpetrosal approach

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