Stereotactic Radiosurgery of Cavernous Sinus Meningiomas

Abstract

Objective Microsurgical resection of cavernous sinus meningiomas (CSM) is associated with a high rate of incomplete resection, recurrence, and the risk for permanent, severe cranial nerve deficits. Stereotactic radiosurgery (SRS) has evolved as alternative treatment for primary and recurrent CSM. Here, we report about the long-term clinical and radiological follow-up (FU) of a unique cohort of patients with CSM treated with LINAC or Cyberknife based SRS. Methods In this single-center retrospective analysis, we include all patients with CSM who underwent single fraction SRS between 1993 and 2016. Clinical and radiological tumor control were evaluated by the Kaplan–Meier method. Additionally, patient data were analyzed in terms of symptom control and incidence of side effects rated by the common terminology criteria for adverse events (CTCAE; v4.03). Results 116 patients (female/male = 91/25; median age, 54 years; range, 33–82 years) were included. Mean tumor volume was 5.7 ± 3.3 cm3 (range, 0.6–16.2 cm3), the median marginal dose was 12.6 Gy applied to isodose levels of 75%. Median clinical FU was 55 months (range, 3–226 months). Tumor control was 98% after 2 and 5 years and 90% after 10 years. Twelve patients (10.3%) had permanent or transient radiation related toxicity (CTCAE I–III). An improvement of symptoms was observed in 26.7% of the symptomatic patients (n = 20 of 75). Conclusion SRS for CSM provides excellent long-term tumor and symptom control without considerable permanent side effects. Thus, SRS should be considered when counseling patients suffering from CSM.

Stereotactic radiosurgery of benign brain tumors in elderly patients: evaluation of outcome and toxicity

“…Our study confirms the high rate of tumor control (> 90%) and effectiveness of SRS, as reported in many other series [ 7 , 8 , 19 , 20 ]. However, the influence of age on tumor control in benign brain tumors is currently not fully understood.…”

“…In addition to micro-neurosurgery, stereotactic radiosurgery (SRS) has evolved as a generally accepted effective therapeutic option, especially for meningiomas and schwannomas. Meanwhile, several studies have reported data on long-term follow-up with tumor control rates exceeding 90% and associated mild toxicity [4][5][6][7][8]. For patients with locally inoperable tumors or patients deemed ineligible for surgery due to medical reasons, SRS such offers a valuable treatment alternative.…”

Stereotactic radiosurgery for treating meningiomas eligible for complete resection

“…The SRS planning was carried out using the software STP (STP 3.3 and 3.5, Howmedica Leibinger, Freiburg, Germany). Subsequently, the radiosurgical treatment was performed using a linear accelerator as previously described [ 7 , 8 ]. In brief, dose application was performed with circular collimators fitted to an adapted linear accelerator (Philips SL 75/20 at 9 MV or Elekta Sli25 at 6 MV).…”

The role of endoscopy and radiosurgery in the management of cavernous sinus meningiomas

“…In their review of the outcomes of large radiosurgical series, Fariselli et al [51] showed progression free survival at 5 and 10 years of 80%-100% and 73%-98%, respectively, and a radiological volume reduction was observed in 29-69% of cases. No mortality was described as secondary to radiation therapy, while the reported morbidity included new neurologic symptoms or symptoms of neurotoxicity (optic neuropathy, pituitary dysfunction, diplopia, and radiation-induced edema), which ranged from 6% to 27.5% [52][53][54][55] . A meta-analysis comparing primary RS vs. surgery followed by adjuvant RS showed a lesser rate of neurological morbidity in the primary RS group (27.5% vs. 59.6%) [55] .…”