Prediction of intracranial edema after radiosurgery of meningiomas

Josef Novotný Jr. M.Sc., Ph.D. 1 , Aurelia Kollová M.D. 1 , and Roman Liščák M.D., Ph.D. 1
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  • 1 Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas; Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, The Czech Republic; and Department of Neurosurgery, University Hospital of L. Pasteur, Kosice, The Slovak Republic
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Object

This study was focused on the development of models with which to predict the occurrence of intracranial edema after Gamma Knife surgery (GKS) of meningiomas, based on clinical and imaging data collected in a large group of patients.

Methods

Data in 368 patients with 381 meningiomas treated using the Leksell Gamma Knife unit were analyzed. Follow up of more than 24 months was available in 331 patients (90%); this time period ranged from 24 to 120 months (median 51 months). The actuarial tumor control rate was 97.9% at 5 years. Perilesional edema after GKS was radiologically confirmed in 51 patients (15.4%) and 32 of them (9.7%) were symptomatic; symptoms were temporary in 23 (6.9%) and permanent in nine (2.7%). Ten different factors were proposed as potential predictors for the occurrence of the intracranial edema after GKS: patient's sex, patient's age, previous surgery, edema before GKS treatment, lobulated margin of meningioma, heterogeneous appearance of the tumor, tumor volume, tumor location, maximum dose to the tumor, and dose to the tumor margin. To identify factors having influence on edema occurrence, univariate and multivariate statistical analyses were performed.

There was a significant difference in the incidence of edema for different patient age groups and a significantly higher incidence of edema occurrence in patients in whom no surgical procedure was performed before GKS, those with edema present before GKS, those with a tumor volume larger than 10 cm3, those in whom the tumor was located in the anterior fossa, those in whom the maximum dose to the tumor was higher than 30 Gy, and for different tumor margin doses. A binary logistic regression multifactorial prediction model was used to identify the following significant factors to predict of edema occurrence after GKS: previous surgery, edema before the treatment, tumor volume, tumor location, and tumor margin dose.

Conclusions

Based on these models estimates of the occurrence of edema after the GKS can be made, and consequently treatment parameters can be adjusted to reduce the occurrence of edema. These results may provide grounds for additional patient care such as more frequent follow up or possibly administration of steroids.

Abbreviations used in this paper: CI = confidence interval; GKS = Gamma Knife surgery; SE = standard error.

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Contributor Notes

Address reprint requests to: Josef Novotný Jr., M.Sc., Ph.D., Department of Radiation Oncology, The University of Texas Southwestern Medical Center, 5801 Forest Park Road, Dallas, Texas 75390-9183. email: josef.novotny@utsouthwestern.edu.
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