Gamma Knife surgery for benign meningioma

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Object

Meningioma is the most frequent benign tumor treated with Gamma Knife surgery (GKS); however, the assessment of its efficacy and safety in slow-growing tumors is an ongoing process, requiring analysis of long-term results.

Methods

Three hundred sixty-eight patients harboring 400 meningiomas treated between 1992 and 1999 at Na Homolce Hospital were evaluated. The median patient age was 57 years (range 18–84 years). The median tumor volume was 4.4 cm3 (range 0.11–44.9 cm3). The median tumor margin dose to the 50% isodose line was 12.55 Gy (range 6.5–24 Gy). Descriptive analysis was performed in 331 patients (90%); 325 patients had a follow-up longer than 24 months (median 60 months), and six patients were included because of posttreatment complications. The volume of treated tumors decreased in 248 cases (69.7%), remained the same in 99 (27.8%), and increased in nine (2.5%). The actuarial tumor control rate was 97.9% at 5 years post-GKS. Perilesional edema after radiosurgery was confirmed on neuroim-aging in 51 patients (15.4%). The temporary and permanent morbidity rates after radiosurgery were 10.2 and 5.7%, respectively.

Results

A significantly higher incidence of tumor volume increase was observed in men compared with women and in tumors treated with a margin dose lower than 12 Gy. Significant risk factors for edema included an age greater than 60 years, no previous surgery, perilesional edema before radiosurgery, a tumor volume greater than 10 cm3, a tumor location in the anterior fossa, and a margin dose greater than 16 Gy.

Conclusions

Stereotactic radiosurgery is a safe method of treatment for meningiomas. A minimum margin dose of 12 to 16 Gy seems to represent the therapeutic window for benign meningiomas with a high tumor control rate in a mid-term follow-up period.

Abbreviations used in this paper: CT = computed tomography; GKS = Gamma Knife surgery; MR = magnetic resonance.
Article Information

Contributor Notes

Address reprint requests to: Roman Liščák, M.D., Ph.D., Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Roentgenova 2, 150 30 Prague 5, Czech Republic. email: roman.liscak@homolka.cz.
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References
  • 1

    Abdel-Aziz KMFroelich SCDagnew EJean WBreneman JCZucarello M: Large sphenoid wing meningiomas involving the cavernous sinus: conservative surgical strategies for better functional outcomes. Neurosurgery 54:137513842004

    • Search Google Scholar
    • Export Citation
  • 2

    Aichholzer MBertalanffy ADietrich WRoessler KPfisterer WUngersboeck K: Gamma knife radiosurgery of skull base meningiomas. Acta Neurochir (Wien) 142:6476532000

    • Search Google Scholar
    • Export Citation
  • 3

    Akagami RNapolitano MSekhar LN: Patient-evaluated outcome after surgery for basal meningiomas. Neurosurgery 50:9419482002

  • 4

    Asari SMaeshiro TTomita SKawauchi MYabuno NKinugasa K: Meningiomas arising from the falcotentorial junction. Clinical features, neuroimaging studies, and surgical treatment. J Neurosurg 82:7267381995

    • Search Google Scholar
    • Export Citation
  • 5

    Bitzer MWockel LLuft ARWahloo AKPetersen DOpitz H: The importance of pial blood supply to the development of peritumoral brain edema in meningiomas. J Neurosurg 87:3683731997

    • Search Google Scholar
    • Export Citation
  • 6

    Black PKathiresan SChung W: Meningioma surgery in the elderly: a case-control study assesing morbidity and mortality. Acta Neurochir (Wien) 140:101310171998

    • Search Google Scholar
    • Export Citation
  • 7

    Chang SDAdler JR Jr: Treatment of cranial base meningiomas with linear accelerator radiosurgery. Neurosurgery 41:101910271997

  • 8

    Couldwell WTFukushima TGiannotta SLWeiss MH: Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 84:20281996

    • Search Google Scholar
    • Export Citation
  • 9

    Cudlip SAWilkins PRJohnston FGMoore AJMarsh HTBell BA: Posterior fossa meningiomas: surgical experience in 52 cases. Acta Neurochir (Wien) 140:100710121998

    • Search Google Scholar
    • Export Citation
  • 10

    DeMonte FMarmor EAl-Mefty OMeningiomas. Kaye AHLaws ER Jr: Brain Tumors LondonChurchill Livingstone2000. 719750

  • 11

    DeMonte FSmith HKAl-Mefty O: Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 81:2452511994

  • 12

    DiBiase SJKwok YYovino SArena CNaqvi STemple R: Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 60:151515192004

    • Search Google Scholar
    • Export Citation
  • 13

    Fahlbush RSchott W: Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 96:2352432002

    • Search Google Scholar
    • Export Citation
  • 14

    Feigl GBundschuh OGharabaghi ASamii MHorstman GA: Volume reduction in meningiomas after gamma knife surgery. J Neurosurg 102:Suppl1891942005

    • Search Google Scholar
    • Export Citation
  • 15

    Ganz JCBacklund EOThorsen FA: The results of Gamma Knife surgery of meningiomas, related to size of tumor and dose. Stereotact Funct Neurosurg 61:1 Suppl23291993

    • Search Google Scholar
    • Export Citation
  • 16

    Goldsmith BJWara WMWilson CBLarson DA: Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967–1990. J Neurosurg 80:1952011994

    • Search Google Scholar
    • Export Citation
  • 17

    Hakim RAlexander E IIILoeffler JSShrieve DCWen PFallon MP: Results of linear accelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 42:4464541998

    • Search Google Scholar
    • Export Citation
  • 18

    Harrigan MR: Angiogenic factors in the central nervous system. Neurosurgery 53:6396612003

  • 19

    Hirsch WLSekhar LNLanzino GPomonis SSen CN: Meningiomas involving the cavernous sinus: value of imaging for predicting surgical complications. AJR Am J Roentgenol 160:108310881993

    • Search Google Scholar
    • Export Citation
  • 20

    Iwai YYamanaka KYasui TKomiyama MNishikawa MNakajima H: Gamma knife surgery for skull base meningiomas. The effectiveness of low-dose treatment. Surg Neurol 52:40451999

    • Search Google Scholar
    • Export Citation
  • 21

    Jung HWYoo HPaek SHChoi KS: Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases. Neurosurgery 46:5675752000

    • Search Google Scholar
    • Export Citation
  • 22

    Kenai HYamashita MNakamura TAsano TSainoh MNagatomi H: Tolerance dose in gamma knife surgery of lesions extending to the anterior visual pathways. J Neurosurg 102:Suppl2302332005

    • Search Google Scholar
    • Export Citation
  • 23

    Kim DGKim CHChung HTPaek SHJeong SSHan DH: Gamma knife surgery of superficially located meningioma. J Neurosurg 102:Suppl2552582005

    • Search Google Scholar
    • Export Citation
  • 24

    Kondziolka DFlickinger JCPerez B: Judicious resection and/or radiosurgery for parasagittal meningiomas: outcomes from a multicenter review. Gamma Knife Meningioma Study Group. Neurosurgery 43:4054141998

    • Search Google Scholar
    • Export Citation
  • 25

    Kondziolka DLevy EINiranjan AFlickinger JCLunsford LD: Long-term outcomes after meningioma radiosurgery: physician and patient perspectives. J Neurosurg 91:44501999

    • Search Google Scholar
    • Export Citation
  • 26

    Kotapka MJKalia KKMartinez AJSekhar LN: Infiltration of the carotid artery by cavernous sinus meningioma. J Neurosurg 81:2522551994

    • Search Google Scholar
    • Export Citation
  • 27

    Kuratsu JKochi MUshio Y: Incidence and clinical features of asymptomatic meningiomas. J Neurosurg 92:7667702000

  • 28

    Lang DANeil-Dwyer GGarfield J: Outcome after complex neurosurgery: the caregiver's burden is forgotten. J Neurosurg 91:3593631999

    • Search Google Scholar
    • Export Citation
  • 29

    Larson JJvan Loveren HRBalko GTew JM Jr: Evidence of meningioma infiltration into cranial nerves: clinical implications for cavernous sinus meningiomas. J Neurosurg 83:5965991995

    • Search Google Scholar
    • Export Citation
  • 30

    Lee JYNiranjan AMcInerney JKondziolka DFlickinger JCLunsford LD: Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurg 97:65722002

    • Search Google Scholar
    • Export Citation
  • 31

    Leksell L: Stereotactic radiosurgery. J Neurol Neurosurg Psychiatry 46:7978031983

  • 32

    Linskey MEDavis SARatanatharathorn V: Relative roles of microsurgery and stereotactic radiosurgery for the treatment of patients with cranial meningiomas: a single-surgeon 4-year integrated experience with both modalities. J Neurosurg 102:Suppl59702005

    • Search Google Scholar
    • Export Citation
  • 33

    Liščák RKollová AVladyka VŠ imonová GNovotný J Jr: Gamma knife radiosurgery of skull base meningiomas. Acta Neurochir 91:Suppl65742004

    • Search Google Scholar
    • Export Citation
  • 34

    Liščák RŠimonová GVymazal JJanoušková LVladyka V: Gamma knife radiosurgery of meningiomas in the cavernous sinus region. Acta Neurochir (Wien) 141:4734801999

    • Search Google Scholar
    • Export Citation
  • 35

    Liščák RVladyka VŠimonová GNovotny J JrSyruček M: Gamma knife radiosurgery of meningiomas—preliminary results and complications. J Radiosurg 1:35411998

    • Search Google Scholar
    • Export Citation
  • 36

    Lunsford LD: Contemporary management of meningiomas: radiation therapy as an adjuvant and radiosurgery as an alternative to surgical removal?. J Neurosurg 80:1871901994

    • Search Google Scholar
    • Export Citation
  • 37

    Maire JPCaudry MGuerin JCelerier DSan Galli FCausse N: Fractionated radiation therapy in the treatment of intracranial meningiomas: local control, functional efficiacy and tolerance in 91 patients. Int J Radiat Oncol Biol Phys 33:3153211995

    • Search Google Scholar
    • Export Citation
  • 38

    Malik IRowe JGWalton LRadatz MWKemeny AA: The use of stereotactic radiosurgery in the management of meningiomas. Br J Neurosurg 19:13202005

    • Search Google Scholar
    • Export Citation
  • 39

    Maruyama KShin MKurita HKawahara NMorita AKirino T: Proposed treatment strategy for cavernous sinus meningiomas: a prospective study. Neurosurgery 55:106810752004

    • Search Google Scholar
    • Export Citation
  • 40

    Mathiesen TLindquist CKihlstrom LKarlsson B: Recurrence of cranial base meningiomas. Neurosurgery 39:291996

  • 41

    Morita ACoffey RJFoote RLSchiff DGorman D: Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients. J Neurosurg 90:42491999

    • Search Google Scholar
    • Export Citation
  • 42

    Muthukumar NKondziolka DLunsford LDFlickinger JC: Stereotactic radiosurgery for tentorial meningiomas. Acta Neurochir (Wien) 140:3153211998

    • Search Google Scholar
    • Export Citation
  • 43

    Nakamura MRoser FMichel JJacobs CSamii M: The natural history of incidental meningiomas. Neurosurgery 53:62712003

  • 44

    Nakasu SNakasu YNakajima MMatsuda MHanda J: Pre-operative identification of meningiomas that are highly likely to recur. J Neurosurg 90:4554621999

    • Search Google Scholar
    • Export Citation
  • 45

    Nicolato AGiorgetti PForoni RGrigolato DPasquin IPZuffante M: Gamma knife radiosurgery in skull base meningiomas: a possible relationship between somatostatin receptor decrease and early neurological improvement without tumor shrinkage at short-term imaging follow-up. Acta Neurochir (Wien) 147:3673752005

    • Search Google Scholar
    • Export Citation
  • 46

    Niiro MYatsushiro KNakamura KKawahara YKuratsu J: Natural history of elderly patients with asymptomatic meningiomas. J Neurol Neurosurg Psychiatry 68:25282000

    • Search Google Scholar
    • Export Citation
  • 47

    Nutting CBrada MBrazil LSibtain ASaran FWestbury C: Radiotherapy in the treatment of benign meningioma of the skull base. J Neurosurg 90:8238271999

    • Search Google Scholar
    • Export Citation
  • 48

    Obeid FAl-Mefty O: Recurrence of olfactory groove meningiomas. Neurosurgery 53:5345432003

  • 49

    Olivero WCLister JRElwood PW: The natural history and growth rate of asymptomatic meningiomas: a review of 60 patients. J Neurosurg 83:2222241995

    • Search Google Scholar
    • Export Citation
  • 50

    O'Sullivan MGvan Loveren HRTew JM Jr: The surgical resectability of meningiomas of the cavernous sinus. Neurosurgery 40:2382471997

    • Search Google Scholar
    • Export Citation
  • 51

    Pan DHGuo WYChang YCChung WYShiau CYWang LW: The effectiveness and factors related to treatment results of gamma knife radiosurgery of meningiomas. Stereotact Funct Neurosurg 70:1 Suppl19321998

    • Search Google Scholar
    • Export Citation
  • 52

    Pendl GSchrottner OEustacchio SFeichtinger KGanz J: Stereotactic radiosurgery of skull base meningiomas. Minim Invasive Neurosurg 40:87901997

    • Search Google Scholar
    • Export Citation
  • 53

    Pendl GUnger FPapaefthymiou GEustacchio S: Staged radio-surgical treatment for large benign cerebral lesions. J Neurosurg 93:3 Suppl1071122000

    • Search Google Scholar
    • Export Citation
  • 54

    Pollock BE: Stereotactic radiosurgery for intracranial meningiomas: indications and results. Neurosurg Focus 14:5E42003

  • 55

    Pourel NAuque JBracard SHoffstetter SLuporsi EVignaud JM: Efficacy of external fractionated radiation therapy in the treatment of meningiomas: a 20-year experience. Radiother Oncol 61:65702001

    • Search Google Scholar
    • Export Citation
  • 56

    Roche PHPellet WFuentes SThomassin JMRegis J: Gamma knife radiosurgical management of petroclival meningiomas result and indications. Acta Neurochir (Wien) 145:8838882003

    • Search Google Scholar
    • Export Citation
  • 57

    Rowe JGWalton LVaughan PMalik IRadatz MKemeny A: Radiosurgical planning of meningiomas: compromises with conformity. Stereotact Funct Neurosurg 82:1691742004

    • Search Google Scholar
    • Export Citation
  • 58

    Samii MCarvalho GATatagiba MMatthies C: Surgical management of meningiomas originating in Meckel's cave. Neurosurgery 41:7677751997

    • Search Google Scholar
    • Export Citation
  • 59

    Samii MCarvalho GATatagiba MMatthies CVorkapic P: Meningiomas of the tentorial notch: surgical anatomy and management. J Neurosurg 84:3753811996

    • Search Google Scholar
    • Export Citation
  • 60

    Sanson MCornu P: Biology of menigiomas. Acta Neurochir (Wien) 142:4935052000

  • 61

    Schaller BMerlo AGratzl OProbst R: Premeatal and retromeatal cerebellopontine angle meningioma. Two distinct clinical entities. Acta Neurochir (Wien) 141:4654711999

    • Search Google Scholar
    • Export Citation
  • 62

    Sekhar LNSwamy NKSJaiswal VRubinstein EHirsh WE JrWright DC: Surgical excision of meningiomas involving the clivus: preoperative and intraoperative features as predictors of postoperative functional deterioration. J Neurosurg 81:8608681994

    • Search Google Scholar
    • Export Citation
  • 63

    Selch MTAhn ELaskari ALee SPAgazaryan NSolberg TD: Stereotactic radiotherapy for treatment of cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 59:1011112004

    • Search Google Scholar
    • Export Citation
  • 64

    Shafron DHFriedman WABuatti JMBova FJMendenhall WM: Linac radiosurgery for benign meningiomas. Int J Radiat Oncol Biol Phys 43:3213271999

    • Search Google Scholar
    • Export Citation
  • 65

    Shrieve DCHazard LBoucher KJensen RL: Dose fractionation in stereotactic radiotherapy for parasellar meningiomas: radiobiological considerations of efficiacy and optic nerve tolerance. J Neurosurg 101:3 Suppl3903952004

    • Search Google Scholar
    • Export Citation
  • 66

    Shuto TInomori SFujino HNagano HHasegawa NKakuta Y: Cyst formation following gamma knife surgery for intracranial meningioma. J Neurosurg 102:Suppl1341392005

    • Search Google Scholar
    • Export Citation
  • 67

    Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22391957

  • 68

    Sindou MPAlaywan M: Most intracranial meningiomas are not cleavable tumors: anatomic-surgical evidence and angiographic predictibility. Neurosurgery 42:4764801998

    • Search Google Scholar
    • Export Citation
  • 69

    Singh VPKansai SVaishya SJulka PKMehta VS: Early complications following gamma knife radiosurgery for intracranial meningiomas. J Neurosurg 93:3 Suppl57612000

    • Search Google Scholar
    • Export Citation
  • 70

    Spiegelmann RNissim OMenhel JAlezra DPfeffer MR: Linear accelerator radiosurgery for meningiomas in and around the cavernous sinus. Neurosurgery 51:137313802002

    • Search Google Scholar
    • Export Citation
  • 71

    Stafford SLPollock BEFoote RLLink MJGorman DASchomberg PJ: Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients. Neurosurgery 49:102910382001

    • Search Google Scholar
    • Export Citation
  • 72

    Steiner LLidquist CSteiner MMeningiomas and gamma knife radiosurgery. Al-Mefty O: Meningiomas New YorkRaven Press1991. 263272

    • Search Google Scholar
    • Export Citation
  • 73

    Stippler MKondziolka D: Skull base meningiomas: is there a place for microsurgery?. Acta Neurochir (Wien) 148:132006

  • 74

    Tischler RBLeoffler JSLunsford LDDuma CAlexander E IIIKooy HM: Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27:2152211993

    • Search Google Scholar
    • Export Citation
  • 75

    Van Havenbergh TCarvalho GTatagiba MPlets CSamii M: Natural history of petroclival meningiomas. Neurosurgery 52:55642003

  • 76

    Vladyka VLiščák RNovotný J JrMarek JJežková J: Radiation tolerance in functioning pituitary tissue in gamma knife surgery for pituitary adenomas. Neurosurgery 52:3093172003

    • Search Google Scholar
    • Export Citation
  • 77

    Voss NFVrionis FDHeilman CBRobertson JH: Meningiomas of the cerebellopontine angle. Surg Neurol 53:4394472000

  • 78

    Yoneoka YFujii YTanaka R: Growth of incidental meningiomas. Acta Neurochir (Wien) 142:5075112000

  • 79

    Yoshioka HHama STaniguchi ESugiyama KArita KKurisu K: Peritumoral brain edema associated with meningioma: influence of vascular endothelial growth factor expression and vascular blood supply. Cancer 85:9369441995

    • Search Google Scholar
    • Export Citation
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