Gamma Knife surgery for benign meningioma

Aurelia Kollová M.D., Roman Liščák M.D., Ph.D., Josef Novotný Jr. M.Sc., Ph.D., Vilibald Vladyka M.D., Ph.D., Gabriela Šimonová M.D., Ph.D., and Ladislava Janoušková M.D., Ph.D.
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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.

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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.
  • 1

    Abdel-Aziz KM, , Froelich SC, , Dagnew E, , Jean W, , Breneman JC, & Zucarello M, : Large sphenoid wing meningiomas involving the cavernous sinus: conservative surgical strategies for better functional outcomes. Neurosurgery 54:13751384, 2004

    • Search Google Scholar
    • Export Citation
  • 2

    Aichholzer M, , Bertalanffy A, , Dietrich W, , Roessler K, , Pfisterer W, & Ungersboeck K, : Gamma knife radiosurgery of skull base meningiomas. Acta Neurochir (Wien) 142:647653, 2000

    • Search Google Scholar
    • Export Citation
  • 3

    Akagami R, , Napolitano M, & Sekhar LN: Patient-evaluated outcome after surgery for basal meningiomas. Neurosurgery 50:941948, 2002

  • 4

    Asari S, , Maeshiro T, , Tomita S, , Kawauchi M, , Yabuno N, & Kinugasa K, : Meningiomas arising from the falcotentorial junction. Clinical features, neuroimaging studies, and surgical treatment. J Neurosurg 82:726738, 1995

    • Search Google Scholar
    • Export Citation
  • 5

    Bitzer M, , Wockel L, , Luft AR, , Wahloo AK, , Petersen D, & Opitz H, : The importance of pial blood supply to the development of peritumoral brain edema in meningiomas. J Neurosurg 87:368373, 1997

    • Search Google Scholar
    • Export Citation
  • 6

    Black P, , Kathiresan S, & Chung W: Meningioma surgery in the elderly: a case-control study assesing morbidity and mortality. Acta Neurochir (Wien) 140:10131017, 1998

    • Search Google Scholar
    • Export Citation
  • 7

    Chang SD, & Adler JR Jr: Treatment of cranial base meningiomas with linear accelerator radiosurgery. Neurosurgery 41:10191027, 1997

  • 8

    Couldwell WT, , Fukushima T, , Giannotta SL, & Weiss MH: Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 84:2028, 1996

    • Search Google Scholar
    • Export Citation
  • 9

    Cudlip SA, , Wilkins PR, , Johnston FG, , Moore AJ, , Marsh HT, & Bell BA: Posterior fossa meningiomas: surgical experience in 52 cases. Acta Neurochir (Wien) 140:10071012, 1998

    • Search Google Scholar
    • Export Citation
  • 10

    DeMonte F, , Marmor E, & Al-Mefty O, Meningiomas. Kaye AH, & Laws ER Jr: Brain Tumors London, Churchill Livingstone, 2000. 719750

  • 11

    DeMonte F, , Smith HK, & Al-Mefty O: Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 81:245251, 1994

  • 12

    DiBiase SJ, , Kwok Y, , Yovino S, , Arena C, , Naqvi S, & Temple R, : Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 60:15151519, 2004

    • Search Google Scholar
    • Export Citation
  • 13

    Fahlbush R, & Schott W: Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 96:235243, 2002

    • Search Google Scholar
    • Export Citation
  • 14

    Feigl G, , Bundschuh O, , Gharabaghi A, , Samii M, & Horstman GA: Volume reduction in meningiomas after gamma knife surgery. J Neurosurg 102:Suppl 189194, 2005

    • Search Google Scholar
    • Export Citation
  • 15

    Ganz JC, , Backlund EO, & Thorsen FA: The results of Gamma Knife surgery of meningiomas, related to size of tumor and dose. Stereotact Funct Neurosurg 61:1 Suppl 2329, 1993

    • Search Google Scholar
    • Export Citation
  • 16

    Goldsmith BJ, , Wara WM, , Wilson CB, & Larson DA: Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967–1990. J Neurosurg 80:195201, 1994

    • Search Google Scholar
    • Export Citation
  • 17

    Hakim R, , Alexander E III, , Loeffler JS, , Shrieve DC, , Wen P, & Fallon MP, : Results of linear accelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 42:446454, 1998

    • Search Google Scholar
    • Export Citation
  • 18

    Harrigan MR: Angiogenic factors in the central nervous system. Neurosurgery 53:639661, 2003

  • 19

    Hirsch WL, , Sekhar LN, , Lanzino G, , Pomonis S, & Sen CN: Meningiomas involving the cavernous sinus: value of imaging for predicting surgical complications. AJR Am J Roentgenol 160:10831088, 1993

    • Search Google Scholar
    • Export Citation
  • 20

    Iwai Y, , Yamanaka K, , Yasui T, , Komiyama M, , Nishikawa M, & Nakajima H, : Gamma knife surgery for skull base meningiomas. The effectiveness of low-dose treatment. Surg Neurol 52:4045, 1999

    • Search Google Scholar
    • Export Citation
  • 21

    Jung HW, , Yoo H, , Paek SH, & Choi KS: Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases. Neurosurgery 46:567575, 2000

    • Search Google Scholar
    • Export Citation
  • 22

    Kenai H, , Yamashita M, , Nakamura T, , Asano T, , Sainoh M, & Nagatomi H: Tolerance dose in gamma knife surgery of lesions extending to the anterior visual pathways. J Neurosurg 102:Suppl 230233, 2005

    • Search Google Scholar
    • Export Citation
  • 23

    Kim DG, , Kim CH, , Chung HT, , Paek SH, , Jeong SS, & Han DH, : Gamma knife surgery of superficially located meningioma. J Neurosurg 102:Suppl 255258, 2005

    • Search Google Scholar
    • Export Citation
  • 24

    Kondziolka D, , Flickinger JC, & Perez B: Judicious resection and/or radiosurgery for parasagittal meningiomas: outcomes from a multicenter review. Gamma Knife Meningioma Study Group. Neurosurgery 43:405414, 1998

    • Search Google Scholar
    • Export Citation
  • 25

    Kondziolka D, , Levy EI, , Niranjan A, , Flickinger JC, & Lunsford LD: Long-term outcomes after meningioma radiosurgery: physician and patient perspectives. J Neurosurg 91:4450, 1999

    • Search Google Scholar
    • Export Citation
  • 26

    Kotapka MJ, , Kalia KK, , Martinez AJ, & Sekhar LN: Infiltration of the carotid artery by cavernous sinus meningioma. J Neurosurg 81:252255, 1994

    • Search Google Scholar
    • Export Citation
  • 27

    Kuratsu J, , Kochi M, & Ushio Y: Incidence and clinical features of asymptomatic meningiomas. J Neurosurg 92:766770, 2000

  • 28

    Lang DA, , Neil-Dwyer G, & Garfield J: Outcome after complex neurosurgery: the caregiver's burden is forgotten. J Neurosurg 91:359363, 1999

    • Search Google Scholar
    • Export Citation
  • 29

    Larson JJ, , van Loveren HR, , Balko G, & Tew JM Jr: Evidence of meningioma infiltration into cranial nerves: clinical implications for cavernous sinus meningiomas. J Neurosurg 83:596599, 1995

    • Search Google Scholar
    • Export Citation
  • 30

    Lee JY, , Niranjan A, , McInerney J, , Kondziolka D, , Flickinger JC, & Lunsford LD: Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurg 97:6572, 2002

    • Search Google Scholar
    • Export Citation
  • 31

    Leksell L: Stereotactic radiosurgery. J Neurol Neurosurg Psychiatry 46:797803, 1983

  • 32

    Linskey ME, , Davis SA, & Ratanatharathorn 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:Suppl 5970, 2005

    • Search Google Scholar
    • Export Citation
  • 33

    Liščák R, , Kollová A, , Vladyka V, , Š imonová G, & Novotný J Jr: Gamma knife radiosurgery of skull base meningiomas. Acta Neurochir 91:Suppl 6574, 2004

    • Search Google Scholar
    • Export Citation
  • 34

    Liščák R, , Šimonová G, , Vymazal J, , Janoušková L, & Vladyka V: Gamma knife radiosurgery of meningiomas in the cavernous sinus region. Acta Neurochir (Wien) 141:473480, 1999

    • Search Google Scholar
    • Export Citation
  • 35

    Liščák R, , Vladyka V, , Šimonová G, , Novotny J Jr, & Syruček M: Gamma knife radiosurgery of meningiomas—preliminary results and complications. J Radiosurg 1:3541, 1998

    • 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 80:187190, 1994

    • Search Google Scholar
    • Export Citation
  • 37

    Maire JP, , Caudry M, , Guerin J, , Celerier D, , San Galli F, & Causse 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 33:315321, 1995

    • Search Google Scholar
    • Export Citation
  • 38

    Malik I, , Rowe JG, , Walton L, , Radatz MW, & Kemeny AA: The use of stereotactic radiosurgery in the management of meningiomas. Br J Neurosurg 19:1320, 2005

    • Search Google Scholar
    • Export Citation
  • 39

    Maruyama K, , Shin M, , Kurita H, , Kawahara N, , Morita A, & Kirino T: Proposed treatment strategy for cavernous sinus meningiomas: a prospective study. Neurosurgery 55:10681075, 2004

    • Search Google Scholar
    • Export Citation
  • 40

    Mathiesen T, , Lindquist C, , Kihlstrom L, & Karlsson B: Recurrence of cranial base meningiomas. Neurosurgery 39:29, 1996

  • 41

    Morita A, , Coffey RJ, , Foote RL, , Schiff D, & Gorman D: Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients. J Neurosurg 90:4249, 1999

    • Search Google Scholar
    • Export Citation
  • 42

    Muthukumar N, , Kondziolka D, , Lunsford LD, & Flickinger JC: Stereotactic radiosurgery for tentorial meningiomas. Acta Neurochir (Wien) 140:315321, 1998

    • Search Google Scholar
    • Export Citation
  • 43

    Nakamura M, , Roser F, , Michel J, , Jacobs C, & Samii M: The natural history of incidental meningiomas. Neurosurgery 53:6271, 2003

  • 44

    Nakasu S, , Nakasu Y, , Nakajima M, , Matsuda M, & Handa J: Pre-operative identification of meningiomas that are highly likely to recur. J Neurosurg 90:455462, 1999

    • Search Google Scholar
    • Export Citation
  • 45

    Nicolato A, , Giorgetti P, , Foroni R, , Grigolato D, , Pasquin IP, & Zuffante 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) 147:367375, 2005

    • Search Google Scholar
    • Export Citation
  • 46

    Niiro M, , Yatsushiro K, , Nakamura K, , Kawahara Y, & Kuratsu J: Natural history of elderly patients with asymptomatic meningiomas. J Neurol Neurosurg Psychiatry 68:2528, 2000

    • Search Google Scholar
    • Export Citation
  • 47

    Nutting C, , Brada M, , Brazil L, , Sibtain A, , Saran F, & Westbury C, : Radiotherapy in the treatment of benign meningioma of the skull base. J Neurosurg 90:823827, 1999

    • Search Google Scholar
    • Export Citation
  • 48

    Obeid F, & Al-Mefty O: Recurrence of olfactory groove meningiomas. Neurosurgery 53:534543, 2003

  • 49

    Olivero WC, , Lister JR, & Elwood PW: The natural history and growth rate of asymptomatic meningiomas: a review of 60 patients. J Neurosurg 83:222224, 1995

    • Search Google Scholar
    • Export Citation
  • 50

    O'Sullivan MG, , van Loveren HR, & Tew JM Jr: The surgical resectability of meningiomas of the cavernous sinus. Neurosurgery 40:238247, 1997

    • Search Google Scholar
    • Export Citation
  • 51

    Pan DH, , Guo WY, , Chang YC, , Chung WY, , Shiau CY, & Wang LW, : The effectiveness and factors related to treatment results of gamma knife radiosurgery of meningiomas. Stereotact Funct Neurosurg 70:1 Suppl 1932, 1998

    • Search Google Scholar
    • Export Citation
  • 52

    Pendl G, , Schrottner O, , Eustacchio S, , Feichtinger K, & Ganz J: Stereotactic radiosurgery of skull base meningiomas. Minim Invasive Neurosurg 40:8790, 1997

    • Search Google Scholar
    • Export Citation
  • 53

    Pendl G, , Unger F, , Papaefthymiou G, & Eustacchio S: Staged radio-surgical treatment for large benign cerebral lesions. J Neurosurg 93:3 Suppl 107112, 2000

    • Search Google Scholar
    • Export Citation
  • 54

    Pollock BE: Stereotactic radiosurgery for intracranial meningiomas: indications and results. Neurosurg Focus 14:5 E4, 2003

  • 55

    Pourel N, , Auque J, , Bracard S, , Hoffstetter S, , Luporsi E, & Vignaud JM, : Efficacy of external fractionated radiation therapy in the treatment of meningiomas: a 20-year experience. Radiother Oncol 61:6570, 2001

    • Search Google Scholar
    • Export Citation
  • 56

    Roche PH, , Pellet W, , Fuentes S, , Thomassin JM, & Regis J: Gamma knife radiosurgical management of petroclival meningiomas result and indications. Acta Neurochir (Wien) 145:883888, 2003

    • Search Google Scholar
    • Export Citation
  • 57

    Rowe JG, , Walton L, , Vaughan P, , Malik I, , Radatz M, & Kemeny A: Radiosurgical planning of meningiomas: compromises with conformity. Stereotact Funct Neurosurg 82:169174, 2004

    • Search Google Scholar
    • Export Citation
  • 58

    Samii M, , Carvalho GA, , Tatagiba M, & Matthies C: Surgical management of meningiomas originating in Meckel's cave. Neurosurgery 41:767775, 1997

    • Search Google Scholar
    • Export Citation
  • 59

    Samii M, , Carvalho GA, , Tatagiba M, , Matthies C, & Vorkapic P: Meningiomas of the tentorial notch: surgical anatomy and management. J Neurosurg 84:375381, 1996

    • Search Google Scholar
    • Export Citation
  • 60

    Sanson M, & Cornu P: Biology of menigiomas. Acta Neurochir (Wien) 142:493505, 2000

  • 61

    Schaller B, , Merlo A, , Gratzl O, & Probst R: Premeatal and retromeatal cerebellopontine angle meningioma. Two distinct clinical entities. Acta Neurochir (Wien) 141:465471, 1999

    • Search Google Scholar
    • Export Citation
  • 62

    Sekhar LN, , Swamy NKS, , Jaiswal V, , Rubinstein E, , Hirsh WE Jr, & Wright DC: Surgical excision of meningiomas involving the clivus: preoperative and intraoperative features as predictors of postoperative functional deterioration. J Neurosurg 81:860868, 1994

    • Search Google Scholar
    • Export Citation
  • 63

    Selch MT, , Ahn E, , Laskari A, , Lee SP, , Agazaryan N, & Solberg TD, : Stereotactic radiotherapy for treatment of cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 59:101111, 2004

    • Search Google Scholar
    • Export Citation
  • 64

    Shafron DH, , Friedman WA, , Buatti JM, , Bova FJ, & Mendenhall WM: Linac radiosurgery for benign meningiomas. Int J Radiat Oncol Biol Phys 43:321327, 1999

    • Search Google Scholar
    • Export Citation
  • 65

    Shrieve DC, , Hazard L, , Boucher K, & Jensen RL: Dose fractionation in stereotactic radiotherapy for parasellar meningiomas: radiobiological considerations of efficiacy and optic nerve tolerance. J Neurosurg 101:3 Suppl 390395, 2004

    • Search Google Scholar
    • Export Citation
  • 66

    Shuto T, , Inomori S, , Fujino H, , Nagano H, , Hasegawa N, & Kakuta Y: Cyst formation following gamma knife surgery for intracranial meningioma. J Neurosurg 102:Suppl 134139, 2005

    • Search Google Scholar
    • Export Citation
  • 67

    Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:2239, 1957

  • 68

    Sindou MP, & Alaywan M: Most intracranial meningiomas are not cleavable tumors: anatomic-surgical evidence and angiographic predictibility. Neurosurgery 42:476480, 1998

    • Search Google Scholar
    • Export Citation
  • 69

    Singh VP, , Kansai S, , Vaishya S, , Julka PK, & Mehta VS: Early complications following gamma knife radiosurgery for intracranial meningiomas. J Neurosurg 93:3 Suppl 5761, 2000

    • Search Google Scholar
    • Export Citation
  • 70

    Spiegelmann R, , Nissim O, , Menhel J, , Alezra D, & Pfeffer MR: Linear accelerator radiosurgery for meningiomas in and around the cavernous sinus. Neurosurgery 51:13731380, 2002

    • Search Google Scholar
    • Export Citation
  • 71

    Stafford SL, , Pollock BE, , Foote RL, , Link MJ, , Gorman DA, & Schomberg PJ, : Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients. Neurosurgery 49:10291038, 2001

    • Search Google Scholar
    • Export Citation
  • 72

    Steiner L, , Lidquist C, & Steiner M, Meningiomas and gamma knife radiosurgery. Al-Mefty O: Meningiomas New York, Raven Press, 1991. 263272

    • Search Google Scholar
    • Export Citation
  • 73

    Stippler M, & Kondziolka D: Skull base meningiomas: is there a place for microsurgery?. Acta Neurochir (Wien) 148:13, 2006

  • 74

    Tischler RB, , Leoffler JS, , Lunsford LD, , Duma C, , Alexander E III, & Kooy HM, : Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27:215221, 1993

    • Search Google Scholar
    • Export Citation
  • 75

    Van Havenbergh T, , Carvalho G, , Tatagiba M, , Plets C, & Samii M: Natural history of petroclival meningiomas. Neurosurgery 52:5564, 2003

  • 76

    Vladyka V, , Liščák R, , Novotný J Jr, , Marek J, & Ježková J: Radiation tolerance in functioning pituitary tissue in gamma knife surgery for pituitary adenomas. Neurosurgery 52:309317, 2003

    • Search Google Scholar
    • Export Citation
  • 77

    Voss NF, , Vrionis FD, , Heilman CB, & Robertson JH: Meningiomas of the cerebellopontine angle. Surg Neurol 53:439447, 2000

  • 78

    Yoneoka Y, , Fujii Y, & Tanaka R: Growth of incidental meningiomas. Acta Neurochir (Wien) 142:507511, 2000

  • 79

    Yoshioka H, , Hama S, , Taniguchi E, , Sugiyama K, , Arita K, & Kurisu K: Peritumoral brain edema associated with meningioma: influence of vascular endothelial growth factor expression and vascular blood supply. Cancer 85:936944, 1995

    • Search Google Scholar
    • Export Citation

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