Radiosurgery for large-volume (> 10 cm3) benign meningiomas

Clinical article

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Object

Stereotactic radiosurgery (SRS) has proven to be a safe and effective treatment for many patients with intracranial meningiomas. Nevertheless, the morbidity associated with radiosurgery of larger meningiomas is poorly understood.

Methods

The authors performed a retrospective review of 116 patients who underwent SRS for meningiomas (WHO Grade I) > 10 cm3 between 1990 and 2007, with a minimum follow-up of 12 months. Patients with atypical or malignant meningiomas and those who received prior radiotherapy were excluded. The average tumor volume was 17.5 cm3 (range 10.1–48.6 cm3); the average tumor margin dose was 15.1 Gy (range 12–18 Gy); and the mean follow-up duration was 70.1 months (range 12–199 months).

Results

Tumor control was 99% at 3 years and 92% at 7 years after radiosurgery. Thirty complications after radiosurgery were noted in 27 patients (23%), including 7 cases of seizures, 6 cases of hemiparesis, 5 cases of trigeminal injury, 4 cases of headaches, 3 cases of diplopia, 2 cases each of cerebral infarction and ataxia, and 1 case of hearing loss. Patients with supratentorial tumors experienced a higher complication rate compared with patients with skull base tumors (44% compared with 18%) (hazard ratio 2.9, 95% CI 1.3–6.7, p = 0.01).

Conclusions

The morbidity associated with SRS for patients with benign meningiomas > 10 cm3 is greater for supratentorial tumors compared with skull base tumors. Whereas radiosurgery is relatively safe for patients with large-volume skull base meningiomas, resection should remain the primary disease management for the majority of patients with large-volume supratentorial meningiomas.

Abbreviations used in this paper: GKS = Gamma Knife surgery; HR = hazard ratio; ICA = internal carotid artery; PIV = prescription isodose volume; SRS = stereotactic radiosurgery.

Article Information

Address correspondence to: Bruce E. Pollock, M.D., Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota 55905. email: pollock.bruce@mayo.edu.

Please include this information when citing this paper: published online September 18, 2009; DOI: 10.3171/2009.8.JNS09703.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Axial long-TR MR images obtained in a 78-year-old woman with Parkinson disease with an enlarging right parietal convexity meningioma. A: Admission MR image obtained before radiosurgery. At radiosurgery the PIV was 12.2 cm3; the tumor margin dose was 16 Gy. B: Follow-up MR image obtained 11 months after radiosurgery. The patient developed left-sided weakness and partial motor seizures requiring corticosteroid therapy for 9 months. C: Follow-up MR image obtained 9 years after radiosurgery showing a reduction in tumor size and resolution of the surrounding edema.

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    Graph comparing the incidence of complications for patients who underwent radiosurgery for supratentorial compared with skull base meningiomas.

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