Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival

Clinical article

Restricted access

Object

Stereotactic radiosurgery serves as an important primary and adjuvant treatment option for patients with many types of intracranial meningiomas. This is particularly true for patients with parasellar meningiomas. In this study, the authors evaluated the outcomes of Gamma Knife surgery (GKS) used to treat parasellar meningiomas.

Methods

The study is a retrospective review of the outcomes in 138 patients with meningiomas treated at the University of Virginia from 1989 to 2006; all patients had a minimum follow-up of 24 months. There were 31 men and 107 women whose mean age was 54 years (range 19–85 years). Eighty-four patients had previously undergone resection. The mean pre-GKS tumor volume was 7.5 ml (range 0.2–54.8 ml). Clinical and radiographic evaluations were performed, and factors related to favorable outcomes in each case were assessed.

Results

The mean follow-up duration was 84 months (median 75.5 months, range 24–216 months). In 118 patients (86%), the tumor volume was unchanged or had decreased at last follow-up. Kaplan-Meier analysis demonstrated radiographic progression-free survival at 5 and 10 years to be 95.4% and 69%, respectively. Fourteen patients (10%) developed new cranial nerve palsies following GKS. Factors associated with tumor control included younger age, a higher isodose, and smaller tumor volume. A longer follow-up duration was associated with either a decrease or increase in tumor volume. Fourteen patients (10%) experienced new or worsening cranial nerve deficits after treatment. Factors associated with this occurrence were larger pretreatment tumor volume, lower peripheral radiation dose, lower maximum dose, tumor progression, and longer follow-up.

Conclusions

Gamma Knife surgery offers an acceptable rate of tumor control for parasellar meningiomas and accomplishes this with a low incidence of neurological deficits. Radiological control after radiosurgery is more likely in those patients with a smaller tumor volume and a higher prescription dose.

Abbreviations used in this paper: GKS = Gamma Knife surgery; PFS = progression-free survival.
Article Information

Contributor Notes

Address correspondence to: Jason P. Sheehan, M.D., Ph.D., Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908. email: jps2f@virginia.edu.Please include this information when citing this paper: published online February 11, 2011; DOI: 10.3171/2011.1.JNS091939.
Headings
References
  • 1

    Al-Mefty OSmith RR: Surgery of tumors invading the cavernous sinus. Surg Neurol 30:3703811988

  • 2

    Brell MVillà STeixidor PLucas AFerrán EMarín S: Fractionated stereotactic radiotherapy in the treatment of exclusive cavernous sinus meningioma: functional outcome, local control, and tolerance. Surg Neurol 65:28342006

    • Search Google Scholar
    • Export Citation
  • 3

    Chang SDAdler JR JrMartin DP: LINAC radiosurgery for cavernous sinus meningiomas. Stereotact Funct Neurosurg 71:43501998

  • 4

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

  • 5

    Chang SDDoty JRMartin DPHancock SLAdler JR: Treatment of cavernous sinus tumors with linear accelerator radiosurgery. Skull Base Surg 9:1952001999

    • Search Google Scholar
    • Export Citation
  • 6

    Chen JCGiannotta SLYu CPetrovich ZLevy MLApuzzo ML: Radiosurgical management of benign cavernous sinus tumors: dose profiles and acute complications. Neurosurgery 48:102210322001

    • Search Google Scholar
    • Export Citation
  • 7

    Cioffi FABernini FPPunzo ANatale MMuras I: Cavernous sinus meningiomas. Neurochirurgia (Stuttg) 30:40471987

  • 8

    Cusimano MDSekhar LNSen CNPomonis SWright DCBiglan AW: The results of surgery for benign tumors of the cavernous sinus. Neurosurgery 37:1101995

    • Search Google Scholar
    • Export Citation
  • 9

    De Jesús OSekhar LNParikh HKWright DCWagner DP: Long-term follow-up of patients with meningiomas involving the cavernous sinus: recurrence, progression, and quality of life. Neurosurgery 39:9159201996

    • Search Google Scholar
    • Export Citation
  • 10

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

  • 11

    Dufour HMuracciole XMétellus PRégis JChinot OGrisoli F: Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with or without previous surgery: is there an alternative to aggressive tumor removal?. Neurosurgery 48:2852962001

    • Search Google Scholar
    • Export Citation
  • 12

    Duma CMLunsford LDKondziolka DHarsh GR IVFlickinger JC: Stereotactic radiosurgery of cavernous sinus meningiomas as an addition or alternative to microsurgery. Neurosurgery 32:6997051993

    • Search Google Scholar
    • Export Citation
  • 13

    Flickinger JCKondziolka DMaitz AHLunsford LD: Gamma knife radiosurgery of imaging-diagnosed intracranial meningioma. Int J Radiat Oncol Biol Phys 56:8018062003

    • Search Google Scholar
    • Export Citation
  • 14

    Friedman WAMurad GJBradshaw PAmdur RJMendenhall WMFoote KD: Linear accelerator surgery for meningiomas. J Neurosurg 103:2062092005

    • Search Google Scholar
    • Export Citation
  • 15

    Han JHKim DGChung HTPark CKPaek SHKim CY: Gamma knife radiosurgery for skull base meningiomas: long-term radiologic and clinical outcome. Int J Radiat Oncol Biol Phys 72:132413322008

    • Search Google Scholar
    • Export Citation
  • 16

    Hasegawa TKida YYoshimoto MKoike JIizuka HIshii D: Long-term outcomes of Gamma Knife surgery for cavernous sinus meningioma. J Neurosurg 107:7457512007

    • Search Google Scholar
    • Export Citation
  • 17

    Heth JAAl-Mefty O: Cavernous sinus meningiomas. Neurosurg Focus 14:6e32003

  • 18

    Iwai YYamanaka KIshiguro T: Gamma knife radiosurgery for the treatment of cavernous sinus meningiomas. Neurosurgery 52:5175242003

    • Search Google Scholar
    • Export Citation
  • 19

    Johnson MDSade BMilano MTLee JHToms SA: New prospects for management and treatment of inoperable and recurrent skull base meningiomas. J Neurooncol 86:1091222008

    • Search Google Scholar
    • Export Citation
  • 20

    Kida YKobayashi TTanaka TOyama HNiwa MMaesawa S: [Radiosurgery of cavernous sinus meningiomas with gamma-knife.]. No Shinkei Geka 24:5295331996. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 21

    Kim DKGrieve JArcher DJUttley D: Meningiomas in the region of the cavernous sinus: a review of 21 patients. Br J Neurosurg 10:4394441996

    • Search Google Scholar
    • Export Citation
  • 22

    Kimball MMFriedman WAFoote KDBova FJChi YY: Linear accelerator radiosurgery for cavernous sinus meningiomas. Stereotact Funct Neurosurg 87:1201272009

    • Search Google Scholar
    • Export Citation
  • 23

    Klink DFSampath PMiller NRBrem HLong DM: Long-term visual outcome after nonradical microsurgery in patients with parasellar and cavernous sinus meningiomas. Am J Ophthalmol 130:6892000

    • Search Google Scholar
    • Export Citation
  • 24

    Klink DFSampath PMiller NRBrem HLong DM: Long-term visual outcome after nonradical microsurgery patients with parasellar and cavernous sinus meningiomas. Neurosurgery 47:24322000

    • Search Google Scholar
    • Export Citation
  • 25

    Knosp EPerneczky AKoos WTFries GMatula C: Meningiomas of the space of the cavernous sinus. Neurosurgery 38:4344441996

  • 26

    Kuo JSChen JCYu CZelman VGiannotta SLPetrovich Z: Gamma knife radiosurgery for benign cavernous sinus tumors: quantitative analysis of treatment outcomes. Neurosurgery 54:138513942004

    • Search Google Scholar
    • Export Citation
  • 27

    Kurita HSasaki TKawamoto STaniguchi MTerahara ATago M: Role of radiosurgery in the management of cavernous sinus meningiomas. Acta Neurol Scand 96:2973041997

    • Search Google Scholar
    • Export Citation
  • 28

    Landeiro JARibeiro CHLapenta MAFlores MSLopes CAMarins J: [Meningiomas of the cavernous sinus: the surgical resectability and complications.]. Arq Neuropsiquiatr 59:3-B7467532001. (Portuguese)

    • Search Google Scholar
    • Export Citation
  • 29

    Leber KABerglöff JPendl G: Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 88:43501998

    • 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

    Liscák RSimonová GVymazal JJanousková LVladyka V: Gamma knife radiosurgery of meningiomas in the cavernous sinus region. Acta Neurochir (Wien) 141:4734801999

    • Search Google Scholar
    • Export Citation
  • 32

    Maguire PDClough RFriedman AHHalperin EC: Fractionated external-beam radiation therapy for meningiomas of the cavernous sinus. Int J Radiat Oncol Biol Phys 44:75791999

    • Search Google Scholar
    • Export Citation
  • 33

    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
  • 34

    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
  • 35

    Mattozo CADe Salles AAKlement IAGorgulho AMcArthur DFord JM: Stereotactic radiation treatment for recurrent nonbenign meningiomas. J Neurosurg 106:8468542007

    • Search Google Scholar
    • Export Citation
  • 36

    Mendenhall WMMorris CGAmdur RJFoote KDFriedman WA: Radiotherapy alone or after subtotal resection for benign skull base meningiomas. Cancer 98:147314822003

    • Search Google Scholar
    • Export Citation
  • 37

    Metellus PRegis JMuracciole XFuentes SDufour HNanni I: Evaluation of fractionated radiotherapy and gamma knife radiosurgery in cavernous sinus meningiomas: treatment strategy. Neurosurgery 57:8738862005

    • Search Google Scholar
    • Export Citation
  • 38

    Milker-Zabel SZabel-du Bois AHuber PSchlegel WDebus J: Fractionated stereotactic radiation therapy in the management of benign cavernous sinus meningiomas: long-term experience and review of the literature. Strahlenther Onkol 182:6356402006

    • Search Google Scholar
    • Export Citation
  • 39

    Mingione VYen CPVance MLSteiner MSheehan JLaws ER: Gamma surgery in the treatment of nonsecretory pituitary macroadenoma. J Neurosurg 104:8768832006

    • Search Google Scholar
    • Export Citation
  • 40

    Nicolato AForoni RAlessandrini FBricolo AGerosa M: Radiosurgical treatment of cavernous sinus meningiomas: experience with 122 treated patients. Neurosurgery 51:115311612002

    • Search Google Scholar
    • Export Citation
  • 41

    Nicolato AForoni RAlessandrini FMaluta SBricolo AGerosa M: The role of Gamma Knife radiosurgery in the management of cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 53:99210002002

    • Search Google Scholar
    • Export Citation
  • 42

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

    • Search Google Scholar
    • Export Citation
  • 43

    Pamir MNKiliç TBayrakli FPeker S: Changing treatment strategy of cavernous sinus meningiomas: experience of a single institution. Surg Neurol 64:Suppl 2S58S662005

    • Search Google Scholar
    • Export Citation
  • 44

    Pendl GSchröttner OEustacchio SGanz JCFeichtinger K: Cavernous sinus meningiomas—what is the strategy: upfront or adjuvant gamma knife surgery?. Stereotact Funct Neurosurg 70:Suppl 133401998

    • Search Google Scholar
    • Export Citation
  • 45

    Pollock BEStafford SL: Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 62:142714312005

    • Search Google Scholar
    • Export Citation
  • 46

    Pollock BEStafford SLUtter AGiannini CSchreiner SA: Stereotactic radiosurgery provides equivalent tumor control to Simpson Grade 1 resection for patients with small-to medium-size meningiomas. Int J Radiat Oncol Biol Phys 55:100010052003

    • Search Google Scholar
    • Export Citation
  • 47

    Pouratian NSheehan JJagannathan JLaws ER JrSteiner LVance ML: Gamma knife radiosurgery for medically and surgically refractory prolactinomas. Neurosurgery 59:2552662006

    • Search Google Scholar
    • Export Citation
  • 48

    Roche PHRégis JDufour HFournier HDDelsanti CPellet W: Gamma knife radiosurgery in the management of cavernous sinus meningiomas. J Neurosurg 93:Suppl 368732000

    • Search Google Scholar
    • Export Citation
  • 49

    Sekhar LNMøller AR: Operative management of tumors involving the cavernous sinus. J Neurosurg 64:8798891986

  • 50

    Sekhar LNPatel SCusimano MWright DCSen CNBank WO: Surgical treatment of meningiomas involving the cavernous sinus: evolving ideas based on a ten year experience. Acta Neurochir Suppl 65:58621996

    • Search Google Scholar
    • Export Citation
  • 51

    Sekhar LNPomeranz SSen CN: Management of tumours involving the cavernous sinus. Acta Neurochir Suppl (Wien) 53:1011121991

  • 52

    Sekhar LNSen CNJho HDJanecka IP: Surgical treatment of intracavernous neoplasms: a four-year experience. Neurosurgery 24:18301989

    • Search Google Scholar
    • Export Citation
  • 53

    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
  • 54

    Shin MKurita HSasaki TKawamoto STago MKawahara N: Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas. J Neurosurg 95:4354392001

    • Search Google Scholar
    • Export Citation
  • 55

    Sibtain APlowman PN: Stereotactic radiosurgery. VII Radiosurgery versus conventionally-fractionated radiotherapy in the treatment of cavernous sinus meningiomas. Br J Neurosurg 13:1581661999

    • Search Google Scholar
    • Export Citation
  • 56

    Sindou MWydh EJouanneau ENebbal MLieutaud T: Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone. J Neurosurg 107:9379442007

    • Search Google Scholar
    • Export Citation
  • 57

    Snell JWSheehan JStroila MSteiner L: Assessment of imaging studies used with radiosurgery: a volumetric algorithm and an estimation of its error. Technical note. J Neurosurg 104:1571622006

    • Search Google Scholar
    • Export Citation
  • 58

    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
  • 59

    Steiner LSheehan JLindquist CStroila MSteiner MGamma surgery in cerebral vascular lesions, malformations, tumors, and functional disorders. Schmidek HHRoberts DW: Schmidek & Sweet Operative Neurosurgical Techniques: Indications Methods and Results ed 5PhiladephiaWB Saunders1:2006. 530576

    • Search Google Scholar
    • Export Citation
  • 60

    Takanashi MFukuoka SHojyo ASasaki TNakagawara JNakamura H: Gamma Knife radiosurgery for skull-base meningiomas. Prog Neurol Surg 22:961112009

    • Search Google Scholar
    • Export Citation
  • 61

    Tishler RBLoeffler 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
  • 62

    Tuniz FSoltys SGChoi CYChang SDGibbs ICFischbein NJ: Multisession cyberknife stereotactic radiosurgery of large, benign cranial base tumors: preliminary study. Neurosurgery 65:8989072009

    • Search Google Scholar
    • Export Citation
  • 63

    Villavicencio ATBlack PMShrieve DCFallon MPAlexander ELoeffler JS: Linac radiosurgery for skull base meningiomas. Acta Neurochir (Wien) 143:114111522001

    • Search Google Scholar
    • Export Citation
  • 64

    Ziyal IMSekhar LNSalas E: Radiosurgery: an effective treatment for cavernous sinus meningiomas?. Crit Rev Neurosurg 9:1071151999

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 811 776 53
Full Text Views 200 75 4
PDF Downloads 149 34 1
EPUB Downloads 0 0 0
PubMed
Google Scholar