Radiosurgery for parasagittal and parafalcine meningiomas

Clinical article

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Object

Parasagittal and parafalcine (PSPF) meningiomas represent the second most common location for intracranial meningiomas. Involvement of the superior sagittal sinus or deep draining veins may prevent gross-total resection of these tumors without significant morbidity. The authors review their results for treatment of PSPF meningiomas with radiosurgery.

Methods

The authors retrospectively reviewed the institutional review board–approved University of Virginia Gamma Knife database and identified 65 patients with 90 WHO Grade I parasagittal (59%) and parafalcine (41%) meningiomas who had a mean MRI follow-up of 56.6 months. The patients' mean age was 57 years, the median preradiosurgery Karnofsky Performance Status score was 80, and the median initial tumor and treatment volumes were 3 and 3.7 cm3, respectively. The median prescription dose was 15 Gy, isodose line was 40%, and the number of isocenters was 5. Kaplan-Meier analysis was used to determine progression-free survival (PFS). Univariate and multivariate Cox regression analyses were used to identify factors associated with PFS.

Results

The median overall PFS was 75.6 months. The actuarial tumor control rate was 85% at 3 years and 70% at 5 years. Parasagittal location, no prior resection, and younger age were found to be independent predictors of tumor PFS. For the 49 patients with clinical follow-up (mean 70.8 months), the median postradiosurgery Karnofsky Performance Status score was 90. Symptomatic postradiosurgery peritumoral edema was observed in 4 patients (8.2%); this group comprised 3 patients (6.1%) with temporary and 1 patient (2%) with permanent clinical sequelae. Two patients (4.1%) died of tumor progression.

Conclusions

Radiosurgery offers a minimally invasive treatment option for PSPF meningiomas, with a good tumor control rate and an acceptable complication rate comparable to most surgical series.

Abbreviations used in this paper:EBRT = external-beam radiation therapy; GKS = Gamma Knife surgery; KPS = Karnofsky Performance Status; PFS = progression-free survival; PSPF = parasagittal and parafalcine.

Article Information

Address correspondence to: Jason P. Sheehan, M.D., Ph.D., Department of Neurological Surgery, University of Virginia, P.O. Box 800212, Charlottesville, VA 22908. email: jps2f@virginia.edu.

Please include this information when citing this paper: published online August 9, 2013; DOI: 10.3171/2013.6.JNS13110.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Chart showing composition of the groups of patients included for analysis. All patients with MRI follow-up (n = 65) were included in the imaging outcomes analysis, whereas only patients with clinical follow-up (n = 49) were included in the clinical outcomes analysis.

  • View in gallery

    Kaplan-Meier plot showing PFS over time for PSPF meningiomas following radiosurgery.

  • View in gallery

    Brain MRI studies obtained with Gd contrast, in axial (A) and coronal (B) views, demonstrating a parafalcine meningioma. After a single session of GKS, brain MRI studies were obtained with Gd contrast, in axial (C) and coronal (D) views, demonstrating successful tumor control with diminished tumor volume at 44 months of MRI follow-up.

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