Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Restricted access

OBJECT

Stereotactic radiosurgery (SRS) has been shown to offer a high probability of tumor control for Grade I meningiomas. However, SRS can sometimes incite edema or exacerbate preexisting edema around the targeted meningioma. The current study evaluates the incidence, timing, and degree of edema around parasagittal or parafalcine meningiomas following SRS.

METHODS

A retrospective review was undertaken of a prospectively maintained database of patients treated with Gamma Knife radiosurgery at the University of Virginia Health System. All patients with WHO Grade I parafalcine or parasagittal meningiomas with at least 6 months of clinical follow-up were identified, resulting in 61 patients included in the study. The median radiographic follow-up was 28 months (range 6–158 months). Rates of new or worsening edema were quantitatively assessed using volumetric analysis; edema indices were computed as a function of time following radiosurgery. Statistical methods were used to identify favorable and unfavorable prognostic factors for new or worsening edema.

RESULTS

Progression-free survival at 2 and 5 years was 98% and 90%, respectively, according to Kaplan-Meier analysis. After SRS, new peritumoral edema occurred or preexisting edema worsened in 40% of treated meningiomas. The median time to onset of peak edema was 36 months post-SRS. Persistent and progressive edema was associated with 11 tumors, and resection was undertaken for these lesions. However, 20 patients showed initial edema progression followed by regression at a median of 18 months after radiosurgery (range 6–24 months). Initial tumor volume greater than 10 cm3, absence of prior resection, and higher margin dose were significantly (p < 0.05) associated with increased risk of new or progressive edema after SRS.

CONCLUSIONS

Stereotactic radiosurgery offers a high rate of tumor control in patients with parasagittal or parafalcine meningiomas. However, it can lead to worsening peritumoral edema in a minority of patients. Following radiosurgery, transient edema occurs earlier than persistent and progressive edema. Longitudinal follow-up of meningioma patients after SRS is required to detect and appropriately treat transient as well as progressive edema.

ABBREVIATIONSGKRS = Gamma Knife radiosurgery; SRS = stereotactic radiosurgery; VEGF = vascular endothelial growth factor.
Article Information

Contributor Notes

Correspondence Jason P. Sheehan, Department of Neurological Surgery, University of Virginia Health System, Box 800212, Charlottesville, VA 22908. email: jsheehan@virginia.edu.INCLUDE WHEN CITING Published online June 26, 2015; DOI: 10.3171/2014.12.JNS142159.DISCLOSURE Dr. Schlesinger reports receiving support of non-study-related research from Elekta AB.

© Copyright 1944-2019 American Association of Neurological Surgeons

Headings
References
  • 1

    Barbaro NMGutin PHWilson CBSheline GEBoldrey EBWara WM: Radiation therapy in the treatment of partially resected meningiomas. Neurosurgery 20:5255281987

    • Search Google Scholar
    • Export Citation
  • 2

    Cai RBarnett GHNovak EChao STSuh JH: Principal risk of peritumoral edema after stereotactic radiosurgery for intracranial meningioma is tumor-brain contact interface area. Neurosurgery 66:5135222010

    • Search Google Scholar
    • Export Citation
  • 3

    Chang JHChang JWChoi JYPark YGChung SS: Complications after gamma knife radiosurgery for benign meningiomas. J Neurol Neurosurg Psychiatry 74:2262302003

    • Search Google Scholar
    • Export Citation
  • 4

    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
  • 5

    Ding DXu ZMcNeill ITYen CPSheehan JP: Radiosurgery for parasagittal and parafalcine meningiomas. J Neurosurg 119:8718772013

    • Search Google Scholar
    • Export Citation
  • 6

    Girvigian MRChen JCRahimian JMiller MJTome M: Comparison of early complications for patients with convexity and parasagittal meningiomas treated with either stereotactic radiosurgery or fractionated stereotactic radiotherapy. Neurosurgery 62:5 SupplA19282008

    • Search Google Scholar
    • Export Citation
  • 7

    Gurkanlar DEr USanli MOzkan MSekerci Z: Peritumoral brain edema in intracranial meningiomas. J Clin Neurosci 12:7507532005

  • 8

    Hasegawa TKida YYoshimoto MIizuka HIshii DYoshida K: Gamma Knife surgery for convexity, parasagittal, and falcine meningiomas. J Neurosurg 114:139213982011

    • Search Google Scholar
    • Export Citation
  • 9

    Kalapurakal JASilverman CLAkhtar NLaske DWBraitman LEBoyko OB: Intracranial meningiomas: factors that influence the development of cerebral edema after stereotactic radiosurgery and radiation therapy. Radiology 204:4614651997

    • Search Google Scholar
    • Export Citation
  • 10

    Kan PLiu JKWendland MMShrieve DJensen RL: Peritumoral edema after stereotactic radiosurgery for intracranial meningiomas and molecular factors that predict its development. J Neurooncol 83:33382007

    • Search Google Scholar
    • Export Citation
  • 11

    Kobayashi TKida YMori Y: Long-term results of stereotactic gamma radiosurgery of meningiomas. Surg Neurol 55:3253312001

  • 12

    Kondziolka DMathieu DLunsford LDMartin JJMadhok RNiranjan A: Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 62:53602008

    • Search Google Scholar
    • Export Citation
  • 13

    Lee KJJoo WIRha HKPark HKChough JKHong YK: Peritumoral brain edema in meningiomas: correlations between magnetic resonance imaging, angiography, and pathology. Surg Neurol 69:3503552008

    • Search Google Scholar
    • Export Citation
  • 14

    Levin VABidaut LHou PKumar AJWefel JSBekele BN: Randomized double-blind placebo-controlled trial of bevacizumab therapy for radiation necrosis of the central nervous system. Int J Radiat Oncol Biol Phys 79:148714952011. (Erratum in Int J Radiat Oncol Biol Phys 84:6)

    • Search Google Scholar
    • Export Citation
  • 15

    Lou ESumrall ALTurner SPeters KBDesjardins AVredenburgh JJ: Bevacizumab therapy for adults with recurrent/progressive meningioma: a retrospective series. J Neurooncol 109:63702012

    • Search Google Scholar
    • Export Citation
  • 16

    Novotný J JrKollová ALiscák R: Prediction of intracranial edema after radiosurgery of meningiomas. J Neurosurg 105:Suppl1201262006

    • Search Google Scholar
    • Export Citation
  • 17

    Osawa TTosaka MNagaishi MYoshimoto Y: Factors affecting peritumoral brain edema in meningioma: special histological subtypes with prominently extensive edema. J Neurooncol 111:49572013

    • Search Google Scholar
    • Export Citation
  • 18

    Otsuka STamiya TOno YMichiue HKurozumi KDaido S: The relationship between peritumoral brain edema and the expression of vascular endothelial growth factor and its receptors in intracranial meningiomas. J Neurooncol 70:3493572004

    • Search Google Scholar
    • Export Citation
  • 19

    Pan HCSun MHChen CCChen CJLee CHSheehan J: Neuroimaging and quality-of-life outcomes in patients with brain metastasis and peritumoral edema who undergo Gamma Knife surgery. J Neurosurg 109:Suppl90982008

    • Search Google Scholar
    • Export Citation
  • 20

    Patil CGHoang SBorchers DJ IIISakamoto GSoltys SGGibbs IC: Predictors of peritumoral edema after stereotactic radiosurgery of supratentorial meningiomas. Neurosurgery 63:4354422008

    • Search Google Scholar
    • Export Citation
  • 21

    Simis APires de Aguiar PHLeite CCSantana PA JrRosemberg STeixeira MJ: Peritumoral brain edema in benign meningiomas: correlation with clinical, radiologic, and surgical factors and possible role on recurrence. Surg Neurol 70:4714772008

    • Search Google Scholar
    • Export Citation
  • 22

    Singh VPKansai SVaishya SJulka PKMehta VS: Early complications following gamma knife radiosurgery for intracranial meningiomas. J Neurosurg 93:Suppl 357612000

    • Search Google Scholar
    • Export Citation
  • 23

    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
  • 24

    Stevens JMRuiz JSKendall BE: Observations on peritumoral oedema in meningioma. Part II: Mechanisms of oedema production. Neuroradiology 25:1251311983

    • Search Google Scholar
    • Export Citation
  • 25

    Sughrue MEKane AJShangari GRutkowski MJMcDermott MWBerger MS: The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas. J Neurosurg 113:102910352010

    • Search Google Scholar
    • Export Citation
  • 26

    Unger KRLominska CEChanyasulkit JRandolph-Jackson PWhite RLAulisi E: Risk factors for posttreatment edema in patients treated with stereotactic radiosurgery for meningiomas. Neurosurgery 70:6396452012

    • Search Google Scholar
    • Export Citation
  • 27

    Warren KEPatronas NAikin AAAlbert PSBalis FM: Comparison of one-, two-, and three-dimensional measurements of childhood brain tumors. J Natl Cancer Inst 93:140114052001

    • Search Google Scholar
    • Export Citation
  • 28

    Williams BJPark DMSheehan JP: Bevacizumab used for the treatment of severe, refractory perilesional edema due to an arteriovenous malformation treated with stereotactic radiosurgery. J Neurosurg 116:9729772012

    • Search Google Scholar
    • Export Citation
  • 29

    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 85:9369441999

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 680 572 113
PDF Downloads 333 239 10
EPUB Downloads 0 0 0
PubMed
Google Scholar