Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients

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  • 1 Departments of Neurosurgery and Neurology, and Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Object. In this study the authors sought to determine the neurological risks and potential clinical benefits of gamma knife radiosurgery for skull base meningiomas.

Methods. A consecutive series of 88 patients harboring skull base meningiomas were treated between 1990 and 1996 by using the Leksell gamma knife in a prospective clinical study that included a strict dose—volume protocol. Forty-nine patients had previously undergone surgery, and six had received external-beam radiotherapy. The median treatment volume was 10 cm3, and the median dose to the tumor margin was 16 Gy. The radiosurgical dosage to the optic nerve, the cavernous sinus, and Meckel's cave was calculated and correlated with clinical outcome. The median patient follow-up time was 35 months (range 12–83 months).

Two tumors (2.3%) progressed after radiosurgery; the progression-free 5-year survival rate was 95%. At last follow-up review, 60 (68%) tumors were smaller and 26 (29.5%) remained unchanged. Clinical improvement (in vision, trigeminal pain, or other cranial nerve symptoms) occurred in 15 patients. Functioning optic nerves received a median dose of 10 Gy (range 1–16 Gy), and no treatment-induced visual loss occurred. Among nine patients with new trigeminal neuropathy, six received doses of more than 19 Gy to Meckel's cave.

Conclusions. Gamma knife radiosurgery appeared to be an effective method to control the growth of most skull base meningiomas in this intermediate-term study. The risk of trigeminal neuropathy seemed to be associated with doses of more than 19 Gy, and the optic apparatus appeared to tolerate doses greater than 10 Gy. Considering the risks to cranial nerves associated with open surgery for comparable tumors, the authors believe that gamma knife radiosurgery is a useful method for the management of properly selected recurrent, residual, or newly diagnosed skull base meningiomas.

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Contributor Notes

Address reprint requests to: Robert J. Coffey, M.D., 1333A North Avenue, New Rochelle, New York 10804. email: robert@elekta.com.
  • 1.

    Black PM: Meningiomas. Neurosurgery 32:643657, 1993 Black PM: Meningiomas. Neurosurgery 32:643–657, 1993

  • 2.

    Chang SD, & Adler JR Jr: Treatment of cranial base meningiomas with linear accelerator radiosurgery. Neurosurgery 41:10191027, 1997 Chang SD, Adler JR Jr: Treatment of cranial base meningiomas with linear accelerator radiosurgery. Neurosurgery 41:1019–1027, 1997

    • Search Google Scholar
    • Export Citation
  • 3.

    Dolenc VV, , Kregar T, & Ferluga M, et al: Treatment of tumors invading the cavernous sinus, in Dolenc VV (ed): The Cavernous Sinus. A Multidisciplinary Approach to Vascular and Tumorous Lesions. Vienna: Springer-Verlag, 1987, pp 377391 Dolenc VV, Kregar T, Ferluga M, et al: Treatment of tumors invading the cavernous sinus, in Dolenc VV (ed): The Cavernous Sinus. A Multidisciplinary Approach to Vascular and Tumorous Lesions. Vienna: Springer-Verlag, 1987, pp 377–391

    • Search Google Scholar
    • Export Citation
  • 4.

    Engenhart R, , Kimmig BN, & Höver KH, et al: Stereotactic single high dose radiation therapy of benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 19:10211026, 1990 Engenhart R, Kimmig BN, Höver KH, et al: Stereotactic single high dose radiation therapy of benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 19:1021–1026, 1990

    • Search Google Scholar
    • Export Citation
  • 5.

    Fukuoka S, , Oka K, & Seo Y, et al: Apoptosis following gamma knife radiosurgery in a case of acoustic schwannoma. Stereotact Funct Neurosurg 70 (Suppl 1):8894, 1998 Fukuoka S, Oka K, Seo Y, et al: Apoptosis following gamma knife radiosurgery in a case of acoustic schwannoma. Stereotact Funct Neurosurg 70 (Suppl 1):88–94, 1998

    • Search Google Scholar
    • Export Citation
  • 6.

    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 (Suppl 1):2329, 1993 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 (Suppl 1):23–29, 1993

    • Search Google Scholar
    • Export Citation
  • 7.

    Girkin CA, , Comey CH, & Lunsford LD, et al: Radiation optic neuropathy after stereotactic radiosurgery. Ophthalmology 104:16341643, 1997 Girkin CA, Comey CH, Lunsford LD, et al: Radiation optic neuropathy after stereotactic radiosurgery. Ophthalmology 104:1634–1643, 1997

    • Search Google Scholar
    • Export Citation
  • 8.

    Goldsmith BJ, , Wara WM, & Wilson CB, et al: Postopertative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 80:195201, 1994 Goldsmith BJ, Wara WM, Wilson CB, et al: Postopertative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 80:195–201, 1994

    • Search Google Scholar
    • Export Citation
  • 9.

    Kida Y, , Kobayashi T, & Tanaka T, et al: [Stereotactic radiosurgery for intracranial meningiomas.] No Shinkei Geka 22:621626, 1994 (Jpn) Kida Y, Kobayashi T, Tanaka T, et al: [Stereotactic radiosurgery for intracranial meningiomas.] No Shinkei Geka 22:621–626, 1994 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 10.

    Kondziolka D, , Lunsford LD, & Coffey RJ, et al: Stereotactic radiosurgery of meningiomas. J Neurosurg 74:552559, 1991 Kondziolka D, Lunsford LD, Coffey RJ, et al: Stereotactic radiosurgery of meningiomas. J Neurosurg 74:552–559, 1991

    • Search Google Scholar
    • Export Citation
  • 11.

    Leber KA, , Berglöff J, & Pendl G: Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 88:4350, 1998 Leber KA, Berglöff J, Pendl G: Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 88:43–50, 1998

    • Search Google Scholar
    • Export Citation
  • 12.

    Pollock BE, , Kondziolka D, & Lunsford LD, et al: Stereotactic radiosurgery for pituitary adenomas: imaging, visual and endocrine results. Acta Neurochir Suppl 62:3338, 1994 Pollock BE, Kondziolka D, Lunsford LD, et al: Stereotactic radiosurgery for pituitary adenomas: imaging, visual and endocrine results. Acta Neurochir Suppl 62:33–38, 1994

    • Search Google Scholar
    • Export Citation
  • 13.

    Sekhar LN, , Swamy NKS, & Jaiswal V, et al: Surgical excision of meningiomas involving the clivus: preoperative and intraoperative features as predictors of postoperative functional deterioration. J Neurosurg 81:860868, 1994 Sekhar LN, Swamy NKS, Jaiswal V, et al: Surgical excision of meningiomas involving the clivus: preoperative and intraoperative features as predictors of postoperative functional deterioration. J Neurosurg 81:860–868, 1994

    • Search Google Scholar
    • Export Citation
  • 14.

    Shaw EG, , Coffey RJ, & Dinapoli RP: Neurotoxicity of radiosurgery. Semin Radiat Oncol 5:235245, 1995 Shaw EG, Coffey RJ, Dinapoli RP: Neurotoxicity of radiosurgery. Semin Radiat Oncol 5:235–245, 1995

    • Search Google Scholar
    • Export Citation
  • 15.

    Steiner L, , Lindquist C, & Steiner M: Meningiomas and gamma knife radiosurgery, in Al-Mefty O (ed): Meningiomas. New York: Raven Press, 1991, pp 263272 Steiner L, Lindquist C, Steiner M: Meningiomas and gamma knife radiosurgery, in Al-Mefty O (ed): Meningiomas. New York: Raven Press, 1991, pp 263–272

    • Search Google Scholar
    • Export Citation
  • 16.

    Subach BR, , Lunsford LD, & Konziolka D, et al: Management of petroclival meningiomas by stereotactic radiosurgery. Neurosurgery 42:437445, 1998 Subach BR, Lunsford LD, Konziolka D, et al: Management of petroclival meningiomas by stereotactic radiosurgery. Neurosurgery 42:437–445, 1998

    • Search Google Scholar
    • Export Citation
  • 17.

    Thompson BG, , Coffey RJ, & Flickinger JC, et al: Stereotactic radiosurgery of small intracranial tumors: neuropathological correlation in three patients. Surg Neurol 33:96104, 1990 Thompson BG, Coffey RJ, Flickinger JC, et al: Stereotactic radiosurgery of small intracranial tumors: neuropathological correlation in three patients. Surg Neurol 33:96–104, 1990

    • Search Google Scholar
    • Export Citation
  • 18.

    Tishler RB, , Loeffler JS, & Lunsford LD, et al: Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27:215221, 1993 Tishler RB, Loeffler JS, Lunsford LD, et al: Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27:215–221, 1993

    • Search Google Scholar
    • Export Citation
  • 19.

    Urie MM, , Fullerton B, & Tatsuzaki H, et al: A dose response analysis of injury to cranial nerves and/or nuclei following proton beam radiation therapy. Int J Radiat Oncol Biol Phys 23:2739, 1992 Urie MM, Fullerton B, Tatsuzaki H, et al: A dose response analysis of injury to cranial nerves and/or nuclei following proton beam radiation therapy. Int J Radiat Oncol Biol Phys 23:27–39, 1992

    • Search Google Scholar
    • Export Citation
  • 20.

    Valentino V, , Schinaia G, & Raimondi AJ: The role of radiosurgical management of 72 middle fossa meningiomas. Acta Neurochir 122:6070, 1993 Valentino V, Schinaia G, Raimondi AJ: The role of radiosurgical management of 72 middle fossa meningiomas. Acta Neurochir 122:60–70, 1993

    • Search Google Scholar
    • Export Citation

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