Gamma knife radiosurgery in the management of cavernous sinus meningiomas

View More View Less
  • 1 Service de Neurochirurgie, CH St. Marguerite; Service de Neurochirurgie Fonctionnelle et Stéréotaxique, Service de Neurochirurgie, CH la Timone, Marseille; and Service de Neurochirurgie, CH Larrey, Angers, France
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object. The authors sought to assess the functional tolerance and tumor control rate of cavernous sinus meningiomas treated by gamma knife radiosurgery (GKS).

Methods. Between July 1992 and October 1998, 92 patients harboring benign cavernous sinus meningiomas underwent GKS. The present study is concerned with the first 80 consecutive patients (63 women and 17 men). Gamma knife radiosurgery was performed as an alternative to surgical removal in 50 cases and as an adjuvant to microsurgery in 30 cases. The mean patient age was 49 years (range 6–71 years). The mean tumor volume was 5.8 cm3 (range 0.9–18.6 cm3). On magnetic resonance (MR) imaging the tumor was confined in 66 cases and extensive in 14 cases. The mean prescription dose was 28 Gy (range 12–50 Gy), delivered with an average of eight isocenters (range two–18). The median peripheral isodose was 50% (range 30–70%). Patients were evaluated at 6 months, and at 1, 2, 3, 5, and 7 years after GKS.

The median follow-up period was 30.5 months (range 12–79 months). Tumor stabilization after GKS was noted in 51 patients, tumor shrinkage in 25 patients, and enlargement in four patients requiring surgical removal in two cases. The 5-year actuarial progression-free survival was 92.8%. No new oculomotor deficit was observed. Among the 54 patients with oculomotor nerve deficits, 15 improved, eight recovered, and one worsened. Among the 13 patients with trigeminal neuralgia, one worsened (contemporary of tumor growing), five remained unchanged, four improved, and three recovered. In a patient with a remnant surrounding the optic nerve and preoperative low vision (3/10) the decision was to treat the lesion and deliberately sacrifice the residual visual acuity. Only one transient unexpected optic neuropathy has been observed. One case of delayed intracavernous carotid artery occlusion occurred 3 months after GKS, without permanent deficit. Another patient presented with partial complex seizures 18 months after GKS. All cases of tumor growth and neurological deficits observed after GKS occurred before the use of GammaPlan. Since the initiation of systematic use of stereotactic MR imaging and computer-assisted modern dose planning, no more side effects or cases of tumor growth have occurred.

Conclusions. Gamma knife radiosurgery was found to be an effective low morbidity—related tool for the treatment of cavernous sinus meningioma. In a significant number of patients, oculomotor functional restoration was observed. The treatment appears to be an alternative to surgical removal of confined enclosed cavernous sinus meningioma and should be proposed as an adjuvant to surgery in case of extensive meningiomas.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Jean Régis, M.D., Service de Neurochirurgie Fonctionnelle et Stéréotaxique, CHU la Timone, 264 Boulevard Saint Pierre, 13385 Marseille Cedex 05, France. email: jregis@ap-hm.fr.
  • 1.

    Chang JW, , Kim SH, & Huh R, et al. : The effects of stereotactic radiosurgery on secondary facial pain. Stereotact Funct Neurosurg 72 (Suppl 1):2937, 1999 Chang JW, Kim SH, Huh R, et al: The effects of stereotactic radiosurgery on secondary facial pain. Stereotact Funct Neurosurg 72 (Suppl 1):29–37, 1999

    • Search Google Scholar
    • Export Citation
  • 2.

    Chang SD, & Adler JR: Treatment of cranial base meningiomas with linear accelerator radiosurgery. Neurosurgery 41:10191127, 1997 Chang SD, Adler JR: Treatment of cranial base meningiomas with linear accelerator radiosurgery. Neurosurgery 41:1019–1127, 1997

    • Search Google Scholar
    • Export Citation
  • 3.

    De Jesus O, , Sekhar LN, & Parikh HK, et al. : Long-term follow-up of patients with meningiomas involving the cavernous sinus: recurrence, progression, and quality of life. Neurosurgery 39 915920, 1996 De Jesus O, Sekhar LN, Parikh HK, et al: Long-term follow-up of patients with meningiomas involving the cavernous sinus: recurrence, progression, and quality of life. Neurosurgery 39 915–920, 1996

    • Search Google Scholar
    • Export Citation
  • 4.

    Demonte F, , Smith HK, & Al-Mefty O: Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 81:245251, 1994 Demonte F, Smith HK, Al-Mefty O: Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 81:245–251, 1994

    • Search Google Scholar
    • Export Citation
  • 5.

    Dolenc VV, , Kregar T, & Ferluga M, et al. : Treatment of tumors invading the cavernous sinus, in Dolenc V (ed): The Cavernous Sinus, a Multidisciplinary Approach to Vascular and Tumourous Lesions. New York: Springer-Verlag, 1987, pp 376391 Dolenc VV, Kregar T, Ferluga M, et al: Treatment of tumors invading the cavernous sinus, in Dolenc V (ed): The Cavernous Sinus, a Multidisciplinary Approach to Vascular and Tumourous Lesions. New York: Springer-Verlag, 1987, pp 376–391

    • Search Google Scholar
    • Export Citation
  • 6.

    Duma CM, , Lunsford LD, & Kondziolka D, et al. : Stereotactic radiosurgery of cavernous sinus meningiomas as an addition or alternative to microsurgery. Neurosurgery 32:699705, 1993 Duma CM, Lunsford LD, Kondziolka D, et al: Stereotactic radiosurgery of cavernous sinus meningiomas as an addition or alternative to microsurgery. Neurosurgery 32:699–705, 1993

    • Search Google Scholar
    • Export Citation
  • 7.

    Goldsmith BJ, , Wara WM, & Wilson CB, et al. : Postoperative 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: Postoperative 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
  • 8.

    Hakim R, , Alexander E, & Loeffler JS, et al. : Results of linear accelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 42:446454, 1998 Hakim R, Alexander E, Loeffler JS, et al: Results of linear accelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 42:446–454, 1998

    • Search Google Scholar
    • Export Citation
  • 9.

    Knosp E, , Perneczky A, & Koos W, et al. : Meningiomas of the space of the cavernous sinus. Neurosurgery 38:434444, 1996 Knosp E, Perneczky A, Koos W, et al: Meningiomas of the space of the cavernous sinus. Neurosurgery 38:434–444, 1996

    • Search Google Scholar
    • Export Citation
  • 10.

    Kondziolka D, , Levy El, & Niranjan A, et al. : Long-term outcomes after meningioma radiosurgery: physician and patient perspectives. J Neurosurg 91:4450, 1999 Kondziolka D, Levy El, Niranjan A, et al: Long-term outcomes after meningioma radiosurgery: physician and patient perspectives. J Neurosurg 91:44–50, 1999

    • Search Google Scholar
    • Export Citation
  • 11.

    Leber KA, , Bergloff 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, Bergloff 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.

    Lim YJ, , Leem W, & Park JT, et al. : Cerebral infarction with ICA occlusion after gamma knife radiosurgery for pituitary adenoma: a case report. Stereotact Funct Neurosurg 72 (Suppl 1):132139, 1999 Lim YJ, Leem W, Park JT, et al: Cerebral infarction with ICA occlusion after gamma knife radiosurgery for pituitary adenoma: a case report. Stereotact Funct Neurosurg 72 (Suppl 1):132–139, 1999

    • Search Google Scholar
    • Export Citation
  • 13.

    Liscak R, , Simonova G, & Vyzamal J, et al. : Gamma knife radiosurgery of meningiomas in the cavernous sinus region. Acta Neurochir 141:473480, 1999 Liscak R, Simonova G, Vyzamal J, et al: Gamma knife radiosurgery of meningiomas in the cavernous sinus region. Acta Neurochir 141:473–480, 1999

    • Search Google Scholar
    • Export Citation
  • 14.

    Mathiesen T, , Lindquist C, & Kihlström L, et al. : Recurrence of cranial base meningiomas. Neurosurgery 39:29, 1996 Mathiesen T, Lindquist C, Kihlström L, et al: Recurrence of cranial base meningiomas. Neurosurgery 39:2–9, 1996

    • Search Google Scholar
    • Export Citation
  • 15.

    Morita A, , Coffey RJ, & Foote RL, et al. : Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients. J Neurosurg 90:4249, 1999 Morita A, Coffey RJ, Foote RL, et al: Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients. J Neurosurg 90:42–49, 1999

    • Search Google Scholar
    • Export Citation
  • 16.

    Nutting C, , Brada M, & Brazil L, et al. : Radiotherapy in the treatment of benign meningioma of the skull base. J Neurosurg 90:823827, 1999 Nutting C, Brada M, Brazil L, et al: Radiotherapy in the treatment of benign meningioma of the skull base. J Neurosurg 90:823–827, 1999

    • Search Google Scholar
    • Export Citation
  • 17.

    O'Connor MM, & Mayberg MR: Effects of radiation on cerebral vasculature: a review. Neurosurgery 46:138151, 2000 O'Connor MM, Mayberg MR: Effects of radiation on cerebral vasculature: a review. Neurosurgery 46:138–151, 2000

    • Search Google Scholar
    • Export Citation
  • 18.

    Pendl G, , Schröttner O, & Eustacchio S, et al. : Cavernous sinus meningiomas. What is the strategy: upfront or adjuvant gamma knife surgery? Stereotact Funct Neurosurg 70 (Suppl 1):3340, 1998 Pendl G, Schröttner O, Eustacchio S, et al: Cavernous sinus meningiomas. What is the strategy: upfront or adjuvant gamma knife surgery? Stereotact Funct Neurosurg 70 (Suppl 1):33–40, 1998

    • Search Google Scholar
    • Export Citation
  • 19.

    Sekhar LN, , Ross DA, & Sen CN: Cavernous sinus and sphenocavernous neoplasms: anatomy and surgery, in Sekhar LN, & Janecka IP (eds): Surgery of Cranial Base Tumors. New York: Raven Press, 1993, pp 521604 Sekhar LN, Ross DA, Sen CN: Cavernous sinus and sphenocavernous neoplasms: anatomy and surgery, in Sekhar LN, Janecka IP (eds): Surgery of Cranial Base Tumors. New York: Raven Press, 1993, pp 521–604

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 321 175 34
Full Text Views 41 15 2
PDF Downloads 29 11 3
EPUB Downloads 0 0 0