Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas

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Object. The long-term outcome of stereotactic radiosurgery for cavernous sinus (CS) meningiomas is not fully understood. The authors retrospectively reviewed their experience with 40 CS meningiomas treated with gamma knife radiosurgery.

Methods. Follow-up periods for the 40 patients ranged from 12 to 123 months (median 42 months), and the overall tumor control rates were 86.4% at 3 years and 82.3% at 10 years. Factors associated with tumor recurrence in univariate analysis were histological malignancy (p < 0.0001), partial treatment (p < 0.0001), suprasellar tumor extension (p = 0.0201), or extension in more than three directions outside the CS (p = 0.0345). When the tumor was completely covered with a dose to the margin that was higher than 14 Gy (Group A, 22 patients), no patient showed recurrence within the median follow-up period of 37 months. On the other hand, when a part of the tumor was treated with 10 to 12 Gy (Group B, 15 patients) or did not receive radiation therapy (Group C, three patients), the recurrence rates were 20% and 100%, respectively. Neurological deterioration was seen in nine patients, but all symptoms were transient or very mild.

Conclusions. The data indicate that stereotactic radiosurgery can control tumor growth if the whole mass can be irradiated by dosages of more than 14 Gy. When optimal radiosurgical planning is not feasible because of a tumor's large size, irregular shape, or proximity to visual pathways, use of limited surgical resection before radiosurgery is the best option and should provide sufficient long-term tumor control with minimal complications.

Article Information

Address reprint requests to: Masahiro Shin, M.D., Department of Neurosurgery, University of Tokyo Hospital, 7–3–1 Hongo, Bunkyo-ku, Tokyo, 113–8655 Japan. email: shinmasa@ka2.so-net.ne.jp.

© AANS, except where prohibited by US copyright law.

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Figures

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    Kaplan—Meier plot of the actuarial progression-free survival after GKS for CS meningiomas.

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    Pretreatment and posttreatment MR images obtained in a 60-year-old woman with frequent episodes of transient diplopia. Axial (A) and coronal (B) T1-weighted MR images demonstrating a homogeneously enhanced tumor in the CS (arrows), which was diagnosed as a meningioma. C: Dose-planning MR image obtained before stereotactic radiosurgery was performed, targeting a dose of 18 Gy at the tumor margin. D: Coronal MR image of the tumor (arrow), demonstrating significant volume reduction 2 years post-GKS.

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    Neuroimages obtained in a 49-year-old woman presenting with hypesthesia and dysesthesia on the right side of her face. Axial (A) and coronal (B) T1-weighted MR images demonstrating a meningioma invading the CS bilaterally and extending into the suprasellar and petroclival regions along the tentorium. After a two-stage resection of the suprasellar and posterior cranial fossa portions of the tumor (C), stereotactic radiosurgery was performed (D). The whole tumor volume was covered within the 14-Gy isodose line, whereas the visual pathway was irradiated with less than 10 Gy. E: Three-dimensional reconstruction of the area being treated. Pink denotes brainstem; orange, optic nerves and chiasma; red, 14-Gy isodose line; and transparent yellow, 10-Gy isodose line. The patient exhibited no neurological deterioration 2 years posttreatment.

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    Pretreatment and posttreatment MR images obtained in a 26-year-old man presenting with abducent nerve palsy on his left side. A: Axial T1-weighted MR image demonstrating a meningioma in the CS extending into the posterior cranial fossa. B: Dose-planning MR image obtained after resection of the part of the tumor in the posterior cranial fossa, after which radiosurgery was performed with a dose to the tumor margin of 14 Gy. C: One year posttreatment, the symptoms resolved completely, and the tumor growth was controlled at 30 months.

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