Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas

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Object. To evaluate long-term outcomes of patients who have undergone stereotactic radiosurgery for cavernous sinus meningiomas, the authors retrospectively reviewed their 14-year experience with these cases.

Methods. One hundred seventy-six patients harbored meningiomas centered within the cavernous sinus. Seventeen patients were lost to follow-up review, leaving 159 analyzable patients, in whom 164 procedures were performed. Seventy-six patients (48%) underwent adjuvant radiosurgery after one or more attempts at surgical resection. Eighty-three patients (52%) underwent primary radiosurgery. Two patients (1%) had previously received fractionated external-beam radiation therapy. Four patients (2%) harbored histologically verified atypical or malignant meningiomas. Conformal multiple isocenter gamma knife surgery was performed. The median dose applied to the tumor margin was 13 Gy.

Neurological status improved in 46 patients (29%), remained stable in 99 (62%), and eventually worsened in 14 (9%). Adverse effects of radiation occurred after 11 procedures (6.7%). Tumor volumes decreased in 54 patients (34%), remained stable in 96 (60%), and increased in nine (6%). The actuarial tumor control rate for patients with typical meningiomas was 93.1 ± 3.3% at both 5 and 10 years. For the 83 patients who underwent radiosurgery as their sole treatment, the actuarial tumor control rate at 5 years was 96.9 ± 3%.

Conclusions. Stereotactic radiosurgery provided safe and effective management of cavernous sinus meningiomas. We believe it is the preferred management strategy for tumors of suitable volume (average tumor diameter ≤ 3 cm or volume ≤ 15 cm3).

Article Information

Address reprint requests to: L. Dade Lunsford, M.D., Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, Pittsburgh, Pennsylvania 15213. email: lunsford@neuronet.pitt.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Axial gadolinium-enhanced MR image demonstrating a multiple-isocenter conformal Gamma Plan for a left-sided cavernous sinus meningioma. The black line corresponds to the 50% isodose line and the gray lines indicate the 40% and 30% isodose curves, respectively.

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    Upper: Axial (left) and coronal (right) gadolinium-enhanced MR images obtained in a 44-year-old man, revealing a right-sided cavernous sinus meningioma. This lesion was treated using GKS during which 13 Gy was delivered to the tumor margin. Lower: Follow-up axial (left) and coronal (right) MR images obtained in the same patient 30 months after radiosurgery. Tumor regression is evident.

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    Left: Axial gadolinium-enhanced MR image obtained in a 53-year-old woman, revealing a meningioma in the right cavernous sinus region. This lesion was treated using GKS during which 13 Gy was delivered to the tumor margin. Right: Follow-up MR image obtained in the same patient 36 months after radiosurgery, demonstrating tumor enlargement.

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    Graph showing Kaplan—Meier survival curve for patients with typical meningiomas. The actuarial tumor control rate is 93.1 ± 3.3% at both 5 and 10 years.

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    Graph comparing Kaplan—Meier survival curves of actuarial tumor-control rates for meningiomas subjected to radiosurgery as primary treatment and as adjuvant therapy. The 5-year tumor-control rate for primary radiosurgery was 96.9 + 3% and that for adjuvant radiosurgery (including atypical and malignant meningiomas) was 79.6% + 7.1%. n = number of patients.

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