Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas

Shin, Masahiro; Kurita, Hiroki; Sasaki, Tomio; Kawamoto, Shunsuke; Tago, Masao; Kawahara, Nobutaka; Morita, Akio; Ueki, Keisuke; Kirino, Takaaki

doi:10.3171/jns.2001.95.3.0435

Cited by 163 publications

(80 citation statements)

References 23 publications

(16 reference statements)

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“…Radiosurgery shows acceptable results of long-term tumor control and related complications for small recurrence or residual tumors. The treatment should cover the entire tumor volume with an adequately high radiation dosage to achieve a high tumor control rate (33). Therefore, if a small piece of tumor has to be left in situ, we should minify the residual tumor volume as long as possible.…”

Section: Radiosurgerymentioning

confidence: 99%

Large medial sphenoid wing meningiomas: long-term outcome and correlation with tumor size after microsurgical treatment in 127 consecutive cases

Liu

Yuan²,

Liu³

et al. 2012

Turkish Neurosurgery

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AIm:We present the long-term outcomes as well as their correlation with tumor size in 127 consecutive patients harboring large MSWM after microsurgical treatment. mATeRIAL and meTHods:The retrospective analysis of clinical data and follow-up data of 127 microsurgical treated patients with MSWM was performed. The mean maximum diameter of tumors was 5.2cm (ranged 1.5-10.0cm).ResuLTs: 104 cases (81.9%) achieved gross total resection. There was no operative mortality. Detailed follow-up data was available in 120 cases for a mean duration of 81.6 months (12-216 months). The permanent morbidity was 14.2%. The mean KPS score 1 year after surgery was 90.6 (ranged 60-100). Among 74 patients of preoperative visual acuity (VA) impairment, postoperative VA improved in 42 cases (56.8%), unchanged in 30 (40.5%), and deteriorated in 2 (2.7%). MR images revealed tumor recurrence after total resection in 10 cases (10.2%) and tumor progression after subtotal resection in 10 cases (45.5%).CoNCLusIoN: Tumor recurrence was the major risk in the long run, thus the initial surgery was extremely important and hence should be aggressive. The size of tumor affected the extent of tumor removal determining clinical outcomes including VA improvement and KPS score immediately after surgery; however, it was not correlated with long-term overall outcomes. BuLGuLAR: 104 olguda (%81,9) gros total rezeksiyon yapıldı. Operatif mortalite yoktu. Ayrıntılı takip verileri 120 olguda ortalama 81,6 ay (12-216 ay) için mevcuttu. Kalıcı morbidite %14,2 oranında görüldü. Cerrahiden 1 yıl sonra ortalama KPS skoru 90,6 (aralık 60-100) bulundu. Preoperatif görme keskinliği bozukluğu olan 74 hasta içinde postoperatif dönemde görme keskinliği 42 hastada (%56,8) arttı, 30'unda (%40,5) değişmedi ve 2'sinde (%2,7) kötüye gitti. MR görüntüleri total rezeksiyon sonrasında 10 olguda (%10,2) tümör reküransı ve subtotal rezeksiyon sonrasında 10 olguda (%45,5) tümör ilerlemesi gösterdi. soNuÇ: Uzun dönemde temel risk tümör reküransıydı ve bu nedenle ilk cerrahi çok önemlidir ve agresif olmalıdır. Tümör büyüklüğü, tümör çıkarma kapsamını etkileyerek ameliyattan hemen sonra görme keskinliği düzelmesi ve KPS skoru dahil klinik sonuçları etkiledi ancak uzun dönemli genel sonuçlarla korelasyon göstermedi.ANAHTAR sÖZCÜKLeR: Medial sfenoid kanat menenjiyomları, Tümör büyüklüğü, Tümör reküransı, İşlevsel sonuç

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Section: Radiosurgerymentioning

confidence: 99%

Large medial sphenoid wing meningiomas: long-term outcome and correlation with tumor size after microsurgical treatment in 127 consecutive cases

Liu

Yuan²,

Liu³

et al. 2012

Turkish Neurosurgery

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“…Proper combination of judicious surgical resection and radiosurgery can realize safe and effective treatment for tumors without compression of the optic apparatus or brainstem, ideally smaller than 10 cm 3 and without atypical pathological features. [37][38][39]77,89,111,128) Therefore, application of stereotactic radiosurgery for resectable lesions in supratentorial location should be carefully considered, especially if the tumors are relatively large. 87) However, stereotactic radiosurgery is a good treatment of choice for intractable skull base tumors.…”

Section: Benign Tumorsmentioning

confidence: 99%

“…The combination of mass reduction by safe surgical resection and stereotactic radiosurgery was safe and effective treatment for skullbase meningiomas. 65,77,128,137) Surgical removal of incompletely obliterated nidus after gamma knife radiosurgery for arteriovenous malformation is also a good treatment strategy because surgical resection of irradiated nidus is feasible and safe. 120) Another approach to reduce radiation-induced adverse events is dose optimization.…”

Section: Refinement Of Treatments I Treatment Strategymentioning

confidence: 99%

Role of Gamma Knife Radiosurgery in Neurosurgery: Past and Future Perspectives

Koga

Shin

Saito

2010

Neurol. Med. Chir.(Tokyo)

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The gamma knife was the first radiosurgical device developed at the Karolinska Institute in 1967. Stereotactic radiosurgery using the gamma knife has been widely accepted in clinical practice and has contributed to the development of neurosurgery. More than 500,000 patients have been treated by gamma knife stereotactic radiosurgery so far, and the method is now an indispensable neurosurgical tool. Here we review long-term outcomes and development of stereotactic radiosurgery using the gamma knife and discuss its future perspectives. The primary role of stereotactic radiosurgery is to control small well-demarcated lesions such as metastatic brain tumors, meningiomas, schwannomas, and pituitary adenomas while preserving the function of surrounding brain tissue. The gamma knife has been used as a primary treatment or in combination with surgery, and some applications have been accepted as standard treatment in the field of neurosurgery. Treatment of cerebral arteriovenous malformations has also been drastically changed after emergence of this technology. Controlling functional disorders is another role of stereotactic radiosurgery. There is a risk of radiation-induced adverse events, which are usually mild and less frequent. However, especially in large or invasive lesions, those risks are not negligible and pose limitations. Advancement of irradiation technology and dose planning software have enabled more sophisticated and safer treatment, and further progress will contribute to better treatment outcomes not only for brain lesions but also for cervical lesions with less invasive treatment.

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“…2,23,31,35) Stereotactic radiosurgery has now become a less invasive and effective treatment option for intracranial meningioma, especially in patients with high-risk tumors such as skull base lesions. 1,[11][12][13][14][15][16]18,19,21,22,26,27,30,32,34,37) Stereotactic radiosurgery provides excellent outcomes with local tumor control rates of 85-100%, but these rates tend to fall with longer follow-up periods. [11][12][13][14][15]18,19,21,26,27,30,32,34) However, recent local tumor control rates have been nearly 100% for patients who had undergone Simpson grade 1 surgery.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Radiosurgery for Skull Base Meningioma

Igaki

Maruyama

Koga

et al. 2009

Neurol. Med. Chir.(Tokyo)

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Stereotactic radiosurgery is now a treatment option for meningiomas, especially for high-risk patients such as those with skull base lesions. The clinical outcomes were retrospectively analyzed of stereotactic radiosurgery using the Leksell Gamma Knife  performed for 98 patients with 106 skull base meningiomas at the University of Tokyo Hospital between June 1990 and April 2006 and followed up for more than a year. After a median follow-up period of 53.2 months (range 12.2-204.4 months), local tumor control rates were 86.9% and 78.9% at 5 years and 10 years, respectively. Tumors with volume of 4 cm 3 or smaller (97.5% vs. 76.1% at 5 years, p ＝ 0.001) and tumors completely included within the isodose line of 14 Gy or more (97.5% vs. 67.2% at 5 years, p ＝ 0.0006) had higher local control rates. Postoperative residual tumors treated by stereotactic radiosurgery were controlled in all 25 cases. Cranial nerve deficits were improved, stable, and deteriorated in 12, 64, and 3 patients, respectively, after stereotactic radiosurgery. Stereotactic radiosurgery was effective treatment method for local control of skull base meningiomas, especially for small or postoperative residual tumors. Correct combination of microsurgery and radiosurgery leads to excellent local control.

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Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas

Cited by 163 publications

References 23 publications

Large medial sphenoid wing meningiomas: long-term outcome and correlation with tumor size after microsurgical treatment in 127 consecutive cases

Large medial sphenoid wing meningiomas: long-term outcome and correlation with tumor size after microsurgical treatment in 127 consecutive cases

Role of Gamma Knife Radiosurgery in Neurosurgery: Past and Future Perspectives

Stereotactic Radiosurgery for Skull Base Meningioma

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