Gamma Knife Radiosurgery for Benign Cavernous Sinus Tumors: Quantitative Analysis of Treatment Outcomes

Kuo, John S.; Chen, Joseph C.T.; Yu, Cheng; Zelman, Vladimir; Giannotta, Steven L.; Petrovich, Zbigniew; MacPherson, Dana M.; Apuzzo, Michael L.J.

doi:10.1227/01.neu.0000124750.13721.94

Cited by 107 publications

(58 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…External-beam radiation therapy 2,11,32,35,36,38,53,55 as well as stereotactic radiosurgery [3][4][5][6]12,14,[16][17][18][19][20]22,26,27,30,31,33,34,37,40,41,[43][44][45][46]48,54,58,60,61,63,64 have become viable adjuvant treatment as well as primary treatment modalities for many meningiomas. Their use is supported by high rates of tumor control and a low incidence of complications.…”

mentioning

confidence: 99%

Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival

Williams¹,

Yen²,

Starke³

et al. 2011

JNS

View full text Add to dashboard Cite

Object. Stereotactic radiosurgery serves as an important primary and adjuvant treatment option for patients with many types of intracranial meningiomas. This is particularly true for patients with parasellar meningiomas. In this study, the authors evaluated the outcomes of Gamma Knife surgery (GKS) used to treat parasellar meningiomas.Methods. The study is a retrospective review of the outcomes in 138 patients with meningiomas treated at the University of Virginia from 1989 to 2006; all patients had a minimum follow-up of 24 months. There were 31 men and 107 women whose mean age was 54 years (range 19-85 years). Eighty-four patients had previously undergone resection. The mean pre-GKS tumor volume was 7.5 ml (range 0.2-54.8 ml). Clinical and radiographic evaluations were performed, and factors related to favorable outcomes in each case were assessed.Results. The mean follow-up duration was 84 months (median 75.5 months, range 24-216 months). In 118 patients (86%), the tumor volume was unchanged or had decreased at last follow-up. Kaplan-Meier analysis demonstrated radiographic progression-free survival at 5 and 10 years to be 95.4% and 69%, respectively. Fourteen patients (10%) developed new cranial nerve palsies following GKS. Factors associated with tumor control included younger age, a higher isodose, and smaller tumor volume. A longer follow-up duration was associated with either a decrease or increase in tumor volume. Fourteen patients (10%) experienced new or worsening cranial nerve deficits after treatment. Factors associated with this occurrence were larger pretreatment tumor volume, lower peripheral radiation dose, lower maximum dose, tumor progression, and longer follow-up.Conclusions. Gamma Knife surgery offers an acceptable rate of tumor control for parasellar meningiomas and accomplishes this with a low incidence of neurological deficits. Radiological control after radiosurgery is more likely in those patients with a smaller tumor volume and a higher prescription dose. (DOI: 10.3171/2011.1.JNS091939) keY WorDs • stereotactic radiosurgery • parasellar meningioma • skull base • cavernous sinus 1571Abbreviations used in this paper: GKS = Gamma Knife surgery; PFS = progression-free survival.

show abstract

mentioning

confidence: 99%

Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival

Williams¹,

Yen²,

Starke³

et al. 2011

JNS

View full text Add to dashboard Cite

show abstract

“…Kuo et al 4) reported the results of gamma knife radiosurgery for the treatment of 139 patients having benign cavernous sinus tumors with median follow-up of 3.5 years. They suggested that the gamma knife is a safe and effective treatment for selected patients with benign cavernous sinus tumors and is an important adjunct for treating residual and/or recurrent postoperative tumor.…”

Section: Discussionmentioning

confidence: 99%

“…The transcranial extradural or intradural approaches do not provide better visualization, and also increase the operative trauma and postoperative complications. 2,9,10,14,27) Recently, developments and refinements of endoscopic-assisted techniques have lead to use in the treatment of adenomas infiltrating the cavernous sinus, 1,4) but no larger series or long-term follow-up periods have been reported. 24) Remnant tumors may be resistant to medical therapy or the financial burden may be unacceptable.…”

Section: Introductionmentioning

confidence: 99%

Oblique Transsphenoethmoidal Approach to the Cavernous Sinus

Gnjidić¹,

Sajko

Malenica

et al. 2008

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Pituitary adenomas frequently invade the cavernous sinus. The standard transsphenoidal approach does not provide satisfactory visualization of the cavernous sinus structures. The transcranial approach has no advantages, and increases the operative trauma and complications. The oblique transsphenoethmoidal approach, a modified standard transsphenoidal approach, was used to treat 19 patients with pituitary adenomas invading the cavernous sinus. Complete tumor removal was achieved in 15 patients and subtotal removal in 4 patients. The patients tolerated this modified transsphenoethmoidal approach well and the postoperative results were satisfactory. Although the number of patients was too small to allow any statistical analysis, the results, compared with other series, are encouraging.

show abstract

“…65 As part of a multimodality strategy for patients with residual cavernous sinus disease, many patients will undergo postoperative adjunctive treatment with medical therapy, radiosurgery, or both. 15,38,56 In a minority of cases, sellar region tumors demonstrate evidence of more pronounced lateral extension, beyond the lateral cavernous sinus membrane, and into the middle fossa (Fig. 5).…”

Section: Lateral Extension Beyond the Cavernous Sinusmentioning

confidence: 99%

Defining the “edge of the envelope”: patient selection in treating complex sellar-based neoplasms via transsphenoidal versus open craniotomy

Zada¹,

Du²,

Laws³

2011

JNS

116

View full text Add to dashboard Cite

Since the reemergence of the transsphenoidal approach as a primary means of accessing and resecting sellar region tumors in the 1960s by Hardy and Guiot, several key advances have improved the ability to safely treat patients with larger and increasingly complex tumors of the anterior and middle skull base. 28,43 In particular, the operating microscope, extended transsphenoidal approaches, advanced neuroimaging, intraoperative neuronavigation, and neuroendoscopy have collectively improved the ability to safely treat many of these lesions. The evolution of extended transsphenoidal approaches and endoscopic instrumentation has facilitated surgical access to lesions of the midline skull base via natural corridors, along a wide arc from the frontal sinus to the odontoid process. 9,31,34,53 Equally important are recent developments in effectively reconstructing the skull base after tumor resection, thereby reducing the incidence of CSF leakage and associated infection, which has traditionally been one of the major pitfalls associated with transsphenoidal and related skull base approaches.As the subspecialty of endoscopic skull base surgery continues to "push the edge of the envelope" in regard to the spectrum of lesions that can be effectively and safely treated, the key limitations to the types and extent of tumor pathology that can be optimally resected via these approaches must be continuously reassessed. In some instances, these limitations are inherent to an individual tumor's biology and pose a surgical challenge regardless of the operative approach that is undertaken. Nevertheless, patient selection remains of paramount importance Results. Thirteen cases exemplifying some of the existing limitations to achieving optimal surgical outcomes via transsphenoidal-based approaches are presented. The following 8 factors are separately discussed that repeatedly limited the extent of resection, increased the risk of the operation, and contributed to perioperative complications: significant suprasellar extension, lateral extension, retrosellar extension, brain invasion with edema, firm tumor consistency, involvement or vasospasm of the arteries of the circle of Willis, and encasement of the optic apparatus or invasion of the optic foramina.Conclusions. Although the ability to approach and resect complex tumors using endonasal skull base techniques has evolved dramatically in recent years, several inherent tumor characteristics mandate extensive preoperative consideration. In selected cases these characteristics may lend support to selecting an open craniotomy as the initial operation. (DOI: 10.3171/2010.8.JNS10520) Key words • transsphenoidal approach • endoscopic surgery • skull base surgery • pituitary adenoma • meningioma • craniopharyngioma • invasionAbbreviations used in this paper: ACA = anterior cerebral artery; DI = diabetes insipidus; EBRT = external-beam radiation therapy; FSH = follicle-stimulating hormone; GTR = gross-total resection; ICA = internal carotid artery; PBRT = proton-beam radiation therapy; P...

show abstract

Gamma Knife Radiosurgery for Benign Cavernous Sinus Tumors: Quantitative Analysis of Treatment Outcomes

Cited by 107 publications

References 18 publications

Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival

Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival

Oblique Transsphenoethmoidal Approach to the Cavernous Sinus

Defining the “edge of the envelope”: patient selection in treating complex sellar-based neoplasms via transsphenoidal versus open craniotomy

Contact Info

Product

Resources

About