Gamma Knife Radiosurgery for Cavernous Sinus Meningiomas: Analysis of Outcome in 166 Patients

Azar, Maziar; Kazemi, Farid; Jahanbakhshi, Amin; Chanideh, Iran; Jalessi, Maryam; Amini, Elahe; Geraily, Ghazale; Farhadi, Mohammad

doi:10.1159/000478024

Cited by 22 publications

(15 citation statements)

References 34 publications

(74 reference statements)

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“…The clinical outcome evaluated in our study was RFS, considered the most appropriate method for tumor growth assessment (Machado et al 2010;Rose et al 2015;Azar et al 2017). Our RFS mean time was 62 months, similar to that found in other series, from 47 to 57 months (Mansouri et al 2008;Nowak et al 2015;Hua et al 2018).…”

Section: Discussionsupporting

confidence: 83%

Preoperative hematological inflammatory markers associated with grade and survival in Meningiomas

et al. 2022

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Meningiomas represent the most frequently diagnosed intracranial tumors. Inflammatory cells present in the tumor can modulate both antitumor and protumor functions, and modify the therapeutic response. Hematological inflammatory parameters have provided prognostic information useful in the treatment and clinical evaluation of several tumors. The aim of this study was to evaluate preoperative hematological markers of patients with meningiomas and to relate them to clinical variables and recurrence-regrowth free survival. Eighty-nine patients without corticosteroid therapy were included. Blood test results and tumor characteristics were collected from medical records. Associations between clinical characteristics and the recurrence-regrowth free survival (RFS) were evaluated using Cox proportional hazard analysis and Kaplan-Meier curves. The receiver operating characteristic (ROC) curves were constructed. Of the 89 cases, 73 (82%) were grade I and 16 (18%) grade II. The mean age was 53 ± 13.9 years, with higher frequency in women. Anemia was observed in 23.6% and neutrophilia in 42% of the patients. In univariate analysis, anemia (p = 0.04), neutrophilia (p = 0.02) and neutrophil/lymphocyt ratio (NLR) (p = 0.02) were associated with an increased risk of recurrence-regrowth and shorter RFS. In multivariate analysis, anemia and NLR > 4.1 represented a higher risk of recurrence-regrowth (p = 0.003). The ROC curve analysis showed that only the lymphocyte/monocyte (L/M) > 2.5 was able to predict the tumor grade. The preoperative presence of anemia, neutrophilia, NLR > 4.1 and L/M > 2.5 were associated with a worse prognosis in meningiomas. The use of preoperative hematological inflammatory parameters as prognostic factors can be promissing for evaluation and follow-up of meningiomas.

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Section: Discussionsupporting

confidence: 83%

Preoperative hematological inflammatory markers associated with grade and survival in Meningiomas

et al. 2022

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“…The patient with a meningioma invading the cavernous sinus experienced trigeminal pain relief after SRS, but the pain increased three months later. Several reports have documented an increase in trigeminal pain after treatment [9,[20][21][22]. During the last follow-up, both patients had stable diseases (RECIST III).…”

Section: Discussionmentioning

confidence: 80%

Visual Symptoms Outcomes in Cavernous Sinus Radiosurgery and a Systematic Review

Moreira¹,

Barahona²,

Ramirez³

et al. 2022

Cureus

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IntroductionThe complex anatomy of the cavernous sinus confers a true challenge when it comes to safe tumor resection. Due to its non-invasive nature, stereotactic radiosurgery (SRS) is expected to have lower mortality and morbidity rates than microsurgery. The purpose of this study was to evaluate clinical results regarding visual symptoms after SRS for benign tumors invading the cavernous sinus. We also conducted a systematic literature review to provide a robust analysis regarding visual outcomes. MethodsThe study included 58 patients (43 women and 15 men; mean age: 52 years) with benign tumors invading the cavernous sinus (27 pituitary adenomas and 31 meningiomas) who underwent SRS with different platforms between August 2011 and December 2021. Of these, 26 patients underwent surgery before SRS, and the remaining 32 had SRS as first-line therapy. We identified symptoms involving cranial nerves (CN) II, III, IV, and VI in 38 patients at the time of SRS. We conducted a systematic review to identify all original studies assessing visual outcomes. We searched PubMed, the Latin American and Caribbean Health Sciences Literature index, and Google Scholar using the Medical Subject Heading search terms "radiosurgery" and "cavernous sinus" for valid studies published until January 31, 2022. ResultsRegarding pituitary adenomas, median tumor volume was 2.05 cc, 3.12 cc, and 2.39 cc for Gamma Knife (GK), CyberKnife (CK), and tomotherapy (Tomo), respectively. Median doses were 14 Gy for GK, 17 Gy for CK, and 15 Gy for Tomo. For meningiomas, median tumor volume was 10.2 cc, 2.62 cc, and 16.3 cc for GK, CK, and Tomo, respectively. The median dose was 14 Gy for GK, 14 Gy for CK, and 14.5 Gy for Tomo. The overall tumor control rate was 100% with a median follow-up of 33 months (range: 6-128 months). A reduction of >30% in total tumor size per the Response Evaluation Criteria in Solid Tumors (RECIST) classification was documented in seven patients (RECIST II; 12.1%), 51 patients (87.9%) had stable disease (RECIST III), and no increase in tumor volume was documented in any patient. Visual symptoms improved in 51.7% of patients. In the systematic review, the mean visual improvement was 36% (range: 25.8-42.5%). ConclusionSRS is an effective treatment for benign tumors invading the cavernous sinus. In this series, patients who underwent SRS as a primary treatment showed improvement in pre-existing cranial neuropathy and visual symptoms. Given the natural history of these tumors, which tend to grow and cause visual alternations, treating asymptomatic patients is a feasible approach worth considering for the appropriate patients.

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“…A total of 58 articles did not present enough data to meet the inclusion criteria. There were 12 articles included in our review ( Figure 4 ) [ 4 , 7 , 8 , 9 , 10 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. After noticing that some articles came from the same institution, we decided to renounce doing a meta-analysis because of the bias induced by duplicates between studies.…”

Section: Resultsmentioning

confidence: 99%

STA-MCA Bypass in Carotid Stenosis after Radiosurgery for Cavernous Sinus Meningioma

Corniola

König

Meling

2021

Cancers

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Background: Cavernous sinus meningiomas (CSM) are mostly non-surgical tumors. Stereotactic radiosurgery (SRS) or radiotherapy (SRT) allow tumor control and improvement of pre-existing cranial nerve (CN) deficits. We report the case of a patient with radiation-induced internal carotid artery (ICA) stenosis. We complete the picture with a review of the literature of vascular and non-vascular complications following the treatment of CSMs with SRS or SRT. Methods: After a case description, a systematic literature review is presented, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2015 guidelines. Results: 115 abstracts were screened and 70 titles were retained for full-paper screening. A total of 58 articles did not meet the inclusion criteria. There were 12 articles included in our review, with a follow-up ranging from 33 to 120 months. Two cases of post-SRT ischemic stroke and one case of asymptomatic ICA stenosis were described. Non-vascular complications were reported in all articles. Conclusion: SRS and SRT carry fewer complications than open surgery, with similar rates of tumor control. Our case shows the importance of a follow-up of irradiated CSMs not only by a radio-oncologist, but also by a neurosurgeon, illustrating the importance of multidisciplinary management of CSMs.

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Gamma Knife Radiosurgery for Cavernous Sinus Meningiomas: Analysis of Outcome in 166 Patients

Cited by 22 publications

References 34 publications

Preoperative hematological inflammatory markers associated with grade and survival in Meningiomas

Preoperative hematological inflammatory markers associated with grade and survival in Meningiomas

Visual Symptoms Outcomes in Cavernous Sinus Radiosurgery and a Systematic Review

STA-MCA Bypass in Carotid Stenosis after Radiosurgery for Cavernous Sinus Meningioma

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