Gamma Knife surgery of meningiomas located in the posterior fossa: factors predictive of outcome and remission

Starke, Robert M.; Nguyen, James; Rainey, Jessica; Williams, Brian J.; Sherman, Jonathan H.; Savage, Jesse J.; Yen, Chun Po; Sheehan, Jason P.

doi:10.3171/2010.11.jns101193

Cited by 60 publications

(65 citation statements)

References 83 publications

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“…Importantly, the authors in that study reported tumor control rates of 95%, 92%, and 81% at 3, 5, and 10 years after radiosurgery, respectively. 20,22 Similarly, we found that GKRS as the initial treatment for small, mildly symptomatic lesions as well as recurrent or progressive tumors resulted in excellent disease control, and no patient treated initially with GKRS experienced progression over the follow-up period. Low rates of progression/recurrence suggest that longterm disease control for these low-grade lesions is possible with the outlined treatment algorithm, even in the setting of STR, and supports the goal of preserving neurological function whenever possible to maximize patient quality of life.…”

Section: 25mentioning

confidence: 82%

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

D’Amico¹,

Banu²,

Petridis³

et al. 2017

Journal of Neurosurgery

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ABBREVIATIONS CN = cranial nerve; CPA = cerebellopontine angle; EMG = electromyography; EOR = extent of resection; GKRS = Gamma Knife radiosurgery; GTR = gross-total resection; IAC = internal auditory canal; STR = subtotal resection; TTP = time to progression. SUBMITTED August 3, 2016 OBJECTIVE Advanced microsurgical techniques contribute to reduced morbidity and improved surgical management of meningiomas arising within the cerebellopontine angle (CPA). However, the goal of surgery has evolved to preserve the quality of the patient's life, even if it means leaving residual tumor. Concurrently, Gamma Knife radiosurgery (GKRS) has become an acceptable and effective treatment modality for newly diagnosed, recurrent, or progressive meningiomas of the CPA. The authors review their institutional experience with CPA meningiomas treated with GKRS, surgery, or a combination of surgery and GKRS. They specifically focus on rates of facial nerve preservation and characterize specific anatomical features of tumor location with respect to the internal auditory canal (IAC). METHODS Medical records of 76 patients with radiographic evidence or a postoperative diagnosis of CPA meningioma, treated by a single surgeon between 1992 and 2016, were retrospectively reviewed. Patients with CPA meningiomas smaller than 2.5 cm in greatest dimension were treated with GKRS, while patients with tumors 2.5 cm or larger underwent facial nerve-sparing microsurgical resection where appropriate. Various patient, clinical, and tumor data were gathered. Anatomical features of the tumor origin as seen on preoperative imaging confirmed by intraoperative investigation were evaluated for prognostic significance. Facial nerve preservation rates were evaluated. RESULTS According to our treatment paradigm, 51 (67.1%) patients underwent microsurgical resection and 25 (32.9%) patients underwent GKRS. Gross-total resection (GTR) was achieved in 34 (66.7%) patients, and subtotal resection (STR) in 17 (33.3%) patients. Tumors recurred in 12 (23.5%) patients initially treated surgically, requiring additional surgery and/or GKRS. Facial nerve function was unchanged or improved in 68 (89.5%) patients. Worsening facial nerve function occurred in 8 (10.5%) patients, all of whom had undergone microsurgical resection. Upfront treatment with GKRS for CPA meningiomas smaller than 2.5 cm was associated with preservation of facial nerve function in all patients over a median follow-up of 46 months, regardless of IAC invasion and tumor origin. Anatomical origin was associated with extent of resection but did not correlate with postoperative facial nerve function. Tumor size, extent of resection, and the presence of an arachnoid plane separating the tumor and the contents of the IAC were associated with postoperative facial nerve outcomes. CONCLUSIONS CPA meningiomas remain challenging lesions to treat, given their proximity to critical neurovascular structures. GKRS is a safe and effective option for managing CPA meningiomas smaller than 2.5 cm without associated mass ef...

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Section: 25mentioning

confidence: 82%

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

D’Amico¹,

Banu²,

Petridis³

et al. 2017

Journal of Neurosurgery

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“…With a median follow-up of 84 months, tumor control and neurological preservation were achieved in 87% and 91% of patients, respectively. 52 Smaller radiosurgical series confirm the efficacy and safety of radiosurgery for patients with posterior fossa meningiomas, even of the foramen magnum. 53,61 The current series represents the largest one to date for posterior fossa meningiomas treated with radiosurgery (Table 8).…”

Section: Stereotactic Radiosurgerymentioning

confidence: 94%

Gamma Knife radiosurgery for posterior fossa meningiomas: a multicenter study

Sheehan

Starke

Kano

et al. 2015

JNS

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abbreviatioNs CI = confidence interval; CN = cranial nerve; CPA = cerebellopontine angle; GKRS = Gamma Knife radiosurgery; HR = hazard ratio; OR = odds ratio; SRS = stereotactic radiosurgery. obJect Posterior fossa meningiomas represent a common yet challenging clinical entity. They are often associated with neurovascular structures and adjacent to the brainstem. Resection can be undertaken for posterior fossa meningiomas, but residual or recurrent tumor is frequent. Stereotactic radiosurgery (SRS) has been used to treat meningiomas, and this study evaluates the outcome of this approach for those located in the posterior fossa.methods At 7 medical centers participating in the North American Gamma Knife Consortium, 675 patients undergoing SRS for a posterior fossa meningioma were identified, and clinical and radiological data were obtained for these cases. Females outnumbered males at a ratio of 3.8 to 1, and the median patient age was 57.6 years (range 12-89 years). Prior resection was performed in 43.3% of the patient sample. The mean tumor volume was 6.5 cm 3 , and a median margin dose of 13.6 Gy (range 8-40 Gy) was delivered to the tumor.results At a mean follow-up of 60.1 months, tumor control was achieved in 91.2% of cases. Actuarial tumor control was 95%, 92%, and 81% at 3, 5, and 10 years after radiosurgery. Factors predictive of tumor progression included age greater than 65 years (hazard ratio [HR] 2.36, 95% CI 1.30-4.29, p = 0.005), prior history of radiotherapy (HR 5.19, 95% CI 1.69-15.94, p = 0.004), and increasing tumor volume (HR 1.05, 95% CI 1.01-1.08, p = 0.005). Clinical stability or improvement was achieved in 92.3% of patients. Increasing tumor volume (odds ratio [OR] 1.06, 95% CI 1.01-1.10, p = 0.009) and clival, petrous, or cerebellopontine angle location as compared with petroclival, tentorial, and foramen magnum location (OR 1.95, 95% CI 1.05-3.65, p = 0.036) were predictive of neurological decline after radiosurgery. After radiosurgery, ventriculoperitoneal shunt placement, resection, and radiation therapy were performed in 1.6%, 3.6%, and 1.5%, respectively.coNclusioNs Stereotactic radiosurgery affords a high rate of tumor control and neurological preservation for patients with posterior fossa meningiomas. Those with a smaller tumor volume and no prior radiation therapy were more likely to have a favorable response after radiosurgery. Rarely, additional procedures may be required for hydrocephalus or tumor progression.

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“…1,16,20,22,27 During the last 20 years, SRS has become an important alternative option for CPA meningiomas. 9,17,26,28 The twin goals of SRS are to maintain or improve function and achieve long-term tumor control.…”

Section: Discussionmentioning

confidence: 99%

“…Nicolato et al 17 documented the reduction of tumor volumes in 55% of patients with posterior fossa meningiomas; they reported that in 40% of patients tumor volume was stable but noted delayed tumor progression in 5%. Starke et al 26 reported that 51% of patients with posterior fossa meningiomas (including 28% of patients with CPA meningiomas) displayed a decrease in tumor volume, 36% had no change in volume, and 13% had an increase in volume. The PFS rates at 3, 5, and 10 years were 98%, 96%, and 78%, respectively.…”

Section: Tumor Control After Srsmentioning

confidence: 99%

“…Iwai et al 9 reported that neurological status improved in 15% of patients with skull base meningiomas. Starke et al 26 reported that 91% of patients with posterior fossa meningiomas had no change or improvement in their neurological condition and 9% of patients showed symptom deterioration. Flannery et al 4 demonstrated that neurological status improved in 26% of patients with petroclival meningiomas, remained stable in 58%, and worsened in 15%.…”

Section: Symptom Improvement and Deterioration After Srsmentioning

confidence: 99%

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Stereotactic radiosurgery for cerebellopontine angle meningiomas

Park

Kano

Niranjan

et al. 2014

JNS

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Object To assess the long-term outcomes of stereotactic radiosurgery (SRS) for cerebellopontine angle (CPA) meningiomas, the authors retrospectively reviewed data from a 20-year experience. They evaluated progression-free survival as well as improvement, stabilization, or deterioration in clinical symptoms. Methods Seventy-four patients with CPA meningiomas underwent SRS involving various Gamma Knife technologies between 1990 and 2010. The most common presenting symptoms were dizziness or disequilibrium, hearing loss, facial sensory dysfunction, and headache. The median tumor volume was 3.0 cm3 (range 0.3–17.1 cm3), and the median radiation dose to the tumor margin was 13 Gy (range 11–16 Gy). The median follow-up period was 40 months (range 4–147 months). Results At last imaging follow-up, the tumor volume had decreased in 46 patients (62%), remained stable in 26 patients (35%), and increased in 2 patients (3%). The progression-free survival after SRS was 98% at 1 year, 98% at 3 years, and 95% at 5 years. At the last clinical follow-up, 23 patients (31%) showed neurological improvement, 43 patients (58%) showed no change in symptoms or signs, and 8 patients (11%) had worsening symptoms or signs. The neurological improvement rate after SRS was 16% at 1 year, 31% at 3 years, and 40% at 5 years. The post-SRS deterioration rate was 5% at 1 year, 10% at 3 years, and 16% at 5 years. A multivariate analysis demonstrated that trigeminal neuralgia was the symptom most likely to worsen after SRS (HR 0.08, 95% CI 0.02–0.31; p = 0.001). Asymptomatic peritumoral edema occurred in 4 patients (5%) after SRS, and symptomatic adverse radiation effects developed in 7 patients (9%). Conclusions Stereotactic radiosurgery for CPA meningiomas provided a high tumor control rate and relatively low risk of ARE. Tumor compression of the trigeminal nerve by a CPA meningioma resulted in an increased rate of facial pain worsening in this patient experience.

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Gamma Knife surgery of meningiomas located in the posterior fossa: factors predictive of outcome and remission

Cited by 60 publications

References 83 publications

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

Gamma Knife radiosurgery for posterior fossa meningiomas: a multicenter study

Stereotactic radiosurgery for cerebellopontine angle meningiomas

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