Personalized Gamma Knife radiosurgery for cavernous sinus hemangiomas: A Chinese single-center retrospective study for 10 years of 187 patients

Abstract

Background Aim of this study is to retrospectively review the effectiveness and safety of personalized Gamma Knife radiosurgery (GKRS) for cavernous sinus hemangiomas (CSHs), summarise experience of personalized GKRS treatment for different volume of CSHs. Methods 187 CSHs patients who received personalized GKRS treatment in our center from 2011.1.1 to 2020.12.31 were enrolled in this study and classified into small and medium CSHs (<20 ml), large CSHs (20-40 ml) and giant CSHs (≥40 ml) according to tumor volume. The personalized GKRS treatment strategy included single GKRS and staged GKRS. Tumor shrinkage rate, clinical symptoms response, and complications after GKRS were recorded during follow-up period. Multivariate factors influencing clinical symptoms response were analyzed after personalized GKRS treatment. Results After a mean follow-up duration of 28 months (range 12-124 months), the tumor control rate was 100%, the mean shrinkage rate of CSHs was 93.2% (61.3%-100%) in the last follow-up. Of the 115 patients with preexisting symptoms, 43 (37.5%) patients showed symptom disappearance, 17 (14.7%) patients demonstrated improvement, and 55 (47.8%) patients remained no change. Previous surgical resection of CSHs (OR=0.025, 95% CI 0.007-0.084, P=0.000) was identified to be an independent risk factor for no symptom improvement after GKRS treatment. Conclusions Personalized GKRS is an effective and safe treatment for different volume of CSHs, which is capable of shrinking the tumor, improving symptoms with extremely low incidence of adverse effects and might be considered as the primary treatment strategy for CSHs.

Clinical and Radiological Response Following Single-Session Gamma Knife Radiosurgery in Cavernous Sinus Hemangiomas

“…associated with a previous attempt at surgical resection, likely a result of irreversible peroperative damage to surrounding cranial nerves. 22 Our data is consistent with existing observations that GKRS in CSH provides excellent longterm control, with symptomatic and neurological improvement. Six months after GKRS, the mean tumor volume reduction was 64.9%, with increasing volume reduction with greater follow-up (Figure 1).…”

“…29 Yang et al demonstrated that a personalized approach to GKRS in CSH, reserving staged procedures for large tumors resulted in 91.5% tumor volume reduction with complications in 3.7% of patients across a spectrum of 19 large and 23 giant CSH. 22 CyberKnife radiosurgery delivered as 21 Gy in three fractions or 22 Gy in four fractions also appears to be effective in giant CSH, producing 88% mean tumor reduction with no radiation-induced complications. 30 Hypofractionated GKRS was employed in two patients with giant CSH delivering five fractions of 5 Gy each.…”

“…They noted that despite 100% tumor control, 55% of patients did not experience clinical improvement, which was independently associated with a previous attempt at surgical resection, likely a result of irreversible peroperative damage to surrounding cranial nerves. 22…”

“…In comparison, larger series published subsequently demonstrated between 80% and 97.3% response at 12 months, highlighting its role, in particular, as a primary treatment strategy alternate to microsurgical excision. [20][21][22] A multi-center series of 30 CSH, 17 residual lesions and 13 primary, treated tumors with a mean volume of 11.5 cc, demonstrating a threshold dose of 10-12 Gy to achieve tumor control. They noted that 15 of 22 patients with preoperative ocular dysmotility or visual impairment improved following GKRS.…”

“…Although some authors have argued in favour of attempted GTR, citing the benign nature of CSH, while attempting to preserve maximal tumor function, series that focused on GTR as the goal of surgery are associated with a significant, often unacceptable rate of new or deteriorating cranial nerve injuries, up to 76.6%. 22,[26][27][28] There are only few series that compare microsurgery and GKRS in CSH-Existing reports are limited in the significantly greater size of lesions that are subjected to microsurgery compared to GKRS. 3,15 A recent report of the use of fractionated RT in large (20-40 cc) and giant (>40 cc) CSH, with a marginal dose of 50 Gy in 25 fractions, demonstrated a mean tumor reduction of 79.7% and symptomatic improvement in all patients within 12 months.…”