Stereotactic radiosurgery for benign meningiomas

Bloch, Orin; Kaur, Gurvinder; Jian, Brian J.; Parsa, Andrew T.; Barani, Igor J.

doi:10.1007/s11060-011-0720-4

Cited by 62 publications

(45 citation statements)

References 64 publications

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“…1 The tumor control rate in our series of asymptomatic patients is consistent with these results, with a 5-year actuarial value of 95.7%. Additionally, the overall PFS rate was 91.1% at 5 years.…”

Section: Discussionsupporting

confidence: 90%

“…Gamma Knife surgery would seemingly be an ideal preemptive treatment for high-risk lesions given the procedure's low morbidity and excellent tumor control and PFS rates for benign meningiomas, which typically exceed 90% at 5 years. 1,17 However, because the primary goal of preemptive treatment is to avoid symptom development altogether, the traditional outcome measures for tumor control and PFS can be difficult to interpret in the setting of a disease that under certain circumstances has excellent PFS if left untreated. The primary aim in the present study was to further examine the role of GKS as a treatment for asymptomatic meningiomas with an emphasis on symptom control, treatment complications, and a novel method of comparison with published natural history studies documenting rates of symptom development that are more applicable to asymptomatic patients.…”

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confidence: 99%

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Gamma Knife surgery for the treatment of patients with asymptomatic meningiomas

Salvetti¹,

Nagaraja²,

C³

et al. 2013

JNS

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Object Increasingly, meningiomas are detected incidentally, prior to symptom development. While these lesions are traditionally managed conservatively until symptoms develop or lesion growth occurs, it is conceivable that patients at high risk for symptom development may benefit from earlier intervention prior to the appearance of symptoms. However, little research has been performed to determine whether Gamma Knife surgery (GKS) can alter the rate of symptom development in such patients. Methods A retrospective case study was performed by screening the University of Virginia GKS database for patients treated for asymptomatic meningiomas. From the patient's medical records, pertinent demographic and treatment information was obtained. Yearly follow-up MRI had been performed to assess tumor control and detect signs of radiation-induced injury. Clinical follow-up via neurological examination had been performed to assess symptom development. Results Forty-two patients, 33 females (78.6%) and 9 males (21.4%), with 42 asymptomatic meningiomas were included in the analysis. The median age at GKS was 53 years. The most common lesion location was the cerebral convexities (10 lesions [23.8%]), and the median lesion size was 4.0 ml. The median duration of imaging and clinical follow-ups was 59 and 76 months, respectively. During the follow-up period, 1 tumor (2.4%) increased in size, 2 patients (4.8%) demonstrated symptoms, and 1 patient (2.4%) exhibited possible signs of radiation-induced injury. Thus, actuarial tumor control rates were 100%, 95.7%, and 95.7% for 2, 5, and 10 years, respectively. Actuarial symptom control at 5 and 10 years was 97% and 93.1%, respectively. Overall progression-free survival was 91.1% and 77.8% at 5 and 10 years, respectively. Conclusions Compared with published rates of symptom development in patients with untreated meningiomas, results in this study indicated that patients with asymptomatic lesions may benefit from prophylactic radiosurgery prior to the appearance of symptoms. Additionally, GKS is a treatment option that offers low morbidity.

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

Gamma Knife surgery for the treatment of patients with asymptomatic meningiomas

Salvetti¹,

Nagaraja²,

C³

et al. 2013

JNS

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“…12,17,18,20,21,32,33 While SRS minimizes many of the morbidities associated with aggressive resection, delayed adverse outcomes such as radiation necrosis, cranial nerve neuropathies, occlusion of the venous structures, hydrocephalus, and edema are possible; the occurrence of these complications is approximately 10% in the reported literature, with variability depending on the cohorts of analyzed patients. 1,31,37,43,44,46,50 Post-SRS edema has been reported as an adverse effect/complication, which can result in neurological symptoms. Location (primarily the convexity and parasagittal regions) and larger initial tumor volume have also been associated with a higher risk of edema.…”

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confidence: 99%

Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas

Mansouri

Larjani

Klironomos

et al. 2015

JNS

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M eningioMas are the most common primary intracranial nonglial neoplasms in adults. 34 When feasible, the ideal management of meningiomas is complete resection of the tumor and associated dura mater, with the goal of minimizing further neurological morbidity for the patient. 28 However, not all meningiomas are amenable to gross-total resection (e.g., extensive involvement of skull base structures or invasion into the venous sinuses or other neurovascular structures), and alternative complementary treatment strategies are necessary. 4,27,40 abbreviatioNs ARE = adverse radiation event; CI RTOG = Radiation Therapy Oncology Group Conformity Index; RT = radiotherapy; SGR = specific growth rate; SRS = stereotactic radiosurgery; TVR = treatment volume ratio. obJect In this paper, the authors' aim was to determine short-term volumetric and diametric tumor growth and identify clinical, radiological, and dosimetric predictors of adverse radiation events (AREs) following stereotactic radiosurgery (SRS) for intracranial WHO Grade I meningiomas. methods This is a retrospective review of all WHO Grade I meningiomas that were treated with SRS (primary or adjuvant) between December 2005 and June 2012 at the University Health Network. Seventy-five patients had at least 24 months of both clinical and radiological follow-up and were, therefore, included in this study. Tumor growth was defined as any volumetric or diametric change greater than 10% per year. Any variation less than +10% was considered growth stability. Volumetric measurements were made using T1-weighted gadolinium-enhanced 3-T MRI scans and ITK-SNAP software. Tumor growth rates were calculated using the specific growth rate (SGR). Univariate statistics were used to identify predictors of post-SRS AREs. All statistical analyses were performed using IBM SPSS. results Women accounted for 69.3% of patients, and the mean treatment age was 58.6 years. Median follow-up was 36.2 months. Twenty-one (28%) patients had undergone prior resection. Two (3%) patients required salvage surgical intervention following SRS. The majority of the lesions (56%) were skull base tumors. Median tumor volume and diameter were 5.2 cm 3 and 27.5 mm, respectively. The absence of tumor growth was observed in 39 cases (52%) based on the volumetric measurements, while the absence of tumor growth was observed in 69 cases (92%) based on the diametric measurements. Twenty-six patients (34.6%) experienced new-onset AREs, including headache (17.3%), cranial neuropathy (10.6%), speech impairment (2.7%), tremors (2.7%), and ataxia (1.3%). Fourteen patients (18.7%) experienced new-onset edema, and 4 of these patients were symptomatic. A lower conformity index (1.24 vs 1.4) was significantly associated with the development of edema (p < 0.001 power > 0.8). Patients with meningiomas that had growth rates of more than 10% per year were more likely to experience long-term headaches after SRS (p = 0.022). coNclusioNs Volume-based reporting of SRS outcomes for meningiomas may be a more accurate method given the ...

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“…We regard the surgery as crucial treatment for large symptomatic JFMs, although it is challenging for surgical management and radiotherapy became an effective alternative for intracranial meningiomas [6,28,52,61]. Patient selection, including preoperative neuroimaging and neurological assessment, surgical approaches and intraoperative preserving cranial nerves, and postoperative management all correlate with the …”

Section: Surgical Managementmentioning

confidence: 99%

“…In the past decades, stereotactic radiosurgery (SRS) became an effective alternative to surgical management for intracranial meningiomas as well as an adjuvant treatment for remnant or recurrent tumors [6,28,52,56]. For benign JFMs, we agree it is reasonable to leave small part of tumor behind to avoid functional deficits, and then may rely on SRS for tumor control.…”

Section: Radiotherapy For Jfmmentioning

confidence: 99%

Microsurgical management of primary jugular foramen meningiomas: a series of 22 cases and review of the literature

Tang

Zhang

et al. 2016

Neurosurg Rev

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This study summarized clinical manifestations, surgical management, histological grading, and long-term outcome of jugular foramen meningiomas (JFMs). Retrospective study was performed in 22 consecutive patients with primary JFMs from January 2004 to October 2010, enrolling 10 men and 12 women with average age of 39.4 (14-57 years). The most common initial symptom is hearing disorder, followed by lower cranial nerve dysfunctions. The tumor was classified into type I (intracranial) in 1, type II (intracranial) in 15, type IV (intracranial-extracranial) in 6, and none type III (extracranial). Surgical approaches mainly included retrosigmoid in 7, far lateral in 10, and juxtacondylar in 5, with some variations. The gross total resection was achieved in 15 cases and subtotal resection in 7. Fourteen patients (63.6 %) developed new or worse neurological deficits immediately after operation, of whom 11 (78.6 %) got alleviation. Postoperatively, keeping airway patency and prevention from aspiration pneumonia is very important. Nasotracheal intubation is much more tolerated than orotracheal intubation for postoperative patient management. WHO grade 2 was found in four cases (18.2 %) and grade 3 in one. During the average time of follow-up in 83.2 months, only one (grade 3) died of tumor regrowth 20 months after surgery and radiosurgery. Five of 17 patients of grade 1 developed tumor regrowth. Radiosurgery provides a good tumor control for tumor regrowth in grade 1, or postoperative grade 2 tumor. In conclusion, JFMs has a favorable long-term overall survival; however, neurological preservation is still challenging, especially low cranial nerves.

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Stereotactic radiosurgery for benign meningiomas

Cited by 62 publications

References 64 publications

Gamma Knife surgery for the treatment of patients with asymptomatic meningiomas

Gamma Knife surgery for the treatment of patients with asymptomatic meningiomas

Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas

Microsurgical management of primary jugular foramen meningiomas: a series of 22 cases and review of the literature

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