Download PDF
J Neurol Surg B Skull Base 2022; 83(S 02): e173-e180
DOI: 10.1055/s-0041-1722937
Original Article

Skull Base Meningiomas in Patients with Neurofibromatosis Type 2: An International Multicenter Study Evaluating Stereotactic Radiosurgery

Henry Ruiz-Garcia
1   Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States
2   Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, United States
,
Daniel M. Trifiletti 
1   Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States
2   Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, United States
,
Nasser Mohammed
3   Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, United States
,
Yi-Chieh Hung
3   Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, United States
,
Zhiyuan Xu
3   Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, United States
,
Tomas Chytka
4   Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
,
Roman Liscak
4   Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
,
Manjul Tripathi 
5   Department of Neurological Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
David Arsanious
6   Department of Neurological Surgery, West Virginia University, Morgantown, West Virginia, United States
,
Christopher P. Cifarelli
6   Department of Neurological Surgery, West Virginia University, Morgantown, West Virginia, United States
,
Marco Perez Caceres
7   Department of Neurological Surgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
,
David Mathieu 
7   Department of Neurological Surgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
,
Herwin Speckter
8   Department of Neurological Surgery, Dominican Gamma Knife Center and CEDIMAT Hospital, Santo Domingo, Dominican Republic
,
Gautam U. Mehta 
9   Department of Neurological Surgery, House Ear Institute, Los Angeles, California, United States
,
Gregory P. Lekovic
9   Department of Neurological Surgery, House Ear Institute, Los Angeles, California, United States
,
Jason P. Sheehan
3   Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, United States
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Objective Meningiomas are the second most common tumors in neurofibromatosis type 2 (NF-2). Microsurgery is challenging in NF-2 patients presenting with skull base meningiomas due to the intrinsic risks and need for multiple interventions over time. We analyzed treatment outcomes and complications after primary Gamma Knife radiosurgery (GKRS) to delineate its role in the management of these tumors.

Methods An international multicenter retrospective study approved by the International Radiosurgery Research Foundation was performed. NF-2 patients with at least one growing and/or symptomatic skull base meningioma and 6-month follow-up after primary GKRS were included. Clinical and radiosurgical parameters were recorded for analysis.

Results In total, 22 NF-2 patients with 54 skull base meningiomas receiving GKRS as primary treatment met inclusion criteria. Median age at GKRS was 38 years (10–79 years). Most lesions were located in the posterior fossa (55.6%). Actuarial progression free survival (PFS) rates were 98.1% at 2 years and 90.0% at 5 and 10 years. The median follow-up time after initial GKRS was 5.0 years (0.6–25.5 years). Tumor volume at GKRS was a predictor of tumor control. Lesions >5.5 cc presented higher chances to progress after radiosurgery (p = 0.043). Three patients (13.64%) developed adverse radiation effects. No malignant transformation or death due to meningioma or radiosurgery was reported.

Conclusions GKRS is effective and safe in the management of skull base meningiomas in NF-2 patients. Tumor volume deserve greater relevance during clinical decision-making regarding the most appropriate time to treat. GKRS offers a minimally invasive approach of particular interest in this specific group of patients.

Keywords

skull base - meningioma - neurofibromatosis type 2 - gamma knife radiosurgery

Supplementary Material



Publication History

Received: 06 August 2020

Accepted: 06 December 2020

Article published online:
19 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Asthagiri AR, Parry DM, Butman JA. et al. Neurofibromatosis type 2. Lancet 2009; 373 (9679): 1974-1986
    CrossrefPubMedGoogle Scholar
  • 2 Smith MJ, Higgs JE, Bowers NL. et al. Cranial meningiomas in 411 neurofibromatosis type 2 (NF2) patients with proven gene mutations: clear positional effect of mutations, but absence of female severity effect on age at onset. J Med Genet 2011; 48 (04) 261-265
    CrossrefPubMedGoogle Scholar
  • 3 Goutagny S, Kalamarides M. Meningiomas and neurofibromatosis. J Neurooncol 2010; 99 (03) 341-347
    CrossrefPubMedGoogle Scholar
  • 4 Baser ME, Friedman JM, Aeschliman D. et al. Predictors of the risk of mortality in neurofibromatosis 2. Am J Hum Genet 2002; 71 (04) 715-723
    CrossrefPubMedGoogle Scholar
  • 5 Desai R, Bruce J. Meningiomas of the cranial base. J Neurooncol 1994; 20 (03) 255-279
    CrossrefPubMedGoogle Scholar
  • 6 Almefty R, Dunn IF, Pravdenkova S, Abolfotoh M, Al-Mefty O. True petroclival meningiomas: results of surgical management. J Neurosurg 2014; 120 (01) 40-51
    CrossrefPubMedGoogle Scholar
  • 7 Gozal YM, Alzhrani G, Abou-Al-Shaar H, Azab MA, Walsh MT, Couldwell WT. Outcomes of decompressive surgery for cavernous sinus meningiomas: long-term follow-up in 50 patients. J Neurosurg 2020; 132 (02) 380-387
    CrossrefPubMedGoogle Scholar
  • 8 Ichinose T, Goto T, Ishibashi K, Takami T, Ohata K. The role of radical microsurgical resection in multimodal treatment for skull base meningioma. J Neurosurg 2010; 113 (05) 1072-1078
    CrossrefPubMedGoogle Scholar
  • 9 Morisako H, Goto T, Ohata K. Petroclival meningiomas resected via a combined transpetrosal approach: surgical outcomes in 60 cases and a new scoring system for clinical evaluation. J Neurosurg 2015; 122 (02) 373-380
    CrossrefPubMedGoogle Scholar
  • 10 Nanda A, Javalkar V, Banerjee AD. Petroclival meningiomas: study on outcomes, complications and recurrence rates. J Neurosurg 2011; 114 (05) 1268-1277
    CrossrefPubMedGoogle Scholar
  • 11 Nanda A, Thakur JD, Sonig A, Missios S. Microsurgical resectability, outcomes, and tumor control in meningiomas occupying the cavernous sinus. J Neurosurg 2016; 125 (02) 378-392
    CrossrefPubMedGoogle Scholar
  • 12 Singh N, Singh DK, Ahmad F, Kumar R. The retrosigmoid approach: workhorse for petroclival meningioma surgery. Asian J Neurosurg 2019; 14 (01) 188-192
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Cohen-Inbar O, Lee CC, Schlesinger D, Xu Z, Sheehan JP. Long-term results of stereotactic radiosurgery for skull base meningiomas. Neurosurgery 2016; 79 (01) 58-68
    CrossrefPubMedGoogle Scholar
  • 14 Sheehan JP, Williams BJ, Yen CP. Stereotactic radiosurgery for WHO grade I meningiomas. J Neurooncol 2010; 99 (03) 407-416
    CrossrefPubMedGoogle Scholar
  • 15 Patibandla MR, Lee CC, Sheehan J. Stereotactic radiosurgery of central skull base meningiomas-volumetric evaluation and long-term outcomes. World Neurosurg 2017; 108: 176-184
    CrossrefPubMedGoogle Scholar
  • 16 Starke RM, Nguyen JH, Reames DL, Rainey J, Sheehan JP. Gamma knife radiosurgery of meningiomas involving the foramen magnum. J Craniovertebr Junction Spine 2010; 1 (01) 23-28
    CrossrefPubMedGoogle Scholar
  • 17 Starke RM, Przybylowski CJ, Sugoto M. et al. Gamma knife radiosurgery of large skull base meningiomas. J Neurosurg 2015; 122 (02) 363-372
    CrossrefPubMedGoogle Scholar
  • 18 Starke RM, Williams BJ, Hiles C, Nguyen JH, Elsharkawy MY, Sheehan JP. Gamma knife surgery for skull base meningiomas. J Neurosurg 2012; 116 (03) 588-597
    CrossrefPubMedGoogle Scholar
  • 19 Goutagny S, Yang HW, Zucman-Rossi J. et al. Genomic profiling reveals alternative genetic pathways of meningioma malignant progression dependent on the underlying NF2 status. Clin Cancer Res 2010; 16 (16) 4155-4164
    CrossrefPubMedGoogle Scholar
  • 20 Bi WL, Abedalthagafi M, Horowitz P. et al. Genomic landscape of intracranial meningiomas. J Neurosurg 2016; 125 (03) 525-535
    CrossrefPubMedGoogle Scholar
  • 21 Lee S, Karas PJ, Hadley CC. et al. The role of merlin/NF2 loss in meningioma biology. Cancers (Basel) 2019; 11 (11) E1633
    CrossrefPubMedGoogle Scholar
  • 22 Goutagny S, Bah AB, Henin D. et al. Long-term follow-up of 287 meningiomas in neurofibromatosis type 2 patients: clinical, radiological, and molecular features. Neuro-oncol 2012; 14 (08) 1090-1096
    CrossrefPubMedGoogle Scholar
  • 23 Walker AJ, Ruzevick J, Malayeri AA. et al. Postradiation imaging changes in the CNS: how can we differentiate between treatment effect and disease progression?. Future Oncol 2014; 10 (07) 1277-1297
    CrossrefPubMedGoogle Scholar
  • 24 Patibandla MR, Lee CC, Tata A, Addagada GC, Sheehan JP. Stereotactic radiosurgery for WHO grade I posterior fossa meningiomas: long-term outcomes with volumetric evaluation. J Neurosurg 2018; 129 (05) 1249-1259
    CrossrefPubMedGoogle Scholar
  • 25 Mehta GU, Zenonos G, Patibandla MR. et al. Outcomes of stereotactic radiosurgery for foramen magnum meningiomas: an international multicenter study. J Neurosurg 2018; 129 (02) 383-389
    CrossrefPubMedGoogle Scholar
  • 26 Aboukais R, Zairi F, Baroncini M. et al. Intracranial meningiomas and neurofibromatosis type 2. Acta Neurochir (Wien) 2013; 155 (06) 997-1001 , discussion 1001
    CrossrefPubMedGoogle Scholar
  • 27 Li P, Wu T, Wang Y. et al. Clinical features of newly developed NF2 intracranial meningiomas through comparative analysis of pediatric and adult patients. Clin Neurol Neurosurg 2020; 194: 105799
    CrossrefPubMedGoogle Scholar
  • 28 Evers S, Verbaan D, Sanchez E, Peerdeman S. 3D volumetric measurement of neurofibromatosis type 2-associated meningiomas: association between tumor location and growth rate. World Neurosurg 2015; 84 (04) 1062-1069
    CrossrefPubMedGoogle Scholar
  • 29 Bassiouni H, Asgari S, Stolke D. Tuberculum sellae meningiomas: functional outcome in a consecutive series treated microsurgically. Surg Neurol 2006; 66 (01) 37-44 , discussion 44–45
    CrossrefPubMedGoogle Scholar
  • 30 D'Amico RS, Banu MA, Petridis P. et al. Efficacy and outcomes of facial nerve-sparing treatment approach to cerebellopontine angle meningiomas. J Neurosurg 2017; 127 (06) 1231-1241
    CrossrefPubMedGoogle Scholar
  • 31 Nanda A, Jawahar A, Sathyanarayana S. Microsurgery for potential radiosurgical skull base lesions: a retrospective analysis and comparison of results. Skull Base 2003; 13 (03) 131-138
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Giammattei L, Starnoni D, Levivier M, Messerer M, Daniel RT. Surgery for clinoidal meningiomas: case series and meta-analysis of outcomes and complications. World Neurosurg 2019; 129: e700-e717
    CrossrefPubMedGoogle Scholar
  • 33 Guduk M, Yener U, Sun HI, Hacihanefioglu M, Ozduman K, Pamir MN. Pterional and unifrontal approaches for the microsurgical resection of olfactory groove meningiomas: experience with 61 consecutive patients. Turk Neurosurg 2017; 27 (05) 707-715
    PubMedGoogle Scholar
  • 34 Goto T, Ohata K. Surgical resectability of skull base meningiomas. Neurol Med Chir (Tokyo) 2016; 56 (07) 372-378
    CrossrefPubMedGoogle Scholar
  • 35 Aichholzer M, Bertalanffy A, Dietrich W. et al. Gamma knife radiosurgery of skull base meningiomas. Acta Neurochir (Wien) 2000; 142 (06) 647-652 , discussion 652–653
    CrossrefPubMedGoogle Scholar
  • 36 Bir SC, Ambekar S, Ward T, Nanda A. Outcomes and complications of gamma knife radiosurgery for skull base meningiomas. J Neurol Surg B Skull Base 2014; 75 (06) 397-401
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Black PM, Villavicencio AT, Rhouddou C, Loeffler JS. Aggressive surgery and focal radiation in the management of meningiomas of the skull base: preservation of function with maintenance of local control. Acta Neurochir (Wien) 2001; 143 (06) 555-562
    CrossrefPubMedGoogle Scholar
  • 38 Couldwell WT, Cole CD, Al-Mefty O. Patterns of skull base meningioma progression after failed radiosurgery. J Neurosurg 2007; 106 (01) 30-35
    CrossrefPubMedGoogle Scholar
  • 39 Eustacchio S, Trummer M, Fuchs I, Schröttner O, Sutter B, Pendl G. Preservation of cranial nerve function following gamma knife radiosurgery for benign skull base meningiomas: experience in 121 patients with follow-up of 5 to 9.8 years. Acta Neurochir Suppl (Wien) 2002; 84: 71-76
    PubMedGoogle Scholar
  • 40 Han JH, Kim DG, Chung HT. et al. Gamma knife radiosurgery for skull base meningiomas: long-term radiologic and clinical outcome. Int J Radiat Oncol Biol Phys 2008; 72 (05) 1324-1332
    CrossrefPubMedGoogle Scholar
  • 41 Hayashi M, Chernov M, Tamura N. et al. Gamma knife robotic microradiosurgery for benign skull base meningiomas: tumor shrinkage may depend on the amount of radiation energy delivered per lesion volume (unit energy). Stereotact Funct Neurosurg 2011; 89 (01) 6-16
    CrossrefPubMedGoogle Scholar
  • 42 Igaki H, Maruyama K, Koga T. et al. Stereotactic radiosurgery for skull base meningioma. Neurol Med Chir (Tokyo) 2009; 49 (10) 456-461
    CrossrefPubMedGoogle Scholar
  • 43 Iwai Y, Yamanaka K, Ikeda H. Gamma knife radiosurgery for skull base meningioma: long-term results of low-dose treatment. J Neurosurg 2008; 109 (05) 804-810
    CrossrefPubMedGoogle Scholar
  • 44 Iwai Y, Yamanaka K, Nakajima H, Yasui T, Kishi H. [Gamma knife radiosurgery for skull base meningiomas: the treatment results and patient satisfaction expressed in answers to a questionnaire]. No Shinkei Geka 2000; 28 (05) 411-415
    PubMedGoogle Scholar
  • 45 Iwai Y, Yamanaka K, Shimohonji W, Ishibashi K. Staged gamma knife radiosurgery for large skull base meningiomas. Cureus 2019; 11 (10) e6001
    PubMedGoogle Scholar
  • 46 Joshi KC, Raghavan A, Muhsen B. et al. Fractionated gamma knife radiosurgery for skull base meningiomas: a single-institution experience. Neurosurg Focus 2019; 46 (06) E8
    CrossrefPubMedGoogle Scholar
  • 47 Kreil W, Luggin J, Fuchs I, Weigl V, Eustacchio S, Papaefthymiou G. Long term experience of gamma knife radiosurgery for benign skull base meningiomas. J Neurol Neurosurg Psychiatry 2005; 76 (10) 1425-1430
    CrossrefPubMedGoogle Scholar
  • 48 Liscák R, Kollová A, Vladyka V, Simonová G, Novotný Jr J. Gamma knife radiosurgery of skull base meningiomas. Acta Neurochir Suppl (Wien) 2004; 91: 65-74
    CrossrefPubMedGoogle Scholar
  • 49 Metellus P, Regis J, Muracciole X. et al. Evaluation of fractionated radiotherapy and gamma knife radiosurgery in cavernous sinus meningiomas: treatment strategy. Neurosurgery 2005; 57 (05) 873-886 , discussion 873–886
    CrossrefPubMedGoogle Scholar
  • 50 Morita A, Coffey RJ, Foote RL, Schiff D, Gorman D. Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients. J Neurosurg 1999; 90 (01) 42-49
    CrossrefPubMedGoogle Scholar
  • 51 Nakaya K, Chernov M, Kasuya H. et al. Risk factors for regrowth of intracranial meningiomas after gamma knife radiosurgery: importance of the histopathological grade and MIB-1 index. Minim Invasive Neurosurg 2009; 52 (5-6): 216-221
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Nicolato A. 111Indium-octreotide brain scintigraphy: a prognostic factor in skull base meningiomas treated with gamma knife radiosurgery. Q J Nucl Med Mol Imaging 2004; 48 (01) 26-32
    PubMedGoogle Scholar
  • 53 Nicolato A, Ferraresi P, Foroni R. et al. Gamma knife radiosurgery in skull base meningiomas. Preliminary experience with 50 cases. Stereotact Funct Neurosurg 1996; 66 (Suppl. 01) 112-120
    CrossrefPubMedGoogle Scholar
  • 54 Nicolato A, Giorgetti P, Foroni R. et al. Gamma knife radiosurgery in skull base meningiomas: a possible relationship between somatostatin receptor decrease and early neurological improvement without tumour shrinkage at short-term imaging follow-up. Acta Neurochir (Wien) 2005; 147 (04) 367-374 , discussion 374–375
    CrossrefPubMedGoogle Scholar
  • 55 Park HR, Lee JM, Park KW. et al. Fractionated gamma knife radiosurgery as initial treatment for large skull base meningioma. Exp Neurobiol 2018; 27 (03) 245-255
    CrossrefPubMedGoogle Scholar
  • 56 Pendl G, Eustacchio S, Unger F. Radiosurgery as alternative treatment for skull base meningiomas. J Clin Neurosci 2001; 8 (Suppl. 01) 12-14
    CrossrefPubMedGoogle Scholar
  • 57 Pendl G, Schröttner O, Eustacchio S, Feichtinger K, Ganz J. Stereotactic radiosurgery of skull base meningiomas. Minim Invasive Neurosurg 1997; 40 (03) 87-90
    Article in Thieme ConnectPubMedGoogle Scholar
  • 58 Pendl G, Schröttner O, Friehs GM, Feichtinger H. Stereotactic radiosurgery of skull base meningiomas. Stereotact Funct Neurosurg 1995; 64 (Suppl. 01) 11-18
    CrossrefPubMedGoogle Scholar
  • 59 Pollock BE, Stafford SL, Link MJ. Gamma knife radiosurgery for skull base meningiomas. Neurosurg Clin N Am 2000; 11 (04) 659-666
    CrossrefPubMedGoogle Scholar
  • 60 Reynolds MR, Hawasli AH, Murphy RK. et al. Acute hemorrhage following gamma knife radiosurgery to a clival meningioma. J Spine Neurosurg 2013; 2 (02) 108
    CrossrefPubMedGoogle Scholar
  • 61 Su CF, Liu DW, Lee CC, Chiu TL. Volume-staged gamma knife surgery for the treatment of large skull base meningioma surrounding the optical apparatus: a snowman-shape design. J Chin Med Assoc 2017; 80 (11) 697-704
    CrossrefPubMedGoogle Scholar
  • 62 Takanashi M, Fukuoka S, Hojyo A, Sasaki T, Nakagawara J, Nakamura H. Gamma knife radiosurgery for skull-base meningiomas. Prog Neurol Surg 2009; 22: 96-111
    CrossrefPubMedGoogle Scholar
  • 63 Vermeulen S, Young R, Li F. et al. A comparison of single fraction radiosurgery tumor control and toxicity in the treatment of basal and nonbasal meningiomas. Stereotact Funct Neurosurg 1999; 72 (Suppl. 01) 60-66
    CrossrefPubMedGoogle Scholar
  • 64 Liu A, Kuhn EN, Lucas Jr JT, Laxton AW, Tatter SB, Chan MD. Gamma knife radiosurgery for meningiomas in patients with neurofibromatosis Type 2. J Neurosurg 2015; 122 (03) 536-542
    CrossrefPubMedGoogle Scholar
  • 65 Gao F, Li M, Wang Z, Shi L, Lou L, Zhou J. Efficacy and safety of gamma knife radiosurgery for meningiomas in patients with neurofibromatosis type 2: a long-term follow-up single-center study. World Neurosurg 2019; 125: e929-e936
    CrossrefPubMedGoogle Scholar
  • 66 Minniti G, Amichetti M, Enrici RM. Radiotherapy and radiosurgery for benign skull base meningiomas. Radiat Oncol 2009; 4: 42
    CrossrefPubMedGoogle Scholar
  • 67 Birckhead B, Sio TT, Pollock BE, Link MJ, Laack NN. Gamma knife radiosurgery for neurofibromatosis type 2-associated meningiomas: a 22-year patient series. J Neurooncol 2016; 130 (03) 553-560
    CrossrefPubMedGoogle Scholar
  • 68 Kondziolka D, Mathieu D, Lunsford LD. et al. Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 2008; 62 (01) 53-58 , discussion 58–60
    CrossrefPubMedGoogle Scholar
  • 69 DiBiase SJ, Kwok Y, Yovino S. et al. Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 2004; 60 (05) 1515-1519
    CrossrefPubMedGoogle Scholar
  • 70 Flickinger JC, Kondziolka D, Maitz AH, Lunsford LD. Gamma knife radiosurgery of imaging-diagnosed intracranial meningioma. Int J Radiat Oncol Biol Phys 2003; 56 (03) 801-806
    CrossrefPubMedGoogle Scholar
  • 71 Kane AJ, Sughrue ME, Rutkowski MJ. et al. Anatomic location is a risk factor for atypical and malignant meningiomas. Cancer 2011; 117 (06) 1272-1278
    CrossrefPubMedGoogle Scholar