J Neurol Surg B Skull Base 2014; 75(06): 397-401
DOI: 10.1055/s-0034-1376422
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Outcomes and Complications of Gamma Knife Radiosurgery for Skull Base Meningiomas

Shyamal C. Bir
1   Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
,
Sudheer Ambekar
1   Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
,
Tabitha Ward
1   Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
,
Anil Nanda
1   Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
› Author Affiliations
Further Information

Publication History

25 February 2014

24 March 2014

Publication Date:
27 May 2014 (online)

Abstract

Objective To review the outcomes and complications of meningiomas treated with gamma knife radiosurgery (GKRS) as a primary treatment as well as an adjunct therapy.

Materials and Methods We performed a retrospective review (2000–2013) of 136 patients with meningiomas who received GKRS. Of 136 patients, 68 patients had recurrent or residual tumors after microsurgical resection, and the other 68 patients received GKRS alone. The study population was evaluated clinically and radiographically after GKRS treatment.

Results GKRS in meningiomas showed significant variations in tumor growth control (decreased in 69 patients [50.7%], arrested growth in 47 patients [34.6%], and increased tumor size in 20 patients [14.7%]). Progression-free survival rates after GKRS at 3, 5, and 10 years were 98%, 95% and 85%, respectively. Overall improvement of signs and symptoms after GKRS was 30% (71% versus 41%) compared with pretreated sign and symptoms (p = 0.0001). The Karnofsky performance scale was significantly improved after GKRS compared with the pretreated status (92 versus 80). Twenty patients (14.7%) required resection after initial GKRS.

Conclusion These study findings revealed that GKRS offers a high rate of tumor control, preservation of multiple nerve functions, and a good quality of life in both new and recurrent patients with meningiomas.

 
  • References

  • 1 Claus EB, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M, Black PM. Epidemiology of intracranial meningioma. Neurosurgery 2005; 57 (6) 1088-1095 ; discussion 1088–1095
  • 2 Bloch O, Kaur G, Jian BJ, Parsa AT, Barani IJ. Stereotactic radiosurgery for benign meningiomas. J Neurooncol 2012; 107 (1) 13-20
  • 3 Stafford SL, Perry A, Suman VJ , et al. Primarily resected meningiomas: outcome and prognostic factors in 581 Mayo Clinic patients, 1978 through 1988. Mayo Clin Proc 1998; 73 (10) 936-942
  • 4 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 (5) 1072-1078
  • 5 Sughrue ME, Kane AJ, Shangari G , et al. The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas. J Neurosurg 2010; 113 (5) 1029-1035
  • 6 Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL. Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 1985; 62 (1) 18-24
  • 7 Pollock BE. Stereotactic radiosurgery for intracranial meningiomas: indications and results. Neurosurg Focus 2003; 14 (5) e4
  • 8 Flickinger JC, Kondziolka D, Maitz AH, Lunsford LD. Gamma knife radiosurgery of imaging-diagnosed intracranial meningioma. Int J Radiat Oncol Biol Phys 2003; 56 (3) 801-806
  • 9 Hasegawa T, Kida Y, Yoshimoto M, Koike J, Iizuka H, Ishii D. Long-term outcomes of gamma knife surgery for cavernous sinus meningioma. J Neurosurg 2007; 107 (4) 745-751
  • 10 Roche PH, Pellet W, Fuentes S, Thomassin JM, Régis J. Gamma knife radiosurgical management of petroclival meningiomas results and indications. Acta Neurochir (Wien) 2003; 145 (10) 883-888 ; discussion 888
  • 11 Elia AE, Shih HA, Loeffler JS. Stereotactic radiation treatment for benign meningiomas. Neurosurg Focus 2007; 23 (4) E5
  • 12 Hasegawa T, Kida Y, Yoshimoto M, Iizuka H, Ishii D, Yoshida K. Gamma knife surgery for convexity, parasagittal, and falcine meningiomas. J Neurosurg 2011; 114 (5) 1392-1398
  • 13 Starke RM, Williams BJ, Hiles C, Nguyen JH, Elsharkawy MY, Sheehan JP. Gamma knife surgery for skull base meningiomas. J Neurosurg 2012; 116 (3) 588-597
  • 14 Engenhart-Cabillic R, Farhoud A, Sure U , et al. Clinicopathologic features of aggressive meningioma emphasizing the role of radiotherapy in treatment. Strahlenther Onkol 2006; 182 (11) 641-646
  • 15 Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957; 20 (1) 22-39
  • 16 Strassner C, Buhl R, Mehdorn HM. Recurrence of intracranial meningiomas: did better methods of diagnosis and surgical treatment change the outcome in the last 30 years?. Neurol Res 2009; 31 (5) 478-482
  • 17 Combs SE, Ganswindt U, Foote RL, Kondziolka D, Tonn JC. State-of-the-art treatment alternatives for base of skull meningiomas: complementing and controversial indications for neurosurgery, stereotactic and robotic based radiosurgery or modern fractionated radiation techniques. Radiat Oncol 2012; 7: 226
  • 18 Kim DG, Kim ChH, Chung HT , et al. Gamma knife surgery of superficially located meningioma. J Neurosurg 2005; 102 (Suppl): 255-258
  • 19 Stafford SL, Pollock BE, Foote RL , et al. Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients. Neurosurgery 2001; 49 (5) 1029-1037 ; discussion 1037–1038
  • 20 Shin M, Kurita H, Sasaki T , et al. Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas. J Neurosurg 2001; 95 (3) 435-439
  • 21 Spiegelmann R, Nissim O, Menhel J, Alezra D, Pfeffer MR. Linear accelerator radiosurgery for meningiomas in and around the cavernous sinus. Neurosurgery 2002; 51 (6) 1373-1379 ; discussion 1379–1380
  • 22 Kondziolka D, Mathieu D, Lunsford LD , et al. Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 2008; 62 (1) 53-58 ; discussion 58–60
  • 23 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 (5) 1515-1519
  • 24 Malik I, Rowe JG, Walton L, Radatz MW, Kemeny AA. The use of stereotactic radiosurgery in the management of meningiomas. Br J Neurosurg 2005; 19 (1) 13-20
  • 25 Kondziolka D, Flickinger JC, Perez B ; Gamma Knife Meningioma Study Group. Judicious resection and/or radiosurgery for parasagittal meningiomas: outcomes from a multicenter review. Neurosurgery 1998; 43 (3) 405-413 ; discussion 413–414
  • 26 Kollová A, Liscák R, Novotný Jr J, Vladyka V, Simonová G, Janousková L. Gamma knife surgery for benign meningioma. J Neurosurg 2007; 107 (2) 325-336
  • 27 Goldsmith BJ, Wara WM, Wilson CB, Larson DA. Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 1994; 80 (2) 195-201
  • 28 Maire JP, Caudry M, Guérin J , et al. Fractionated radiation therapy in the treatment of intracranial meningiomas: local control, functional efficacy, and tolerance in 91 patients. Int J Radiat Oncol Biol Phys 1995; 33 (2) 315-321
  • 29 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