Long term results of Gamma Knife radiosurgery for deep-seated cavernous malformations

Object In this study, the authors evaluate the long-term results after Gamma Knife radiosurgery of cranial base meningiomas. This study is a follow-up to their previously published report on the early results. Methods Between January 1994 and December 2001, the authors treated benign cranial base meningiomas in 108 patients using low-dose Gamma Knife radiosurgery. The tumor volumes ranged from 1.7 to 55.3 cm3 (median 8.1 cm3), and the radiosurgery doses ranged from 8 to 12 Gy (median 12 Gy) to the tumor margin. Results The mean duration of follow-up was 86.1 months (range 20–144 months). Tumor volume decreased in 50 patients (46%), remained stable in 51 patients (47%), and increased (local failure) in 7 patients (6%). Eleven patients experienced tumor recurrence outside the treatment field. Among these patients, marginal failure was seen in 5 and distant recurrence was seen in 6. Seven patients were thought to have malignant transformation based on histological or radiological characteristics of the lesion. The actuarial progression-free survival rate, including malignant transformation and outside recurrence, was 93% at 5 years and 83% at 10 years. Neurological status improved in 16 patients (15%). Permanent radiation injury occurred in 7 patients (6%). Conclusions Gamma Knife radiosurgery is a safe and effective treatment for cranial base meningiomas as demonstrated with a long-term follow-up period of > 7 years. Surgeons must be aware of the possibility of treatment failure, defined as local failure, marginal failure, and malignant transformation; however, this may be the natural course of meningiomas and not related to radiosurgery.

Download Full-text

P14.67 Long-term results of gamma knife radiosurgery for treatment of intracranial glomus jugulare tumors

Neuro-Oncology ◽

10.1093/neuonc/noab180.175 ◽

2021 ◽

Vol 23 (Supplement_2) ◽

pp. ii50-ii51

Author(s):

R M Emad Eldin ◽

K M Abdel Karim ◽

A M N El-Shehaby ◽

W A Reda ◽

A M Nabeel ◽

...

Keyword(s):

Clinical Improvement ◽

Gamma Knife ◽

Tumor Volume ◽

Gamma Knife Radiosurgery ◽

Long Term Results ◽

Glomus Jugulare ◽

The Mean ◽

Mean Time

Abstract BACKGROUND Glomus Jugulare tumors are benign but locally aggressive ones that represent a therapeutic challenge. Previous studies about the use of Gamma Knife Radiosurgery (GRS) in those tumors have documented good results that needed larger number of patients and longer follow up periods to be confirmed. MATERIAL AND METHODS Between August 2001 and December 2017, 70 patients with glomus jugulare tumors were treated at the Gamma Knife Center, Cairo. They were 46 females and 24 males. The mean age was 48 years (16–71 years). Nineteen of these patients were previously operated, 5 were partially embolized, 3 underwent embolization and subsequent surgery and 43 had gamma knife as their primary treatment. Volume-staged gamma knife radiosurgery was used in 10 patients and single-session in 60 patients, with a total of 86 sessions. The mean target volume was 12.7 cm3 (range 0.2 to 34.5 cm3). The mean tumor volume was 15.5 cm3 (range 0.2 to 105 cm3). The mean prescription dose was 14.5 Gy (range 12 to 18 Gy). RESULTS The mean follow up period was 60 months (range 18 to 206 months), and by the time of the data analysis, two of the patients were dead (66 and 24 months after GK treatment). The tumor control was 98.6% (69/70). Thirty-two tumors became smaller and 37 were unchanged. The symptoms improved in 36 patients, were stable in 32 patients, and worsened in 2 patients who developed a transient facial palsy and worsened hearing. Symptomatic improvement began before any reduction in tumor volume could be detected, where the mean time to clinical improvement was 7 months whereas the mean time to tumor shrinkage was 18 months. CONCLUSION This study about the long term follow up of the GKR for the intracranial glomus jugulare tumors confirmed that this is a highly effective and safe treatment. This data shows that the clinical improvement is not correlated with the radiological volume reduction.

Download Full-text

Gamma-Knife Radiosurgery for Cranial Base Meningiomas: Experience of Tumor Control, Clinical Course, and Morbidity in a Follow-Up of More than 8 Years

Neurosurgery ◽

10.1227/01.neu.0000190654.82265.a3 ◽

2006 ◽

Vol 58 (1) ◽

pp. 28-36 ◽

Cited By ~ 100

Author(s):

Iris Zachenhofer ◽

Stefan Wolfsberger ◽

Martin Aichholzer ◽

Alexander Bertalanffy ◽

Karl Roessler ◽

...

Keyword(s):

Gamma Knife ◽

Open Surgery ◽

Clinical Course ◽

Gamma Knife Radiosurgery ◽

Cranial Base ◽

Long Term Results ◽

Tumor Control ◽

Long Term Follow Up

Abstract OBJECTIVE: Surgical resection of cranial base meningiomas is often limited owing to involvement of crucial neural structures. Within the last 2 decades Gamma Knife radiosurgery (GKRS) has gained increasing importance as an adjunct treatment after incomplete resection and as an alternative treatment to open surgery. However, reports of long-term results are still sparse. We therefore performed this study to analyze the long-term results of GKRS treatment of cranial base meningiomas, following our previously published early follow-up experience. METHODS: A retrospective analysis of the medical files for Gamma Knife and surgical treatments, clinicoradiological findings, and outcome was carried out focusing on tumor control, clinical course, and morbidity. RESULTS: Between 1992 and 1995, we treated 36 patients with cranial base meningiomas using GKRS (male:female ratio, 1:5; mean age, 59 yr; range, 44–89 yr). Twenty-five patients were treated with GKRS after open surgery, and 11 patients received GKRS alone. Tumor control, neurological outcomes, and adverse effects were analyzed after a long-term follow-up period (mean, 103 mo; range, 70–133 mo) and compared with our previous results after an early follow-up period (mean, 48 mo; range, 36–76 mo). Control of tumor growth was achieved in 94% of patients. Compared with the early follow-up period, the late neuroradiological effects of GKRS on cranial base meningiomas were continuing tumor shrinkage in 11 patients (33%), stable tumor size in 20 patients (64%) and tumor progression in two meningiomas (6%). The neurological status improved in 16 patients (44%), remained stable in 19 patients (52%), and deteriorated in one patient (4%). Adverse side effects of GKRS were found only during the early follow-up period. CONCLUSION: Our data confirm that GKRS is not only a safe and effective treatment modality for cranial base meningiomas in short-term observation, but also in a mean long-term follow-up period of more than 8 years. Tumor shrinkage and clinical improvement also continued during the longer follow-up period.

Download Full-text

Long-Term Results of Stereotactic Gamma Knife Radiosurgery for Pituitary Adenomas

Progress in Neurological Surgery - Japanese Experience with Gamma Knife Radiosurgery ◽

10.1159/000163384 ◽

2008 ◽

pp. 77-95 ◽

Cited By ~ 43

Author(s):

Tatsuya Kobayashi

Keyword(s):

Gamma Knife ◽

Pituitary Adenomas ◽

Gamma Knife Radiosurgery ◽

Long Term Results

Download Full-text

Initial Gamma Knife Radiosurgery for Large or Documented Growth Asymptomatic Meningiomas: Long-Term Results From a 27-Year Experience

Frontiers in Oncology ◽

10.3389/fonc.2020.598582 ◽

2020 ◽

Vol 10 ◽

Author(s):

Junyi Fu ◽

Lisha Wu ◽

Chao Peng ◽

Xin Yang ◽

Hongji You ◽

...

Keyword(s):

Median Time ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Long Term Results ◽

Tumor Control ◽

Long Term Outcomes ◽

Radiological Progression ◽

Design And Methods

ObjectiveThe aims of this study were to investigate the long-term outcomes of initial Gamma Knife radiosurgery (GKRS) for large (≥20 mm) or documented growth asymptomatic meningiomas.Design and MethodsThis was a single-center retrospective study. Fifty-nine patients with large (≥20 mm) or documented growth asymptomatic meningiomas undergoing initial GKRS were enrolled. The median age was 56 (range, 27–83) years. The median time of follow-up was 66.8 (range, 24.6–245.6) months, and the median tumor margin dose was 13.0 Gy (range, 11.6–22.0 Gy).ResultsTumors shrunk in 35 patients (59.3%) and remained stable in 23 (39.0%). One patient (1.7%) experienced radiological progression at 54 months after GKRS. The PFS was 100%, 97%, and 97% at 3, 5, and 10 years, respectively. Nine patients (15.3%) occurred new neurological symptoms or signs at a median time of 8.1 (range, 3.0–81.6) months. The symptom PFS was 90% and 78% at 5 and 10 years, respectively. Fifteen patients (25.4%) occurred peritumoral edema (PTE) at a median time of 7.2 (range, 2.0–81.6) months. One patient underwent surgical resection for severe PTE. In univariate and multivariate analysis, Only tumor size (≥25 mm) and maximum dose (≥34 Gy) were significantly associated with PTE [hazard ratio (HR)= 3.461, 95% confidence interval (CI)=1.157-10.356, p=0.026 and HR=3.067, 95% CI=1.068-8.809, P=0.037, respectively].ConclusionsIn this study, initial GKRS can provide a high tumor control rate as well as an acceptable rate of complications in large or documented growth asymptomatic meningiomas. GKRS may be an alternative initial treatment for asymptomatic meningiomas.

Download Full-text

Long-term Results after Stereotactic Radiosurgery for Patients with Cavernous Malformations

Neurosurgery ◽

10.1097/00006123-200206000-00003 ◽

2002 ◽

Vol 50 (6) ◽

pp. 1190-1198 ◽

Cited By ~ 23

Author(s):

Toshinori Hasegawa ◽

James McInerney ◽

Douglas Kondziolka ◽

John Y.K. Lee ◽

John C. Flickinger ◽

...

Keyword(s):

High Risk ◽

Stereotactic Radiosurgery ◽

Gamma Knife Radiosurgery ◽

Long Term Results ◽

Major Hemorrhage ◽

Cavernous Malformations ◽

Before And After ◽

Risk Of Hemorrhage

Abstract OBJECTIVE Stereotactic radiosurgery has been used for patients with high-risk cavernous malformations of the brain. We performed radiosurgery for patients with symptomatic, imaging-confirmed hemorrhages for which resection was believed to be associated with high risk. This study examines the long-term hemorrhage rate after radiosurgery. METHODS We reviewed data obtained before and after gamma knife radiosurgery on 82 patients treated between 1987 and 2000. Most patients had multiple hemorrhages from brainstem or diencephalic cavernous malformations. Follow-up data were examined to identify hemorrhages, and an overall hemorrhage rate was calculated. RESULTS Observation before treatment averaged 4.33 years (range, 0.17–18 yr) for a total of 354 patient-years. During this period, 202 hemorrhages were observed, for an annual hemorrhage rate of 33.9%, excluding the first hemorrhage. Temporal clustering of hemorrhages was not significant. After radiosurgery, patient follow-up averaged 5 years (range, 0.42–12.08 yr), for a total of 401 patient-years. During this period, 19 hemorrhages were identified, 17 in the first 2 years posttreatment and 2 after 2 years. The annual hemorrhage rate was 12.3% per year for the first 2 years after radiosurgery, followed by 0.76% per year from Years 2 to 12. Eleven patients had new neurological symptoms without hemorrhage after radiosurgery (13.4%). The symptoms were minor in six of these patients and temporary in five. CONCLUSION Radiosurgery confers a reduction in the risk of hemorrhage for high-risk cavernous malformations. Risk reduction, although in evidence during initial follow-up, is most pronounced after 2 years. Given the difficulty of identifying high-risk patients, treatment after one major hemorrhage should be considered in selected younger patients. Such a strategy warrants further investigation.

Download Full-text

Long-term results of Gamma Knife radiosurgery for facial nerve schwannomas

Neurological Research ◽

10.1080/01616412.2020.1796379 ◽

2020 ◽

Vol 42 (12) ◽

pp. 1055-1060

Author(s):

Göktuğ Akyoldaş ◽

Alperen Şirin ◽

Meltem Yılmaz ◽

Meriç Şengöz ◽

Selçuk Peker

Keyword(s):

Facial Nerve ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Long Term Results

Download Full-text

Initial experience with gamma knife radiosurgery for advanced glaucoma

Journal of Neurosurgery ◽

10.3171/jns.2000.93.supplement_3.0180 ◽

2000 ◽

Vol 93 (supplement_3) ◽

pp. 180-183 ◽

Cited By ~ 6

Author(s):

Vilibald Vladyka ◽

Roman Liščk ◽

Oldřich Šubrt ◽

Jozef Vymazal ◽

Jiri Pilbauer ◽

...

Keyword(s):

Intraocular Pressure ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Long Term Results ◽

Initial Experience ◽

Ocular Pain ◽

Content Type ◽

Advanced Glaucoma ◽

Fine Print

Object. The authors assessed the affect of gamma knife radiosurgery on patients with glaucoma. Methods. Fifteen eyes in 14 patients were treated with gamma knife radiosurgery during a 14-month period. Ocular pain was alleviated in all patients and intraocular pressure was decreased. There were no early side effects. Conclusions. Further studies are needed to elucidate the best treatment parameters, long-term results, and some of the pathophysiological effects.

Download Full-text