Gamma Knife Surgery of Meningiomas Involving the Cavernous Sinus

Neurosurgery ◽  
2010 ◽  
Vol 66 (4) ◽  
pp. 661-669 ◽  
Author(s):  
Bente Sandvei Skeie ◽  
P. Ø. Enger ◽  
G. O. Skeie ◽  
F. Thorsen ◽  
P-H. Pedersen
Keyword(s):  
Tumor Growth ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Complication Rate ◽  
Growth Control ◽  
Gamma Knife Surgery ◽  
Long Term Outcome ◽  
Long Term Follow Up

Abstract OBJECTIVE Resection of meningiomas involving the cavernous sinus often is incomplete and associated with considerable morbidity. As a result, an increasing number of patients with such tumors have been treated with gamma knife surgery (GKS). However, few studies have investigated the long-term outcome for this group of patients. METHODS 100 patients (23 male/77 female) with meningiomas involving the cavernous sinus received GKS at the Department of Neurosurgery at Haukeland University Hospital, Bergen, Norway, between November 1988 and July 2006. They were followed for a mean of 82.0 (range, 0–243) months. Only 2 patients were lost to long-term follow-up. Sixty patients underwent craniotomy before radiosurgery, whereas radiosurgery was the primary treatment for 40 patients. RESULTS Tumor growth control was achieved in 84.0% of patients. Twelve patients required re-treatment: craniotomy (7), radiosurgery (1), or both (4). Three out of 5 patients with repeated radiosurgery demonstrated secondary tumor growth control. Excluding atypical meningiomas, the growth control rate was 90.4%. The 1-, 5-, and 10-year actuarial tumor growth control rates are 98.9%, 94.2%, and 91.6%, respectively. Treatment failure was preceded by clinical symptoms in 14 of 15 patients. Most tumor growths appeared within 2.5 years. Only one third grew later (range, 6–20 yr). The complication rate was 6.0%: optic neuropathy (2), pituitary dysfunction (3), worsening of diplopia (1), and radiation edema (1). Mortality was 0. At last follow-up, 88.0% were able to live independent lives. CONCLUSION GKS gives long-term growth control and has a low complication rate. Most tumor growths manifest within 3 years following treatment. However, some appear late, emphasizing the need for long-term follow-up.

Gamma Knife Radiosurgery for the Treatment of Cavernous Sinus Meningiomas

Neurosurgery ◽  
2003 ◽  
Vol 52 (3) ◽  
pp. 517-524 ◽  
Author(s):  
Yoshiyasu Iwai ◽  
Kazuhiro Yamanaka ◽  
Tomoya Ishiguro
Keyword(s):  
Tumor Growth ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Tumor Regression ◽  
Gamma Knife Radiosurgery ◽  
Growth Control ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Tumor Diameter

Abstract OBJECTIVE We report on the efficacy of gamma knife radiosurgery for cavernous sinus meningiomas. METHODS Between January 1994 and December 1999, we used gamma knife radiosurgery for the treatment of 43 patients with cavernous sinus meningiomas. Forty-two patients were followed up for a mean of 49.4 months (range, 18–84 mo). The patients' average age was 55 years (range, 18–81 yr). Twenty-two patients (52%) underwent operations before radiosurgery, and 20 patients (48%) underwent radiosurgery after the diagnosis was made by magnetic resonance imaging. The tumor volumes ranged from 1.2 to 101.5 cm3 (mean, 14.7 cm3). The tumors either compressed or were attached to the optic apparatus in 17 patients (40.5%). The marginal radiation dose was 8 to 15 Gy (mean, 11 Gy), and the optic apparatus was irradiated with 2 to 12 Gy (mean, 6.2 Gy). Three patients with a mean tumor diameter greater than 4 cm were treated by two-stage radiosurgery. RESULTS Thirty-eight patients (90.5%) demonstrated tumor growth control during the follow-up period after radiosurgery. Tumor regression was observed in 25 patients (59.5%), and growth was unchanged in 13 patients (31%). Regrowth or recurrence occurred in four patients (9.5%). The actual tumor growth control rate at 5 years was 92%. Only one patient (2.4%) experienced regrowth within the treatment field; in other patients, regrowth occurred at sites peripheral to or outside the treatment field. Twelve patients (28.6%) had improved clinically by the time of the follow-up examination. None of the patients experienced optic neuropathy caused by radiation injury or any new neurological deficits after radiosurgery. CONCLUSION Gamma knife radiosurgery may be a useful option for the treatment of cavernous sinus meningiomas not only as an adjuvant to surgery but also as an alternative to surgical removal. We have shown it to be safe and effective even in tumors that adhere to or are in close proximity to the optic apparatus.

scholarly journals Gamma Knife surgery for incidental cerebral arteriovenous malformations

2014 ◽  
Vol 121 (5) ◽  
pp. 1015-1021 ◽  
Author(s):  
Chun-Po Yen ◽  
Dale Ding ◽  
Ching-Hsiao Cheng ◽  
Robert M. Starke ◽  
Mark Shaffrey ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Latency Period ◽  
Invasive Procedure ◽  
Gamma Knife Surgery ◽  
Neurological Deficits ◽  
Cerebral Arteriovenous Malformations ◽  
Long Term Follow Up

Object A relatively benign natural course of unruptured cerebral arteriovenous malformations (AVMs) has recently been recognized, and the decision to treat incidentally found AVMs has been questioned. This study aims to evaluate the long-term imaging and clinical outcomes of patients with asymptomatic, incidentally discovered AVMs treated with Gamma Knife surgery (GKS). Methods Thirty-one patients, each with an incidentally diagnosed AVM, underwent GKS between 1989 and 2009. The nidus volumes ranged from 0.3 to 11.1 cm3 (median 3.2 cm3). A margin dose between 15 and 26 Gy (median 20 Gy) was used to treat the AVMs. Four patients underwent repeat GKS for still-patent AVM residuals after the initial GKS procedure. Clinical follow-up ranged from 24 to 196 months, with a mean of 78 months (median 51 months) after the initial GKS. Results Following GKS, 19 patients (61.3%) had a total AVM obliteration on angiography. In 7 patients (22.6%), no flow voids were observed on MRI but angiographic confirmation was not available. In 5 patients (16.1%), the AVMs remained patent. A small nidus volume was significantly associated with increased AVM obliteration rate. Thirteen patients (41.9%) developed radiation-induced imaging changes: 11 were asymptomatic (35.5%), 1 had only headache (3.2%), and 1 developed seizure and neurological deficits (3.2%). Two patients each had 1 hemorrhage during the latency period (116.5 risk years), yielding an annual hemorrhage rate of 1.7% before AVM obliteration. Conclusions The decision to treat asymptomatic AVMs, and if so, which treatment approach to use, remain the subject of debate. GKS as a minimally invasive procedure appears to achieve a reasonable outcome with low procedure-related morbidity. In those patients with incidental AVMs, the benefits as well as the risks of radiosurgical intervention will only be fully defined with long-term follow-up.

scholarly journals Clinical results of Gamma Knife surgery for cavernous sinus hemangiomas

2012 ◽  
Vol 117 (Special_Suppl) ◽  
pp. 89-95 ◽  
Author(s):  
Peng Li ◽  
Haibo Ren ◽  
Shizhen Zhang ◽  
Wei Wang
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Adjuvant Treatment ◽  
Clinical Results ◽  
Gamma Knife Surgery ◽  
Mr Images ◽  
Peripheral Dose ◽  
Long Term Follow Up ◽  
Model C

Object The purpose of this study was to gain an understanding of the efficacy and safety of Gamma Knife surgery (GKS) for the treatment of cavernous sinus hemangiomas (CSHs). The authors report on 16 patients who underwent GKS as a primary or adjuvant treatment for CSH. Methods Sixteen patients harboring CSHs (14 women and 2 men ranging in age from 21 to 65 years [mean 41.3 years]) underwent GKS at West China Hospital. In 4 patients the diagnosis was based on histological findings; in the other 12 patients it was based on findings on MR images. After patients were given a local anesthetic agent, the treatments were performed using a Leksell Gamma Knife model C. Gadolinium-enhanced MR images of T1-weighted, T2-weighted, and FLAIR sequences were obtained to determine the pretreatment location of the lesion. A mean peripheral dose of 13.3 Gy (range 11–14 Gy) was directed to the 40%–50% isodose line. Results The mean follow-up time in this study was 21.5 months (range 12–36 months). In 11 of 12 patients with symptoms, clinical improvement was reported at an average of 3.3 months (range 1–8 months) after GKS. Significant or partial tumor shrinkage was observed in 14 patients (87.5%) at the last follow-up. No new neurological impairments were reported after GKS. Conclusions Magnetic resonance imaging may play an important role in the preoperative diagnosis of CSHs. Gamma Knife surgery may be a safe and effective primary or adjuvant treatment option for CSHs; however, long-term follow-up with more cases is needed to verify the benefits of this treatment.

scholarly journals Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study

2019 ◽  
Vol 130 (2) ◽  
pp. 388-397 ◽  
Author(s):  
Josa M. Frischer ◽  
Elise Gruber ◽  
Verena Schöffmann ◽  
Adolf Ertl ◽  
Romana Höftberger ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Acoustic Neuroma ◽  
Gamma Knife Radiosurgery ◽  
Hearing Preservation ◽  
Tumor Control ◽  
Long Term Outcome ◽  
Acoustic Neuromas ◽  
Long Term Follow Up

OBJECTIVEThe authors present long-term follow-up data on patients treated with Gamma Knife radiosurgery (GKRS) for acoustic neuroma.METHODSSix hundred eighteen patients were radiosurgically treated for acoustic neuroma between 1992 and 2016 at the Department of Neurosurgery, Medical University Vienna. Patients with neurofibromatosis and patients treated too recently to attain 1 year of follow-up were excluded from this retrospective study. Thus, data on 557 patients with spontaneous acoustic neuroma of any Koos grade are presented, as are long-term follow-up data on 426 patients with a minimum follow-up of 2 years. Patients were assessed according to the Gardner-Robertson (GR) hearing scale and the House-Brackmann facial nerve function scale, both prior to GKRS and at the times of follow-up.RESULTSFour hundred fifty-two patients (81%) were treated with radiosurgery alone and 105 patients (19%) with combined microsurgery-radiosurgery. While the combined treatment was especially favored before 2002, the percentage of cases treated with radiosurgery alone has significantly increased since then. The overall complication rate after GKRS was low and has declined significantly in the last decade. The risk of developing hydrocephalus after GKRS increased with tumor size. One case (0.2%) of malignant transformation after GKRS was diagnosed. Radiological tumor control rates of 92%, 91%, and 91% at 5, 10, and 15 years after GKRS, regardless of the Koos grade or pretreatment, were observed. The overall tumor control rate without the need for additional treatment was even higher at 98%. At the last follow-up, functional hearing was preserved in 55% of patients who had been classified with GR hearing class I or II prior to GKRS. Hearing preservation rates of 53%, 34%, and 34% at 5, 10, and 15 years after GKRS were observed. The multivariate regression model revealed that the GR hearing class prior to GKRS and the median dose to the cochlea were independent predictors of the GR class at follow-up.CONCLUSIONSIn small to medium-sized spontaneous acoustic neuromas, radiosurgery should be recognized as the primary treatment at an early stage. Although minimizing the cochlear dose seems beneficial for hearing preservation, the authors, like others before, do not recommend undertreating intracanalicular tumors in favor of low cochlear doses. For larger acoustic neuromas, radiosurgery remains a reliable management option with tumor control rates similar to those for smaller acoustic neuromas; however, careful patient selection and counseling are recommended given the higher risk of side effects. Microsurgery must be considered in acoustic neuromas with significant brainstem compression or hydrocephalus.

Gamma Knife Surgery for Pediatric Arteriovenous Malformations: Long-term Follow-up in 186 Patients

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 539-539
Author(s):  
Stephen J. Monteith ◽  
Chun Po Yen ◽  
James Nguyen ◽  
Jessica Rainey ◽  
David Schlesinger ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Surgery ◽  
Long Term Follow Up

Long-term outcomes of Gamma Knife surgery for cavernous sinus meningioma

2007 ◽  
Vol 107 (4) ◽  
pp. 745-751 ◽  
Author(s):  
Toshinori Hasegawa ◽  
Yoshihisa Kida ◽  
Masayuki Yoshimoto ◽  
Joji Koike ◽  
Hiroshi Iizuka ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Initial Treatment ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Long Term Outcomes ◽  
The Mean

Object The aim of this study was to evaluate long-term outcomes, including tumor control and neurological function, in patients with cavernous sinus meningiomas treated using Gamma Knife surgery (GKS). Methods One hundred fifteen patients with cavernous sinus meningiomas, excluding atypical or malignant meningiomas, were treated with GKS between 1991 and 2003. Forty-nine patients (43%) underwent GKS as the initial treatment. The mean tumor volume was 14 cm3, and the mean maximum and margin doses applied to the tumor were 27 and 13 Gy, respectively. The median follow-up period was 62 months. During the follow-up, 111 patients were able to be evaluated with neuroimaging. Results The actuarial 5- and 10-year progression-free survival rates were 87 and 73%, respectively. Similarly, the actuarial 5- and 10-year focal tumor control rates were 94 and 92%, respectively. Regarding functional outcomes, 43 patients (46%) experienced some degree of improvement, 40 (43%) remained stable, and 11 (12%) had worse preexisting or newly developed symptoms. Patients who underwent GKS as the initial treatment experienced significant improvement of their symptoms (p = 0.006). Conclusions Gamma Knife surgery is a safe and effective treatment over the long term in selected patients with cavernous sinus meningiomas. Tumor progression is more likely to occur from the lesion margin outside the treatment volume. In small to medium-sized tumors, GKS is an excellent alternative to resection, preserving good neurological function. For relatively large-sized tumors, low-dose radiosurgery (≤ 12 Gy) is acceptable for the prevention of tumor progression.

Radiosurgery for Nonfunctioning Pituitary Adenomas

Neurosurgery ◽  
2005 ◽  
Vol 56 (4) ◽  
pp. 699-705 ◽  
Author(s):  
Yoshiyasu Iwai ◽  
Kazuhiro Yamanaka ◽  
Katsunobu Yoshioka
Keyword(s):  
Tumor Growth ◽  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Growth Control ◽  
Cyst Formation ◽  
Morbidity Rate ◽  
Nonfunctioning Pituitary Adenomas ◽  
Long Term Follow Up

Abstract OBJECTIVE: We evaluated the effectiveness of gamma knife radiosurgery in the treatment of nonfunctioning pituitary adenomas. METHODS: Between January 1994 and December 1999, we treated 34 patients with nonfunctioning pituitary adenomas. Thirty-one of these patients were followed for more than 30 months. Their mean age was 52.9 years. All patients underwent resection before radiosurgery. In four patients, treatment was performed with staged radiosurgery. The treatment volume was 0.7 to 36.2 cm3 (median, 2.5 cm3). The treatment dose ranged from 8 to 20 Gy (median, 14.0 Gy) to the tumor margin. In 15 patients (48.4%), the tumor either compressed or was attached to the optic apparatus. The maximum dose to the optic apparatus was from 2 to 11 Gy (median, 8 Gy). RESULTS: Patients were followed for 30 to 108 months (median, 59.8 mo). The tumor size decreased in 18 patients (58.1%), remained unchanged in 9 patients (29.0%), and increased in four patients (12.9%). The 5-year actual tumor growth control rate was 93%. Among patients with tumor growth, two cases were secondary to cyst formation. Two patients (6.5%) required adrenal and thyroid hormonal replacement during the follow-up period after radiosurgery because of radiation-induced endocrinopathy. None of the patients sustained new cranial nerve deficits, which included optic neuropathy. CONCLUSION: In this series, radiosurgery had a high tumor growth control rate during the long-term follow-up period. Furthermore, we observed a low morbidity rate, with endocrinopathies and optic neuropathies. This low rate included even patients in whom the tumor compressed or was attached to the optic apparatus. We emphasize the necessity of long-term follow-up to evaluate late complications.

Gamma Knife surgery for low-grade astrocytomas: evaluation of long-term outcome based on a 10-year experience

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 127-132 ◽  
Author(s):  
Ling-Wei Wang ◽  
Cheng-Ying Shiau ◽  
Wen-Yuh Chung ◽  
Hsiu-Mei Wu ◽  
Wan-Yuo Guo ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Gamma Knife ◽  
Salvage Treatment ◽  
Gamma Knife Surgery ◽  
World Health ◽  
Low Grade ◽  
Long Term Outcome ◽  
Long Term Treatment

ObjectThe authors report the long-term treatment results of Gamma Knife surgery (GKS) for patients with low-grade astrocytomas who underwent surgery at a single institution.MethodsA series of 21 patients (median age 20 years) with 25 intracranial low-grade astrocytomas (World Health Organization Grades I and II) were treated with GKS between 1993 and 2003. Among them, four underwent GKS as a primary treatment. Two underwent GKS as a treatment boost after radiotherapy. In the other 15 patients, GKS was performed as an adjuvant or salvage treatment for residual/recurrent tumors after the patients had undergone craniotomy. Tumor volumes ranged from 0.2 to 13.3 ml (median 2.4 ml). Prescription margin doses ranged from 8 to 18 Gy (median 14.5 Gy). Radiation volumes were 1.3 to 21.6 ml (median 3.6 ml). Patients underwent regular follow up, with neurological evaluation and magnetic resonance imaging studies obtained at 6-month intervals.One patient was lost to follow-up. The clinical follow-up time was 5 to 144 months (median 67 months). Complete tumor remission was seen in three patients. The 10-year progression-free patient survival rate after GKS was 65%. Tumor progression was found in six patients of whom five received further salvage treatment. All the tumor progression occurred within the GKS-treated volumes. Mild-to-moderate adverse radiation effects (AREs) were found in eight patients. Both of the patients who had undergone GKS as a treatment boost after radiotherapy developed AREs, but with good shrinkage of tumors.Conclusions Gamma Knife surgery provides durable long-term local tumor control with acceptable toxicity for some patients with highly selected low-grade astrocytomas.

Gamma Knife surgery in vestibular schwannomas: impact on the anterior and posterior labyrinth

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 128-135 ◽  
Author(s):  
Massimo Gerosa ◽  
Nazarena Mesiano ◽  
Michele Longhi ◽  
Antonio De Simone ◽  
Roberto Foroni ◽  
...  
Keyword(s):  
Tumor Growth ◽  
Gamma Knife ◽  
Growth Control ◽  
Hearing Preservation ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas ◽  
Medium Size ◽  
Tumor Control ◽  
Brainstem Response

Object During the past decades, in small-to-medium size vestibular schwannomas, Gamma Knife surgery (GKS) has become a reliable therapeutic option because of either excellent local tumor control or minimal morbidity, with cranial neuropathy becoming increasingly rare. Although still insufficiently analyzed in larger cohorts of patients with long-term follow-ups, adequate chances of hearing preservation and vestibular sparing seem clinically guaranteed. However, deeper investigations are needed in this regard, expanding the number of cases and the follow-up period. Methods A small group of patients with vestibular schwannomas (74 patients, including 41 men and 33 women) treated between 2003 and 2009 using GKS at the authors' institution were analyzed—both before and after GKS—with computerized static stabilometry and electronystagmography for balance disorders, vertigo, and ataxia on 1 side and pure tone average, vocal speech discrimination score, auditory brainstem response, and so forth for hearing impairment and tinnitus on the other side. Eligibility criteria for this prospective study included previously untreated unilateral lesions and a Gardner-Robertson hearing class of I–III. Dosimetry plans had been programmed at the lower effective dosages for these tumors (median surface dose 12.4 Gy, range 10–13 Gy), carefully avoiding even minimal toxic dosages on the most vulnerable targets: the cochlea (never > 6 Gy) and the vestibular canals (< 7.5 Gy). Results To date, tumor growth control rates remain satisfactory; at a mean follow-up of 50 months, the rate was 96%. The overall level of hearing preservation was 72%, with 81% having Gardner-Robertson Class I hearing. Tinnitus decreased, from 52% to 28% of patients (p < 0.01). Significant improvements were also observed in vestibular symptoms, with computerized static stabilometry abnormalities decreasing from 62% to 32% (p < 0.001) and electronystagmography abnormalities reducing from 48% to 14% (p < 0.001). Conclusions Using appropriate radiodosimetry planning, GKS seems to guarantee not only adequate tumor growth control rates, but also better levels of hearing preservation, with a documented, long-lasting improvement in vestibular functions.

scholarly journals Stereotactic radiosurgery for the treatment of glomus tumors

2018 ◽  
Vol 20 (2) ◽  
pp. 136-142
Author(s):  
Vladimir Zaccariotti ◽  
João Arruda ◽  
Jean Paiva ◽  
Wenzel Abreu ◽  
Criseide Dourado ◽  
...  
Keyword(s):  
Tumor Growth ◽  
Cranial Nerves ◽  
Growth Control ◽  
Slight Reduction ◽  
Lower Cranial Nerve ◽  
Shaped Beam ◽  
Glomus Jugulare ◽  
Long Term Follow Up

Introduction: Despite of being a slow growing hypervascular benign tumor, Glomus Jugulare is a challenge for the neurosurgeon, due to its complex localization and relation to the cranial nerves. Microsurgery alone or associated with radiation therapy have been used for decades, and is frequently associated with severe neurological sequelae. In the last decade, radiosurgery has been employed for tumor growth control, but long term follow up is still missing. Objective: The objective is to analyze the late results of radiosurgery alone in the treatment of glomus jugulare tumors. Material and Methods: From a series of 596 patients submitted to radiosurgery at our institution, seven patients with eight complex glomus jugulare tumors were selected. All patients were submitted to radiosurgery, 4 men and 3 women, age 20 to 78. The median volume of the lesions was 12.56 cc (range from 3.06 to 19.6 cc). The primary symptoms were pain and tinnitus, one patient had facial palsy before the initial treatment. Two patients were submitted to surgery before radiosurgery, and both developed lower cranial dysfunction, one of them underwent to conventional radiotherapy before radiosurgery. The patients received a single dose of 18 Gy to 20 Gy, using a LINAC with a conformal shaped beam collimator. Results: All patients had important pain relief (no more medication necessary) and a follow up of 30 to 96 months showed slight reduction in all of eight lesions. No patient suffered a new lower cranial nerve deficit after conformal shaped beam radiosurgery. Conclusion: Despite of the small number of cases, long term follow-up showed that radiosurgery is safe and effective to provide tumor growth control and to reduce pain associated with glomus jugulare tumors.

Sign in / Sign up

Export Citation Format

Share Document