Does Prior Microsurgery Improve or Worsen the Outcomes of Stereotactic Radiosurgery for Cavernous Sinus Meningiomas?

Neurosurgery ◽  
2013 ◽  
Vol 73 (3) ◽  
pp. 401-410 ◽  
Author(s):  
Hideyuki Kano ◽  
Kyun-Jae Park ◽  
Douglas Kondziolka ◽  
Aditya Iyer ◽  
Xiaomin Liu ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Progression Free Survival ◽  
Tumor Control ◽  
Improvement Rate ◽  
Cranial Nerve Function ◽  
Cranial Neuropathies ◽  
Microsurgical Resection

Abstract BACKGROUND: Stereotactic radiosurgery (SRS) is an important option for patients with cavernous sinus meningiomas. OBJECTIVE: To evaluate cranial nerve outcomes in patients who underwent SRS for cavernous sinus meningiomas with or without prior microsurgery. METHODS: During a 23-year interval, 272 patients underwent Gamma Knife SRS for cavernous sinus meningiomas (70 men, 202 women; median age, 54 years). In this series, 99 patients underwent prior microsurgical resection. The median tumor volume was 7.9 cm3 and median marginal dose was 13 Gy. The median follow-up period was 62 months (range, 6-209 months). RESULTS: The progression-free survival after SRS was 96% at 3 years, 94% at 5 years, and 86% at 10 years. After SRS, 13 of 91 patients (14%) who underwent prior microsurgery had improvement of preexisting cranial nerve symptoms or signs. In comparison, 54 of 145 patients (37%) without prior microsurgery had improvement of preexisting cranial nerve symptoms or signs. The improvement rate of cranial nerve deficits after SRS in patients without prior microsurgery was 20% at 1 year, 34% at 2 years, 36% at 3 years, and 39% at 5 years. Patients who had not undergone prior microsurgery had significantly higher improvement rates of preexisting cranial nerve symptoms and signs (P = .001). After SRS, 29 patients (11%) developed new or worsened cranial nerve function. CONCLUSION: SRS provided long-term effective tumor control and a low risk of new cranial nerve deficits. Improvement in preexisting cranial neuropathies was detected in significantly more patients who had not undergone prior microsurgical procedures.

scholarly journals Stereotactic radiosurgery for jugular foramen schwannomas: an international multicenter study

2018 ◽  
Vol 129 (4) ◽  
pp. 928-936 ◽  
Author(s):  
Hideyuki Kano ◽  
Antonio Meola ◽  
Huai-che Yang ◽  
Wan-Yuo Guo ◽  
Roberto Martínez-Alvarez ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Radiation Effects ◽  
Tumor Volume ◽  
Progression Free Survival ◽  
Jugular Foramen ◽  
Management Approach ◽  
Tumor Control ◽  
Cranial Neuropathies ◽  
Microsurgical Resection ◽  
International Multicenter Study

OBJECTIVEFor some jugular foramen schwannomas (JFSs), complete resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery (SRS) is a minimally invasive alternative or adjunct to microsurgery for JFSs. The authors reviewed clinical and imaging outcomes of SRS for patients with these tumors.METHODSNine participating centers of the International Gamma Knife Research Foundation identified 92 patients who underwent SRS between 1990 and 2013. Forty-one patients had prior subtotal microsurgical resection. The median interval between previous surgery and SRS was 15 months (range 0.5–144 months). Eighty-four patients had preexisting cranial nerve (CN) symptoms and signs. The median tumor volume was 4.1 cm3 (range 0.8–22.6 cm3), and the median margin dose was 12.5 Gy (range 10–18 Gy). Patients with neurofibromatosis were excluded from this study.RESULTSThe median follow-up was 51 months (range 6–266 months). Tumors regressed in 47 patients, remained stable in 33, and progressed in 12. The progression-free survival (PFS) was 93% at 3 years, 87% at 5 years, and 82% at 10 years. In the entire series, only a dumbbell shape (extension extracranially via the jugular foramen) was significantly associated with worse PFS. In the group of patients without prior microsurgery (n = 51), factors associated with better PFS included tumor volume < 6 cm3 (p = 0.037) and non–dumbbell-shaped tumors (p = 0.015). Preexisting cranial neuropathies improved in 27 patients, remained stable in 51, and worsened in 14. The CN function improved after SRS in 12% of patients at 1 year, 24% at 2 years, 27% at 3 years, and 32% at 5 years. Symptomatic adverse radiation effects occurred in 7 patients at a median of 7 months after SRS (range 5–38 months). Six patients underwent repeat SRS at a median of 64 months (range 44–134 months). Four patients underwent resection at a median of 14 months after SRS (range 8–30 months).CONCLUSIONSStereotactic radiosurgery proved to be a safe and effective primary or adjuvant management approach for JFSs. Long-term tumor control rates and stability or improvement in CN function were confirmed.

Cranial Nerve Preservation and Outcomes after Stereotactic Radiosurgery for Jugular Foramen Schwannomas

Neurosurgery ◽  
2007 ◽  
Vol 61 (1) ◽  
pp. 76-81 ◽  
Author(s):  
Juan J. Martin ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
David Mathieu ◽  
Ajay Niranjan ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cranial Nerve ◽  
Gamma Knife Radiosurgery ◽  
Jugular Foramen ◽  
Tumor Control ◽  
Lower Cranial Nerve ◽  
Nerve Preservation ◽  
Cranial Nerve Function ◽  
Cranial Neuropathies ◽  
Cranial Nerve Preservation

Abstract OBJECTIVE Jugular foramen region schwannomas are rare intracranial tumors that usually present with multiple lower cranial nerve deficits. For some patients, complete surgical resection is possible but may be associated with significant morbidity. Stereotactic radiosurgery is a minimally invasive alternative or adjunct to microsurgery for such tumors. We reviewed our clinical and imaging outcomes after patients underwent gamma knife radiosurgery for management of jugular foramen schwannomas. METHODS Thirty-four patients with 35 tumors (one patient had bilateral tumors) underwent radiosurgery between May 1990 and December 2005. Twenty-two patients had previous microsurgical resection and all patients experienced various cranial neuropathies. A median of six isocenters were used. Median marginal and maximum doses were 14 and 28 Gy, respectively. RESULTS None of the patients were lost to evaluation and the mean duration of follow-up was 83 months. Tumors regressed in 17 patients, remained stable in 16, and progressed in two. Five- and 10-year actuarial control rates were 97 and 94%, respectively. Preexisting cranial neuropathies improved in 20% and remained stable in 77% after radiosurgery. One patient worsened. The function of all previous intact nerves was preserved after radiosurgery. CONCLUSION Stereotactic radiosurgery proved to be a safe and effective management for newly diagnosed or residual jugular foramen schwannomas. Long-term tumor control rates and stability or improvement in cranial nerve function was confirmed.

TRANSSPHENOIDAL DECOMPRESSION OF THE SELLAR FLOOR FOR CAVERNOUS SINUS MENINGIOMAS

Neurosurgery ◽  
2009 ◽  
Vol 65 (1) ◽  
pp. 54-62 ◽  
Author(s):  
Hiroyoshi Akutsu ◽  
Jürgen Kreutzer ◽  
Rudolf Fahlbusch ◽  
Michael Buchfelder
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Adjuvant Radiotherapy ◽  
Complete Recovery ◽  
Endocrine Function ◽  
Hormone Deficiency ◽  
Tumor Control ◽  
Cranial Nerve Dysfunction ◽  
Cranial Nerve Function

ABSTRACT OBJECTIVE The aim of this study was to assess the outcome of cranial nerve and endocrine function after transsphenoidal decompression for symptomatic cavernous sinus (CS) meningioma. METHODS Between 1991 and 2007, 21 patients (19 women and 2 men; mean age, 51.1 ± 10.6 years) harboring symptomatic CS meningiomas underwent transsphenoidal decompression. Sufficient bone removal, opening of the inferomedial wall of the CS, and tumor debulking were performed. RESULTS Notably, the grading of preoperative optomotoric paresis improved in 15 of the 17 patients who presented with that symptom. Complete recovery could be achieved in 8 patients. Complete recovery rates in patients with preoperative grading of “good,” “fair,” and “poor” were 77.7%, 20%, and 0%, respectively (P = 0.0088). Improvement of cranial nerve dysfunction was found in 32 of 34 deficits. No worsening of cranial nerve function occurred. Endocrinologically, the prolactin level was normalized in 13 of the 17 patients with preoperative hyperprolactinemia. Recovery of growth hormone deficiency and hypogonadism were found in 3 patients (37.5%) and 1 patient (33.3%), respectively. Seventeen patients were followed for more than 3 years. Of these 17 patients, 12 patients received initial postoperative adjuvant radiotherapy. The overall tumor control rate after surgery with initial adjuvant radiotherapy was 100% (median follow-up, 65 months; range, 36–126 months). CONCLUSION Transsphenoidal decompression is a safe and effective treatment to improve cranial nerve and endocrine dysfunction in patients with symptomatic CS meningiomas. The less severe optomotoric nerve palsy before surgery, the better the chance of complete recovery of its function. Combined with adjuvant radiotherapy, this minimally invasive management also provided excellent long-term tumor control.

scholarly journals Stereotactic Radiosurgery of Cavernous Sinus Meningiomas

2019 ◽  
Vol 81 (02) ◽  
pp. 158-164
Author(s):  
Daniel Rueß ◽  
Fenja Fritsche ◽  
Stefan Grau ◽  
Harald Treuer ◽  
Mauritius Hoevels ◽  
...  
Keyword(s):  
Side Effects ◽  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Symptom Control ◽  
High Rate ◽  
Tumor Control ◽  
Incomplete Resection ◽  
Kaplan Meier ◽  
Microsurgical Resection

Abstract Objective Microsurgical resection of cavernous sinus meningiomas (CSM) is associated with a high rate of incomplete resection, recurrence, and the risk for permanent, severe cranial nerve deficits. Stereotactic radiosurgery (SRS) has evolved as alternative treatment for primary and recurrent CSM. Here, we report about the long-term clinical and radiological follow-up (FU) of a unique cohort of patients with CSM treated with LINAC or Cyberknife based SRS. Methods In this single-center retrospective analysis, we include all patients with CSM who underwent single fraction SRS between 1993 and 2016. Clinical and radiological tumor control were evaluated by the Kaplan–Meier method. Additionally, patient data were analyzed in terms of symptom control and incidence of side effects rated by the common terminology criteria for adverse events (CTCAE; v4.03). Results 116 patients (female/male = 91/25; median age, 54 years; range, 33–82 years) were included. Mean tumor volume was 5.7 ± 3.3 cm3 (range, 0.6–16.2 cm3), the median marginal dose was 12.6 Gy applied to isodose levels of 75%. Median clinical FU was 55 months (range, 3–226 months). Tumor control was 98% after 2 and 5 years and 90% after 10 years. Twelve patients (10.3%) had permanent or transient radiation related toxicity (CTCAE I–III). An improvement of symptoms was observed in 26.7% of the symptomatic patients (n = 20 of 75). Conclusion SRS for CSM provides excellent long-term tumor and symptom control without considerable permanent side effects. Thus, SRS should be considered when counseling patients suffering from CSM.

184 Cranial Nerve Function Before and After Stereotactic Radiosurgery for Cavernous Sinus Meningiomas

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. E571-E572 ◽  
Author(s):  
Hideyuki Kano ◽  
Kyung-Jae Park ◽  
Aditya K. Iyer ◽  
Ajay Niranjan ◽  
John Flickinger ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Nerve Function ◽  
Cranial Nerve Function ◽  
Before And After

scholarly journals Gamma Knife stereotactic radiosurgery for cavernous sinus meningioma: long-term follow-up in 200 patients

2019 ◽  
Vol 130 (6) ◽  
pp. 1799-1808 ◽  
Author(s):  
Kyung-Jae Park ◽  
Hideyuki Kano ◽  
Aditya Iyer ◽  
Xiaomin Liu ◽  
Daniel A. Tonetti ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Cavernous Sinus Meningioma ◽  
Long Term Study

OBJECTIVEThe authors of this study evaluate the long-term outcomes of stereotactic radiosurgery (SRS) for cavernous sinus meningioma (CSM).METHODSThe authors retrospectively assessed treatment outcomes 5–18 years after SRS in 200 patients with CSM. The median patient age was 57 years (range 22–83 years). In total, 120 (60%) patients underwent Gamma Knife SRS as primary management, 46 (23%) for residual tumors, and 34 (17%) for recurrent tumors after one or more surgical procedures. The median tumor target volume was 7.5 cm3 (range 0.1–37.3 cm3), and the median margin dose was 13.0 Gy (range 10–20 Gy).RESULTSTumor volume regressed in 121 (61%) patients, was unchanged in 49 (25%), and increased over time in 30 (15%) during a median imaging follow-up of 101 months. Actuarial tumor control rates at the 5-, 10-, and 15-year follow-ups were 92%, 84%, and 75%, respectively. Of the 120 patients who had undergone SRS as a primary treatment (primary SRS), tumor progression was observed in 14 (11.7%) patients at a median of 48.9 months (range 4.8–120.0 months) after SRS, and actuarial tumor control rates were 98%, 93%, 85%, and 85% at the 1-, 5-, 10-, and 15-year follow-ups post-SRS. A history of tumor progression after microsurgery was an independent predictor of an unfavorable response to radiosurgery (p = 0.009, HR = 4.161, 95% CI 1.438–12.045). Forty-four (26%) of 170 patients who had presented with at least one cranial nerve (CN) deficit improved after SRS. Development of new CN deficits after initial microsurgical resection was an unfavorable factor for improvement after SRS (p = 0.014, HR = 0.169, 95% CI 0.041–0.702). Fifteen (7.5%) patients experienced permanent CN deficits without evidence of tumor progression at a median onset of 9 months (range 2.3–85 months) after SRS. Patients with larger tumor volumes (≥ 10 cm3) were more likely to develop permanent CN complications (p = 0.046, HR = 3.629, 95% CI 1.026–12.838). Three patients (1.5%) developed delayed pituitary dysfunction after SRS.CONCLUSIONSThis long-term study showed that Gamma Knife radiosurgery provided long-term tumor control for most patients with CSM. Patients who underwent SRS for progressive tumors after prior microsurgery had a greater chance of tumor growth than the patients without prior surgery or those with residual tumor treated after microsurgery.

Stereotactic radiosurgery for cerebellopontine angle meningiomas

2014 ◽  
Vol 120 (3) ◽  
pp. 708-715 ◽  
Author(s):  
Seong-Hyun Park ◽  
Hideyuki Kano ◽  
Ajay Niranjan ◽  
John C. Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cerebellopontine Angle ◽  
Tumor Volume ◽  
Progression Free Survival ◽  
Tumor Control ◽  
Improvement Rate ◽  
Free Survival ◽  
Neurological Improvement ◽  
Presenting Symptoms

Object To assess the long-term outcomes of stereotactic radiosurgery (SRS) for cerebellopontine angle (CPA) meningiomas, the authors retrospectively reviewed data from a 20-year experience. They evaluated progression-free survival as well as improvement, stabilization, or deterioration in clinical symptoms. Methods Seventy-four patients with CPA meningiomas underwent SRS involving various Gamma Knife technologies between 1990 and 2010. The most common presenting symptoms were dizziness or disequilibrium, hearing loss, facial sensory dysfunction, and headache. The median tumor volume was 3.0 cm3 (range 0.3–17.1 cm3), and the median radiation dose to the tumor margin was 13 Gy (range 11–16 Gy). The median follow-up period was 40 months (range 4–147 months). Results At last imaging follow-up, the tumor volume had decreased in 46 patients (62%), remained stable in 26 patients (35%), and increased in 2 patients (3%). The progression-free survival after SRS was 98% at 1 year, 98% at 3 years, and 95% at 5 years. At the last clinical follow-up, 23 patients (31%) showed neurological improvement, 43 patients (58%) showed no change in symptoms or signs, and 8 patients (11%) had worsening symptoms or signs. The neurological improvement rate after SRS was 16% at 1 year, 31% at 3 years, and 40% at 5 years. The post-SRS deterioration rate was 5% at 1 year, 10% at 3 years, and 16% at 5 years. A multivariate analysis demonstrated that trigeminal neuralgia was the symptom most likely to worsen after SRS (HR 0.08, 95% CI 0.02–0.31; p = 0.001). Asymptomatic peritumoral edema occurred in 4 patients (5%) after SRS, and symptomatic adverse radiation effects developed in 7 patients (9%). Conclusions Stereotactic radiosurgery for CPA meningiomas provided a high tumor control rate and relatively low risk of ARE. Tumor compression of the trigeminal nerve by a CPA meningioma resulted in an increased rate of facial pain worsening in this patient experience.

Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas

2001 ◽  
Vol 95 (3) ◽  
pp. 435-439 ◽  
Author(s):  
Masahiro Shin ◽  
Hiroki Kurita ◽  
Tomio Sasaki ◽  
Shunsuke Kawamoto ◽  
Masao Tago ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Univariate Analysis ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Long Term Outcome ◽  
Content Type ◽  
Fine Print

Object. The long-term outcome of stereotactic radiosurgery for cavernous sinus (CS) meningiomas is not fully understood. The authors retrospectively reviewed their experience with 40 CS meningiomas treated with gamma knife radiosurgery. Methods. Follow-up periods for the 40 patients ranged from 12 to 123 months (median 42 months), and the overall tumor control rates were 86.4% at 3 years and 82.3% at 10 years. Factors associated with tumor recurrence in univariate analysis were histological malignancy (p < 0.0001), partial treatment (p < 0.0001), suprasellar tumor extension (p = 0.0201), or extension in more than three directions outside the CS (p = 0.0345). When the tumor was completely covered with a dose to the margin that was higher than 14 Gy (Group A, 22 patients), no patient showed recurrence within the median follow-up period of 37 months. On the other hand, when a part of the tumor was treated with 10 to 12 Gy (Group B, 15 patients) or did not receive radiation therapy (Group C, three patients), the recurrence rates were 20% and 100%, respectively. Neurological deterioration was seen in nine patients, but all symptoms were transient or very mild. Conclusions. The data indicate that stereotactic radiosurgery can control tumor growth if the whole mass can be irradiated by dosages of more than 14 Gy. When optimal radiosurgical planning is not feasible because of a tumor's large size, irregular shape, or proximity to visual pathways, use of limited surgical resection before radiosurgery is the best option and should provide sufficient long-term tumor control with minimal complications.

Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas

2002 ◽  
Vol 97 (1) ◽  
pp. 65-72 ◽  
Author(s):  
John Y. K. Lee ◽  
Ajay Niranjan ◽  
James McInerney ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
External Beam Radiation ◽  
Tumor Control ◽  
Tumor Diameter ◽  
Beam Radiation ◽  
Content Type ◽  
Tumor Control Rate ◽  
Fine Print

Object. To evaluate long-term outcomes of patients who have undergone stereotactic radiosurgery for cavernous sinus meningiomas, the authors retrospectively reviewed their 14-year experience with these cases. Methods. One hundred seventy-six patients harbored meningiomas centered within the cavernous sinus. Seventeen patients were lost to follow-up review, leaving 159 analyzable patients, in whom 164 procedures were performed. Seventy-six patients (48%) underwent adjuvant radiosurgery after one or more attempts at surgical resection. Eighty-three patients (52%) underwent primary radiosurgery. Two patients (1%) had previously received fractionated external-beam radiation therapy. Four patients (2%) harbored histologically verified atypical or malignant meningiomas. Conformal multiple isocenter gamma knife surgery was performed. The median dose applied to the tumor margin was 13 Gy. Neurological status improved in 46 patients (29%), remained stable in 99 (62%), and eventually worsened in 14 (9%). Adverse effects of radiation occurred after 11 procedures (6.7%). Tumor volumes decreased in 54 patients (34%), remained stable in 96 (60%), and increased in nine (6%). The actuarial tumor control rate for patients with typical meningiomas was 93.1 ± 3.3% at both 5 and 10 years. For the 83 patients who underwent radiosurgery as their sole treatment, the actuarial tumor control rate at 5 years was 96.9 ± 3%. Conclusions. Stereotactic radiosurgery provided safe and effective management of cavernous sinus meningiomas. We believe it is the preferred management strategy for tumors of suitable volume (average tumor diameter ≤ 3 cm or volume ≤ 15 cm3).

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