Gamma Knife surgery for benign meningioma

Object Meningioma is the most frequent benign tumor treated with Gamma Knife surgery (GKS); however, the assessment of its efficacy and safety in slow-growing tumors is an ongoing process, requiring analysis of long-term results. Methods Three hundred sixty-eight patients harboring 400 meningiomas treated between 1992 and 1999 at Na Homolce Hospital were evaluated. The median patient age was 57 years (range 18–84 years). The median tumor volume was 4.4 cm3 (range 0.11–44.9 cm3). The median tumor margin dose to the 50% isodose line was 12.55 Gy (range 6.5–24 Gy). Descriptive analysis was performed in 331 patients (90%); 325 patients had a follow-up longer than 24 months (median 60 months), and six patients were included because of posttreatment complications. The volume of treated tumors decreased in 248 cases (69.7%), remained the same in 99 (27.8%), and increased in nine (2.5%). The actuarial tumor control rate was 97.9% at 5 years post-GKS. Perilesional edema after radiosurgery was confirmed on neuroim-aging in 51 patients (15.4%). The temporary and permanent morbidity rates after radiosurgery were 10.2 and 5.7%, respectively. Results A significantly higher incidence of tumor volume increase was observed in men compared with women and in tumors treated with a margin dose lower than 12 Gy. Significant risk factors for edema included an age greater than 60 years, no previous surgery, perilesional edema before radiosurgery, a tumor volume greater than 10 cm3, a tumor location in the anterior fossa, and a margin dose greater than 16 Gy. Conclusions Stereotactic radiosurgery is a safe method of treatment for meningiomas. A minimum margin dose of 12 to 16 Gy seems to represent the therapeutic window for benign meningiomas with a high tumor control rate in a mid-term follow-up period.

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Gamma Knife radiosurgery for vestibular schwannomas: evaluation of tumor control and its predictors in a large patient cohort in The Netherlands

Journal of Neurosurgery ◽

10.3171/2015.4.jns142415 ◽

2016 ◽

Vol 124 (6) ◽

pp. 1619-1626 ◽

Cited By ~ 41

Author(s):

Stijn Klijn ◽

Jeroen B. Verheul ◽

Guus N. Beute ◽

Sieger Leenstra ◽

Jef J. S. Mulder ◽

...

Keyword(s):

Gamma Knife ◽

Tumor Volume ◽

Gamma Knife Radiosurgery ◽

Hearing Preservation ◽

Cox Proportional Hazards Model ◽

Tumor Control ◽

Complication Rates ◽

Tumor Control Rate ◽

Large Patient

OBJECT The authors of this study sought to assess tumor control and complication rates in a large cohort of patients who underwent Gamma Knife radiosurgery (GKRS) for vestibular schwannoma (VS) and to identify predictors of tumor control. METHODS The records of 420 patients treated with GKRS for VS with a median marginal dose of 11 Gy were retrospectively analyzed. Patients with neurofibromatosis Type 2 or who had undergone treatment for VS previously were excluded. The authors assessed tumor control and complication rates with chart review and used the Cox proportional hazards model to identify predictors of tumor control. Preservation of serviceable hearing, defined as Gardner-Robertson Class I–II, was evaluated in a subgroup of 71 patients with serviceable hearing at baseline and with available follow-up audiograms. RESULTS The median VS tumor volume was 1.4 cm3, and the median length of follow-up was 5.1 years. Actuarial 5-and 10-year tumor control rates were 91.3% and 84.8%, respectively. Only tumor volume was a statistically significant predictor of tumor control rate. The tumor control rate decreased from 94.1% for tumors smaller than 0.5 cm3 to 80.7% for tumors larger than 6 cm3. Thirteen patients (3.1%) had new or increased permanent trigeminal nerve neuropathy, 4 (1.0%) had new or increased permanent facial weakness, and 5 (1.2%) exhibited new or increased hydrocephalus requiring a shunting procedure. Actuarial 3-year and 5-year hearing preservation rates were 65% and 42%, respectively. CONCLUSIONS The 5-year actuarial tumor control rate of 91.3% in this cohort of patients with VS compared slightly unfavorably with the rates reported in other large studies, but the complication and hearing preservation rates in this study were similar to those reported previously. Various factors may contribute to the observed differences in reported outcomes. These factors include variations in treatment indication and in the definition of treatment failure, as well as a lack of standardization of terminology and of evaluation of complications. Last, differences in dosimetric variables may also be an explanatory factor.

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Volume reduction in meningiomas after gamma knife surgery

Journal of Neurosurgery ◽

10.3171/jns.2005.102.s_supplement.0189 ◽

2005 ◽

Vol 102 ◽

pp. 189-194 ◽

Cited By ~ 26

Author(s):

Guenther C. Feigl ◽

Otto Bundschuh ◽

Alireza Gharabaghi ◽

Madjid Samii ◽

Gerhard A. Horstmann

Keyword(s):

Gamma Knife ◽

Tumor Volume ◽

Gamma Knife Surgery ◽

Volume Reduction ◽

World Health ◽

Tumor Control ◽

Content Type ◽

The Mean ◽

Fine Print

Object.The purpose of this study was to evaluate the volume-reducing effects of gamma knife surgery (GKS) of meningiomas with and without previous surgical treatment.Methods.A group of 127 patients with a mean age of 57.1 years (range 9–81 years) with 142 meningiomas (128 World Health Organization Grade I and 14 Grade II) were included in this study. The management strategy reduces tumor volume with surgery when necessary (81 patients). Stereotactic GKS with a Gamma Knife model C was performed in all tumors of suitable size. Magnetic resonance imaging follow-up examinations with volumetric tumor analysis was performed 6 months after treatment and annually thereafter.The mean tumor volume was 5.9 cm3(range < 5 to > 40 cm3). The mean follow-up time after GKS was 29.3 months (range 11–61 months). The mean prescription dose was 13.8 Gy (range 10–18 Gy). A reduction in volume occurred in 117 (82.4%) of all tumors, and in 20 tumors (14.1%) growth ceased. The overall tumor control rate of 96.4%. The mean volume reduction achieved with GKS was more than 46.1%. Only five tumors (3.5%) showed a volume increase.Conclusions.Gamma knife surgery was effective in reducing meningioma volume at short-term follow up. Further studies are needed to examine the development of these findings over a longer period.

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Long-term tumor control and cranial nerve outcomes following Gamma Knife surgery for larger-volume vestibular schwannomas

Journal of Neurosurgery ◽

10.3171/2011.11.jns11811 ◽

2012 ◽

Vol 116 (3) ◽

pp. 598-604 ◽

Cited By ~ 56

Author(s):

Brian D. Milligan ◽

Bruce E. Pollock ◽

Robert L. Foote ◽

Michael J. Link

Keyword(s):

Posterior Fossa ◽

Gamma Knife ◽

Cranial Nerve ◽

Tumor Volume ◽

Gamma Knife Surgery ◽

Tumor Control ◽

Tumor Diameter ◽

Tumor Margin ◽

Median Maximum

Object Gamma Knife surgery (GKS) for vestibular schwannoma (VS) is an accepted treatment for small- to medium-sized tumors, generally smaller than 2.5 cm in the maximum posterior fossa dimension. The purpose of this study was to evaluate the efficacy and toxicity of GKS for larger tumors. Methods Prospectively collected data were analyzed for 22 patients who had undergone GKS for VSs larger than 2.5 cm in the posterior fossa diameter between 1997 and 2006. No patient had symptomatic brainstem compression at the time of GKS. The median treated tumor volume was 9.4 cm3 (range 5.3–19.1 cm3). The median maximum posterior fossa diameter was 2.8 cm (range 2.5–3.8 cm). The median tumor margin dose was 12 Gy (range 12–14 Gy). Serial imaging, audiometry (10 patients with serviceable hearing pre-GKS), and clinical follow-up were available for a median of 66 months (range 26–121 months). Tumor control failure was defined as either a progressive increase in tumor diameter of at least 2 mm in any dimension or a later resection. Results Four patients met the criteria for GKS failure, including 1 patient who demonstrated sarcomatous degeneration more than 7 years after GKS and died 3 months after microsurgical debulking. An enlarging cystic component was the surgical indication in 1 of the 2 patients who required resection, although 27% of tumors (6 lesions) were cystic before GKS. The 3-year actuarial rate of tumor control, freedom from new facial neuropathy, and preservation of functional hearing were 86%, 92%, and 47%, respectively. At 5 years post-GKS, these rates decreased to 82%, 85%, and 28%, respectively. At the most recent follow-up, 91% of tumors were smaller than at the time of GKS and the median maximum posterior fossa diameter reduction was 26%. On multivariate analysis, none of the following factors was associated with GKS failure, new facial weakness, new trigeminal neuropathy, or loss of serviceable hearing: patient age, tumor volume, tumor margin dose, and preoperative cranial nerve dysfunction. Conclusions Single-session radiosurgery is a successful treatment for the majority of patients with larger VSs. Although tumor control rates are lower than those for smaller VSs managed with GKS, the cranial nerve morbidity of GKS is significantly lower than that typically achieved via resection of larger VSs.

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Gamma Knife surgery for central neurocytomas

Journal of Neurosurgery ◽

10.3171/2012.6.gks12214 ◽

2012 ◽

Vol 117 (Special_Suppl) ◽

pp. 96-101 ◽

Cited By ~ 11

Author(s):

Bengt Karlsson ◽

Wan-Yuo Guo ◽

Teo Kejia ◽

Nivedh Dinesh ◽

David Hung-Chi Pan ◽

...

Keyword(s):

Gamma Knife ◽

Traffic Accident ◽

Central Neurocytoma ◽

Gamma Knife Surgery ◽

Tumor Control ◽

Local Tumor ◽

Combine Data ◽

Tumor Control Rate ◽

Distant Tumor

Object The optimal management of central neurocytoma (CN) remnants and recurrences is still not clear. To date no large series of patients treated with Gamma Knife surgery (GKS) for CNs has been published. For that reason the authors decided to combine data from 5 different centers so that they could analyze the largest population of patients treated with GKS for CN currently available. Methods Data obtained in 42 patients who were treated for CN with GKS before July 1, 2010, were retrospectively collected and analyzed. The median prescribed dose was 13 Gy (range 11–25 Gy). The follow-up time in these patients ranged from 0.5 to 14.7 years (mean 6.1 years, median 4.9 years). Eleven patients were followed up for 5–10 years and 9 patients for more than 10 years. All patients were alive and well at the closing of the study except 1 patient, who died of injuries sustained in a traffic accident. Results Two cases of local tumor progression and 2 cases of distant tumor recurrence occurred among the patient population, yielding 5- and 10-year tumor control rates of 91% and 81%, respectively. No permanent complications occurred. The findings were in line with results reported in earlier publications. Despite the high tumor control rate, enlargement of part of or the whole ventricular system was seen in 45% of patients. Conclusions The high tumor control rate and the low complication rate following GKS indicate that GKS is the preferred treatment for CN tumor remnants or recurrences following microsurgery. However, data from longer follow-up times in more patients are needed before this conclusion can be validated. The patients need to be closely monitored and potential hydrocephalus managed despite tumor control.

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Same-day stereotactic aspiration and Gamma Knife surgery for cystic intracranial tumors

Journal of Neurosurgery ◽

10.3171/2012.7.gks121019 ◽

2012 ◽

Vol 117 (Special_Suppl) ◽

pp. 45-48 ◽

Cited By ~ 11

Author(s):

Xiaomin Liu ◽

Qi Yu ◽

Zhiyuan Zhang ◽

Yipei Zhang ◽

Yanhe Li ◽

...

Keyword(s):

Gamma Knife ◽

Tumor Volume ◽

Symptom Relief ◽

Gamma Knife Surgery ◽

Tumor Control ◽

Intracranial Tumors ◽

Glial Tumor ◽

Stereotactic Aspiration ◽

Cyst Aspiration

Object The goal of this study was to evaluate the efficacy and safety of same-day stereotactic aspiration and Gamma knife surgery (GKS) for cystic intracranial tumors. Methods Between 1996 and 2007, 77 patients harboring cystic intracranial tumors underwent a same-day procedure of MRI-guided cyst aspiration followed by GKS. The diagnoses were metastatic tumor in 43 patients, glial tumor in 12 patients, vestibular schwannoma in 10 patients, craniopharyngioma in 9 patients, and hemangioblastoma in 3 patients. Results An improvement in symptoms was achieved in 68 patients (88.3%) immediately after cyst aspiration. The mean tumor volume in this group of patients was 25.1 cm3 before aspiration and 11.1 cm3 afterward. Hemorrhage during the course of aspiration was encountered in 1 patient. Transient nausea after cyst aspiration developed in 3 patients. There was no treatment-related hematoma, seizure, neurological deficit, or infection. The median follow-up period was 16 months (range 6–108 months). Tumor control was achieved in 50 (80.6%) of 62 patients who participated in follow-up for at least 6 months. Conclusions The same-day stereotactic aspiration and GKS procedure was safe in patients with cystic brain tumors. Prompt symptom relief was obtained after cyst aspiration. The decrease in tumor volume following aspiration made GKS more effective because a higher prescription dose could be administered with a lower possibility of radiation-induced side effects.

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Volume reduction in meningiomas after gamma knife surgery

Journal of Neurosurgery ◽

10.3171/sup.2005.102.s_supplement.0189 ◽

2005 ◽

Vol 102 (Special_Supplement) ◽

pp. 189-194 ◽

Cited By ~ 8

Author(s):

Guenther C. Feigl ◽

Otto Bundschuh ◽

Alireza Gharabaghi ◽

Madjid Samii ◽

Gerhard A. Horstmann

Keyword(s):

Gamma Knife ◽

Tumor Volume ◽

Gamma Knife Surgery ◽

Volume Reduction ◽

World Health ◽

Tumor Control ◽

Content Type ◽

The Mean ◽

Fine Print

Object. The purpose of this study was to evaluate the volume-reducing effects of gamma knife surgery (GKS) of meningiomas with and without previous surgical treatment. Methods. A group of 127 patients with a mean age of 57.1 years (range 9–81 years) with 142 meningiomas (128 World Health Organization Grade I and 14 Grade II) were included in this study. The management strategy reduces tumor volume with surgery when necessary (81 patients). Stereotactic GKS with a Gamma Knife model C was performed in all tumors of suitable size. Magnetic resonance imaging follow-up examinations with volumetric tumor analysis was performed 6 months after treatment and annually thereafter. The mean tumor volume was 5.9 cm3 (range < 5 to > 40 cm3). The mean follow-up time after GKS was 29.3 months (range 11–61 months). The mean prescription dose was 13.8 Gy (range 10–18 Gy). A reduction in volume occurred in 117 (82.4%) of all tumors, and in 20 tumors (14.1%) growth ceased. The overall tumor control rate of 96.4%. The mean volume reduction achieved with GKS was more than 46.1%. Only five tumors (3.5%) showed a volume increase. Conclusions. Gamma knife surgery was effective in reducing meningioma volume at short-term follow up. Further studies are needed to examine the development of these findings over a longer period.

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Multisession Gamma Knife surgery for benign orbital tumors

Journal of Neurosurgery ◽

10.3171/2012.7.gks12780 ◽

2012 ◽

Vol 117 (Special_Suppl) ◽

pp. 102-107 ◽

Cited By ~ 5

Author(s):

Kyung-Il Jo ◽

Yong Seok Im ◽

Doo-Sik Kong ◽

Ho Jun Seol ◽

Do-Hyun Nam ◽

...

Keyword(s):

Visual Acuity ◽

Optic Nerve ◽

Gamma Knife ◽

Direct Contact ◽

Tumor Volume ◽

Gamma Knife Surgery ◽

Tumor Control ◽

Orbital Tumors ◽

Cavernous Hemangiomas

Object The goal of this study was to investigate the safety and efficacy of multisession Gamma Knife surgery (GKS) in the treatment of benign orbital tumors. Methods Twenty-three patients who retained their vision despite having tumors touching their optic nerve were treated with multisession (4-fraction) GKS. The median tumor volume was 2800 mm3 (range 211–10,800 mm3), and the median cumulative margin dose was 20 Gy (range 18–22 Gy). Results The median clinical follow-up duration in these patients was 38 months (range 9–74 months). No patient experienced tumor progression in this study. In particular, a higher degree of tumor shrinkage was found in the 7 patients with cavernous hemangiomas than in patients with other types of lesions (p < 0.05). Of the 23 patients whose preoperative vision was preserved, 11 showed improvement in visual acuity and/or visual field and 12 showed stable visual acuity. No GKS-related adverse events were noted during or after treatment. Conclusions Multisession radiosurgery using the Gamma Knife may be a good strategy for tumors in direct contact with the optic nerve. A cumulative margin dose of up to 22 Gy delivered in 4 sessions is safe for preservation of visual function with a high probability of tumor control.

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Gamma Knife radiosurgery for glomus jugulare tumors: a single-center series of 75 cases

Journal of Neurosurgery ◽

10.3171/2016.4.jns152667 ◽

2017 ◽

Vol 126 (5) ◽

pp. 1488-1497 ◽

Cited By ~ 17

Author(s):

Ramez Ibrahim ◽

Mohannad B. Ammori ◽

John Yianni ◽

Alison Grainger ◽

Jeremy Rowe ◽

...

Keyword(s):

Gamma Knife ◽

Treatment Option ◽

Gamma Knife Radiosurgery ◽

Long Term Results ◽

Tumor Control ◽

Tumor Control Rate ◽

Glomus Jugulare ◽

Alternative Treatment Option

OBJECTIVEGlomus jugulare tumors are rare indolent tumors that frequently involve the lower cranial nerves (CNs). Complete resection can be difficult and associated with lower CN injury. Gamma Knife radiosurgery (GKRS) has established its role as a noninvasive alternative treatment option for these often formidable lesions. The authors aimed to review their experience at the National Centre for Stereotactic Radiosurgery, Sheffield, United Kingdom, specifically the long-term tumor control rate and complications of GKRS for these lesions.METHODSClinical and radiological data were retrospectively reviewed for patients treated between March 1994 and December 2010. Data were available for 75 patients harboring 76 tumors. The tumors in 3 patients were treated in 2 stages. Familial and/or hereditary history was noted in 12 patients, 2 of whom had catecholamine-secreting and/or active tumors. Gamma Knife radiosurgery was the primary treatment modality in 47 patients (63%). The median age at the time of treatment was 55 years. The median tumor volume was 7 cm3, and the median radiosurgical dose to the tumor margin was 18 Gy (range 12–25 Gy). The median duration of radiological follow-up was 51.5 months (range 12–230 months), and the median clinical follow-up was 38.5 months (range 6–223 months).RESULTSThe overall tumor control rate was 93.4% with low CN morbidity. Improvement of preexisting deficits was noted in 15 patients (20%). A stationary clinical course and no progression of symptoms were noted in 48 patients (64%). Twelve patients (16%) had new symptoms or progression of their preexisting symptoms. The Kaplan-Meier actuarial tumor control rate was 92.2% at 5 years and 86.3% at 10 years.CONCLUSIONSGamma Knife radiosurgery offers a risk-versus-benefit treatment option with very low CN morbidity and stable long-term results.

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Neuroophthalmological evaluation after Gamma Knife surgery for cavernous sinus meningiomas

Neurosurgical FOCUS ◽

10.3171/foc-07/12/e10 ◽

2007 ◽

Vol 23 (6) ◽

pp. E9 ◽

Cited By ~ 7

Author(s):

Alberto Franzin ◽

Alberto Vimercati ◽

Marzia Medone ◽

Carlo Serra ◽

Stefania Bianchi Marzoli ◽

...

Keyword(s):

Gamma Knife ◽

Cavernous Sinus ◽

Tumor Volume ◽

Tumor Resection ◽

Cranial Nerves ◽

Gamma Knife Surgery ◽

Tumor Control ◽

Tumor Control Rate ◽

Line Therapy ◽

The Mean

Object Treatment options for patients with cavernous sinus meningiomas (CSMs) include microsurgical tumor resection, radiotherapy, and radiosurgery. Gamma Knife surgery (GKS) is increasingly being used because it is associated with lower mortality and morbidity rates than microsurgery. The purpose of this study was to assess the role of GKS in the treatment of CSM and to thoroughly analyze the clinical response to GKS. Methods Between January 2001 and December 2005, 123 patients (25 men and 98 women; mean age 62.6 ± 11 years, range 31–86 years) who underwent treatment for CSMs were included in this study. Of these, 41 patients underwent microsurgery before GKS, whereas the remaining 82 had GKS as a first-line therapy after a diagnosis was made based on magnetic resonance imaging findings. Dysfunction in cranial nerves (CNs) II, III, IV, V, and VI was noted in 74 patients at the time of GKS. The mean tumor volume was 7.99 cm3 (0.7–30.5 cm3). The mean prescription dose to the tumor margin was 13.8 ± 1.1 Gy (range 10–20 Gy). Results The overall tumor control rate was 98.4% with a median follow-up of 36 months. The actuarial tumor control rate at 5 years was 90.5%. A reduction in tumor volume was observed in 53 patients (43.1%), whereas in 68 patients (55.3%) no volumetric variation was recorded. Of the 74 patients who presented with CN deficits, improvement was noted in 23 (31.1%). Conclusions Gamma Knife surgery is a useful treatment for CSM both as a first- or second-line therapy. It is a safe and effective treatment for tumors located close to the optic pathways.

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Long-term results of Gamma Knife surgery for uveal melanomas

Journal of Neurosurgery ◽

10.3171/2012.8.gks121002 ◽

2012 ◽

Vol 117 (Special_Suppl) ◽

pp. 108-114 ◽

Cited By ~ 10

Author(s):

Dong Wan Kang ◽

Sung Chul Lee ◽

Yong Gou Park ◽

Jong Hee Chang

Keyword(s):

Gamma Knife ◽

Visual Function ◽

Tumor Volume ◽

Tumor Regression ◽

Hand Movement ◽

Gamma Knife Surgery ◽

Long Term Results ◽

Tumor Control ◽

The Mean ◽

Uveal Melanomas

Object Gamma Knife surgery (GKS) is currently believed to be a safe and minimally invasive modality in the treatment of uveal melanomas. It could be used as an alternative treatment to enucleation, preserving the eyeball as well as visual function. The authors report their experiences with GKS for uveal melanomas for the period from February 1998 to December 2006. Methods Twenty-two patients with uveal melanoma were enrolled in this study. The population consisted of 12 men and 10 women with a mean age of 53.4 years (range 24–79 years). The mean tumor volume was 877 mm3, and the mean margin dose was 45.6 Gy. The median follow-up period was 67 months (range 3–126 months). All of the patients had received a diagnosis and referral from an ophthalmology clinic; the patients underwent a preoperative orbital examination that included MRI. Results Tumor regression was achieved in 20 patients (90.9%), whereas tumor progression was observed in 2 patients (9.1%) 3 years after GKS. The cumulative 1-year and 2-year mean rates of tumor thickness reduction were 18.8% and 42.8%, respectively. The mean rate of tumor volume reduction was 63.7%. The rate of eye retention 5 years after radiosurgery was 77.3% (17 of 22 patients). Overall visual acuity was reduced after GKS in all patients; 14 patients (63.6%) displayed preserved visual function better than hand-movement perception. The most frequent side effect was cataract, which was detected in 9 patients (40.9%); this was followed in frequency by radiation-induced retinopathy in 5 patients (22.7%). Conclusions Gamma Knife surgery provides excellent local control of uveal melanomas with a decrease in volume over time. This procedure not only preserves the eyeball and its potential visual function, but also decreases the potential for hematological dissemination and achieves sufficient local tumor control with a gradual reduction in volume.

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