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Acta Neurochirurgica
Erschienen in: Acta Neurochirurgica 1/2009

01.01.2009 | Clinical Article

Gamma Knife surgery of large meningiomas: early response to treatment

verfasst von: J. C. Ganz, W. A. Reda, K. Abdelkarim

Erschienen in: Acta Neurochirurgica | Ausgabe 1/2009

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Abstract

Purpose

Gamma Knife treatment is traditionally limited to tumours with a diameter not exceeding 3–3.5 cm. The current paper presents 97 patients with meningiomas with a minimum volume of 10 cm3, treated with a prescription dose of 12 Gy (or sometimes less to protect neighbouring structures). The post-treatment assessment of these patients, the early response to treatment and the complications of treatment are presented.

Methods

There were 97 patients, 70 females and 27 males. The mean age was 48.1 years (range 20.4–87.2 years). The mean follow-up was 54 months (range 25–86 months). All tumours had a volume of 10 cm3 or more. The mean volume was 15.9 cm3 (range 10.0–43.2 cm3). Post-treatment follow-up used quantitative and qualitative assessments, which are described.

Results

No tumour continued to grow. Twenty-seven were smaller and 72 unchanged in volume. Three patients suffered adverse radiation effects (defined as a new post-treatment oedema detected on the magnetic resonance image with or without contrast leakage). In one case this was silent. In two cases the clinical and radiological effects were temporary and resolved completely.

Conclusions

It is suggested on the basis of this material that the dosimetry used here permits the safe Gamma Knife treatment of larger meningiomas within the range reported. The early radiological response is encouraging, but further follow-up is needed to check long term tumour control. A qualitative method of tumour volume assessment is presented. It seems to be a simpler and more reliable way of assessing tumour volume changes than other methods currently in routine use.
Literatur
1.
Altinors N, Gurses L, Arda N, Turker A, Senveli E, Donmez T, Sanli M, Bavbek M, Caner H (1998) Intracranial meningiomasAnalysis of 344 surgically treated cases. Neurosurg Rev 21:106–110PubMedCrossRef
2.
Alheit H, Saran FH, Warrington AP, Rosenberg I, Perks J, Jalali R, Shepherd S, Beardmore C, Baumert B, Brada M (1999) Stereotactically guided conformal radiotherapy for meningiomas. Radiother Oncol 50:145–150PubMedCrossRef
3.
Arienta C, Caroli M, Crotti F, Villani R (1990) Treatment of intracranial meningiomas in patients over 70 years old. Acta Neurochir (Wien) 107:47–55CrossRef
4.
Brell M, Villa S, Teixidor P, Ferran E, Marin S, Acebes JJ (2006) Fractionated stereotactic radiotherapy in the treatment of exclusive cavernous sinus meningioma: functional outcome, local control, and tolerance. Surg Neurol 65:28–33PubMedCrossRef
5.
Buhl R, Hasan A, Behnke A, Mehdorn HM (2000) Results in the operative treatment of elderly patients with intracranial meningioma. Neurosurg Rev 23:25–29PubMedCrossRef
6.
Candish C, McKenzie M, Clark BG, Ma R, Lee R, Vollans E, Robar J, Gete E, Martin M (2006) Stereotactic fractionated radiotherapy for the treatment of benign meningiomas. Int J Radiat Oncol Biol Phys 66(Suppl 4):3–6
7.
Chang JH, Chang JW, Choi JY, Park YG, Chung SS (2003) Complications after gamma knife radiosurgery for benign meningiomas. J Neurol Neurosurg Psychiatry 74:226–230PubMedCrossRef
8.
Chin LS, Ma L, DiBiase S (2001) Radiation necrosis following gamma knife surgery: a case-controlled comparison of treatment parameters and long-term clinical follow up. J Neurosurg 94:899–904PubMed
9.
Cornu P, Chatellier G, Dagreou F, Clemenceau S, Foncin JF, Rivierez M, Philippon J (1990) Intracranial meningiomas in elderly patients. Postoperative morbidity and mortality factors predictive of outcome. Acta Neurochir (Wien) 102:98–102CrossRef
10.
D’Andrea G, Roperto R, Caroli E, Crispo F, Ferrante L (2005) Thirty-seven cases of intracranial meningiomas in the ninth decade of life: our experience and review of the literature. Neurosurgery 56:956–961PubMed
11.
Debus J, Wuendrich M, Pirzkall A, Hoess A, Schlegel W, Zuna I, Engenhar-Cabilliac R, Wannenmacher M (2001) High efficacy of fractionated stereotactic radiotherapy of large base-of–skull meningiomas: long term results. J Clin Oncol 19:3547–3553PubMed
12.
DiBiase SJ, Kwok Y, Yovino S, Arena C, Naqvi S, Temple R, Regine WF, Amin P, Guo C, Chin LS (2004) Factors predicting local tumour control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 60:1515–1519PubMed
13.
El Shehaby A, Ganz JC, Reda WA, Hafez A (2005) Temporary symptomatic swelling of meningiomas following gamma knife surgery. Report of two cases. J Neurosurg 102(Suppl):293–296PubMed
14.
Eustacchio S, Trummer M, Fuchs I, Schrottner O, Sutter B, Pendl G (2002) Preservation of cranial nerve function following Gamma Knife radiosurgery for benign skull base meningiomas: experience in 121 patients with follow-up of 5 to 9.8 years. Acta Neurochir Suppl 84:71–76PubMed
15.
Feigl GC, Bundschuh O, Gharabaghi A, Samii M, Horstmann GA (2005) Volume reduction in meningiomas after gamma knife surgery. J Neurosurg 102(Suppl):189–194PubMedCrossRef
16.
Flickinger JC, Kondziolka D, Maitz AH, Lunsford LD (2003) Gamma knife radiosurgery of imaging-diagnosed intracranial meningioma. Int J Radiat Oncol Biol Phys 56:801–806PubMed
17.
Ganz JC, Schrottner O, Pendl G (1996) Radiation-induced edema after Gamma Knife treatment for meningiomas. Stereotact Funct Neurosurg 66(Suppl 1):129–133PubMedCrossRef
18.
Ganz JC et al, ANCH-D-08-00144_081007
19.
Guo WY (1993) Radiological aspects of gamma knife radiosurgery for arteriovenous malformations and other non-tumoural disorders of the brain. Acta Radiol Suppl 388:1–34PubMed
20.
Hamm K, Henzel M, Gross MW, Kleinert G, Engenhart-Cabillac R (2008) Radiosurgery/stereotactic radiotherapy in the therapeutical concept for skull base meningiomas. Zentralbl Neurochir 69:14–21PubMedCrossRef
21.
Henzel M, Gross MW, Hamm K, Surber G, Kleinert G, Failing T Strassmann G, Engelhart-Cabillac R (2006) Significant tumor volume reduction of meningiomas after stereotactic radiotherapy: results of a prospective multicenter study. Neurosurgery 59:1188–1194PubMedCrossRef
22.
Hudgins WR, Barker JL, Schwartz DE, Nichols TD (1996) Gamma Knife treatment of 100 consecutive meningiomas. Stereotact Funct Neurosurg 66(Suppl 1):121–128PubMedCrossRef
23.
Iwai Y, Yamanaka K, Ishiguro T (2003) Gamma knife radiosurgery for the treatment of cavernous sinus meningiomas. Neurosurgery 52:517–524PubMedCrossRef
24.
Iwai Y, Yamanaka K, Nakajima H, Yasui T, Kishi H (2000) Gamma knife radiosurgery for skull base meningiomas: the treatment results and patient satisfaction expressed in answers to a questionnaire. No Shinkei Geka 28:411–415PubMed
25.
Iwai Y, Yamanaka K, Nakajima H (2001) The treatment of skull base meningiomas—combining surgery and radiosurgery. J Clin Neurosci 8:528–533PubMedCrossRef
26.
Kim DG, Kim ChH, Chung HT, Paek SH, Jeong SS, Han DH, Jung HW (2005) Gamma knife surgery of superficially located meningioma. J Neurosurg 102(Suppl):255–258PubMed
27.
Kobayashi T, Kida Y, Mori Y (2001) Long-term results of stereotactic gamma radiosurgery of meningiomas. Surg Neurol 55:325–331PubMedCrossRef
28.
Kondziolka D, Levy EI, Niranjan A, Flickinger JC, Lunsford LD (1999) Long-term outcomes after meningioma radiosurgery: physician and patient perspectives. J Neurosurg 91:44–50PubMed
29.
Kondziolka D, Lunsford LD (1992) Radiosurgery of meningiomas. Neurosurg Clin N Am 3:219–230PubMed
30.
Kondziolka D, Lunsford LD, Flickinger JC (1998) Gamma knife brain surgery. In: Lunsford LD, Kondziolka D, Flickinger JC (eds) Stereotactic radiosurgery fo meningioma. Karger, New York, pp 104–113
31.
Kondziolka D, Lunsford LD, Linsskey ME, Flickinger JC (1993) Skull base radiosurgery. In: Aleander E, Loeffler JS, Lunsford LD (eds) Stereotactic radiosurgery. McGraw Hill, New York, pp 175–188
32.
Kreil W, Luggin J, Fuchs I, Weigl V, Eustacchio S, Papaefthymiou G (2005) Long term experience of gamma knife radiosurgery for benign skull base meningiomas. J Neurol Neurosurg Psychiatry 76:1425–1430PubMedCrossRef
33.
Lieu AS, Howng SL (1998) Surgical treatment of intracranial meningiomas in geriatric patients. Kaohsiung J Med Sci 14:498–503PubMed
34.
Linskey ME, Davis SA, Ratanatharathorn V (2005) Relative roles of microsurgery and stereotactic radiosurgery for the treatment of patients with cranial meningiomas: a single-surgeon 4-year integrated experience with both modalities. J Neurosurg 102(Suppl):59–70PubMed
35.
Liscak R, Kollova A, Vladyka V, Simonova G, Novotny J Jr (2004) Gamma knife radiosurgery of skull base meningiomas. Acta Neurochir Suppl 91:65–74PubMed
36.
Liscak R, Simonova G, Vymazal J, Janouskova L, Vladyka V (1999) Gamma knife radiosurgery of meningiomas in the cavernous sinus region. Acta Neurochir (Wien) 141:473–480CrossRef
37.
Lo SS, Cho KH, Hall WA, Kossow RJ, McCollow KK, Gerbi BJ, Higgins PD, Lee CK, Dusenbery KE (2002) Single dose fractionated stereotactic radiotherapy for meningiomas. Can J Neurol Sci 29:240–248PubMed
38.
Maguire PD, Clough R, Friedman AH, Halperin EC (1999) Fractionated external-beam radiation therapy for meningiomas of the cavernous sinus. Int J Radiat Oncol Biol Phys 44:75–79PubMedCrossRef
39.
Maire P, Vendrely V, Dautheribes M Bonichon N, Darrouzet V (2000) Fractionated radiotherapy of intracranial meingiomas and neurinomas. Cancer Radiother 4(Suppl 1):84–94
40.
Majhail NS, Chander S, Mehta VS, Julka PK, Ganesh T, Rath GK (2001) Factors influencing early complications following Gamma Knife radiosurgery. A prospective study. Stereotact Funct Neurosurg 76:36–46PubMedCrossRef
41.
Mathiesen T, Kihlström L, Karlsson B, Lindquist C (2003) Potential complications following radiotherapy for meningiomas. Surg Neurol 60:193–198PubMedCrossRef
42.
Metellus P, Regis J, Muracciole X, Fuentes S, Dufour H, Nanni I, Chinot O, Martin PM, Grisoli F (2005) Evaluation of fractionated radiotherapy and gamma knife radiosurgery in cavernous sinus meningiomas: treatment strategy. Neurosurgery 57:873–886PubMedCrossRef
43.
Milker-Zabel S, Zabel A, Schulz-Ertner D, Schlegel W, Wannenmacher M, Debus J (2005) Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningioma: long-term experience and prognostic factors. Int J Radiat Oncol Biol Phys 61:809–816PubMed
44.
Milker-Zabel S, Zabel du Bois A, Huber P, Schlegel W, Debus J (2006) Fractionated stereotactic radiation therapy in the management of benign cavernous sinus meningiomas: long-term experience and review of the literature. Strahlen Onkol 182:635–640CrossRef
45.
Nakamura M, Struck M, Roser F, Vorkapic P, Samii M (2007) Olfactory groove meningiomas: clinical outcome and recurrence rates after tumour removal through the frontolateral and bifrontal approach. Neurosurgery 60:844–852PubMedCrossRef
46.
Nakamura S, Hiyama H, Arai K, Nakaya K, Sato H, Hayashi M, Kawamata T, Izawa M, Takakura K (1996) Gamma Knife radiosurgery for meningiomas: four cases of radiation-induced edema. Stereotact Funct Neurosurg 66(Suppl 1):142–145PubMedCrossRef
47.
Nakaya K, Hayashi M, Nakamura S, Atsuchi S, Sato H, Ochial T, Yamamoto M, Izawa M, Hori T, Takakura K (1999) Low-dose radiosurgery for meningiomas. Stereotact Funct Neurosurg 72(Suppl 1):67–72PubMedCrossRef
48.
Pan DH, Guo WY, Chang YC, Chung WY, Shiau CY, Wang LW, Wu SM (1998) The effectiveness and factors related to treatment results of gamma knife radiosurgery for meningiomas. Stereotact Funct Neurosurg 70(Suppl 1):19–32PubMedCrossRef
49.
Pendl G, Schrottner O, Eustacchio S, Feichtinger K, Ganz J (1997) Stereotactic radiosurgery of skull base meningiomas. Minim Invasive Neurosurg 40:87–90PubMedCrossRef
50.
Pendl G, Schrottner O, Friehs GM, Feichtinger H (1995) Stereotactic radiosurgery of skull base meningiomas. Stereotact Funct Neurosurg 64(Suppl 1):11–18PubMed
51.
Pollock BE (2003) Stereotactic radiosurgery for intracranial meningiomas: indications and results. Neurosurg Focus 14(5):e4PubMedCrossRef
52.
Pompili A, Cacciani L, Cattani F, Caroli F, Crecco M, Mastrostefano R, Mazzitelli MR, Raus L (1997) [Intracranial meningiomas in the elderly]. Minerva Med 88:229–236PubMed
53.
Pourel N, Auque J, Bracard S Hoffstetter S, Luporsi E, Vignaud JM, Bey P (2001) Efficacy of external fractionated radiation therapy in the treatment of meningiomas: a 20-year experience. Radiother Oncol 61:65–70PubMedCrossRef
54.
Proust F, Verdure L, Toussaint P, Bellow F, Callonec F, Menard JF, Freger P (1997) [Intracranial meningioma in the elderly. Postoperative mortality, morbidity and quality of life in a series of 39 patients over 70 years of age]. Neurochirurgie 43:15–20PubMed
55.
Reinert M, Babey M, Curschmann J, Vajtai I, Seiler RW, Mariani L (2006) Morbidity in 201 patients with small sized meningioma treated by microsurgery. Acta Neurochir (Wien) 148:1257–1265CrossRef
56.
Riffaud L, Mazzon A, Haegelen C, Hamlat A, Morandi X (2007) [Surgery for intracranial meningiomas in patients older than 80 years]. Presse Med 36:197–202PubMedCrossRef
57.
Roche PH, Pellet W, Fuentes S, Thomassin JM, Regis J (2003) Gamma knife radiosurgical management of petroclival meningiomas results and indications. Acta Neurochir (Wien) 145:883–888CrossRef
58.
Schick U, Bleyen J, Bani A, Hassler W (2006) Management of meningiomas en plaque of the sphenoid wing. J Neurosurg 104:208–214PubMedCrossRef
59.
Selch MT, Ahn E, Laskari A, Lee SP, Agazaryan N, Solberg TD, Cabatan-Awang C, Frighetto L, DeSalles AA (2004) Stereotactic radiotherapy for treatment of cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 59:101–111PubMed
60.
Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, Farnan N (2000) Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumours and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys 47:291–298PubMedCrossRef
61.
Singh VP, Kansai S, Vaishya S, Julka PK, Mehta VS (2000) Early complications following gamma knife radiosurgery for intracranial meningiomas. J Neurosurg 93(Suppl 3):57–61PubMed
62.
Stafford SL, Pollock BE, Foote RL, Link MJ, Gorman DA, Schomberg PJ, Leavitt JA (2001) Meningioma radiosurgery: tumour control, outcomes, and complications among 190 consecutive patients. Neurosurgery 49:1029–1037PubMedCrossRef
63.
Torres RC, Frighetto L, De Salles AA, Goss B, Medin P, Solberg T, Ford JM, Selch M (2003) Radiosurgery and stereotactic radiotherapy for intracranial meningiomas. Neurosurg Focus 14(5):e5PubMedCrossRef
64.
Vermeulen S, Young R, Li F, Meier R, Raisis J, Klein S, Kohler E (1999) A comparison of single fraction radiosurgery tumour control and toxicity in the treatment of basal and nonbasal meningiomas. Stereotact Funct Neurosurg 72(Suppl):160–166CrossRef
Metadaten
Titel
Gamma Knife surgery of large meningiomas: early response to treatment
verfasst von
J. C. Ganz
W. A. Reda
K. Abdelkarim
Publikationsdatum
01.01.2009
Verlag
Springer Vienna
Erschienen in
Acta Neurochirurgica / Ausgabe 1/2009
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-008-0166-4

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