Gamma Knife Radiosurgery for Benign Cavernous Sinus Tumors: Treatment Concept and Outcomes in 120 Cases

Motohiro HAYASHI; Mikhail CHERNOV; Noriko TAMURA; Manabu TAMURA; Ayako HORIBA; Yoshiyuki KONISHI; Yoshikazu OKADA; Yoshihiro MURAGAKI; Hiroshi ISEKI; Kintomo TAKAKURA

doi:10.2176/nmc.52.714

The 70th Annual Meeting Special Topics — Part III: Multidisciplinary Treatment for Skull Base Tumors

Gamma Knife Radiosurgery for Benign Cavernous Sinus Tumors: Treatment Concept and Outcomes in 120 Cases

Motohiro HAYASHI, Mikhail CHERNOV, Noriko TAMURA, Manabu TAMURA, Ayako HORIBA, Yoshiyuki KONISHI, Yoshikazu OKADA, Yoshihiro MURAGAKI, Hiroshi ISEKI, Kintomo TAKAKURA

Author information

Motohiro HAYASHI
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University
Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
Saitama Gamma Knife Center, Sanai Hospital
Mikhail CHERNOV
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University
Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
Noriko TAMURA
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University
Manabu TAMURA
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University
Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
Ayako HORIBA
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University
Yoshiyuki KONISHI
Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
Yoshikazu OKADA
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University
Yoshihiro MURAGAKI
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University
Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
Hiroshi ISEKI
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University
Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
Kintomo TAKAKURA
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University
Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University

Keywords: gamma knife radiosurgery, microradiosurgery, automatic positioning system, cavernous sinus tumor, outcome

JOURNAL OPEN ACCESS

2012 Volume 52 Issue 10 Pages 714-723

DOI https://doi.org/10.2176/nmc.52.714

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Abstract

Availability of modern computer-aided robotized devices, such as the Automatic Positioning System (APS^TM; Elekta Instruments AB, Stockholm, Sweden) and Perfexion^TM (Elekta Instruments AB), allowed us to develop the original concept of robotic gamma knife microradiosurgery, which is based on the very precise irradiation of the lesion with regard to conformity and selectivity; intentional avoidance of the excessive irradiation of functionally-important anatomical structures, particularly cranial nerves, located both within and in the vicinity of the target; and delivery of sufficient irradiation energy to the tumor with the intention to attain lesion shrinkage, while keeping the marginal dose sufficiently low for prevention of possible complications. The results of such treatment strategy were evaluated retrospectively in 120 patients with benign cavernous sinus neoplasms (pituitary adenomas, meningiomas, schwannomas, and hemangiomas), who were followed up from 24 to 78 months (mean 47 months) after radiosurgery. Tumor growth control and shrinkage rates were 98% and 68%, respectively. More than 50% volume reduction was noted in 25% of lesions. The most prominent volumetric tumor response was observed in hemangiomas, followed by schwannomas, pituitary adenomas, and meningiomas. Treatment-related complications were marked in 7% of cases, and were mainly related to transient isolated cranial neuropathy appearing within several months after radiosurgery. Major morbidity was limited to one patient (0.8%). Application of microradiosurgical treatment principles provides effective and safe management of benign cavernous sinus tumors and is associated with high probability of lesion shrinkage and minimal risk of complications.

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