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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

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Staged radiosurgical treatment for large benign cerebral lesions (meningiomas and AVMs)

Mehrzeitige Radiochirurgie bei großen Meningeomen und AV-Malformationen

Meeting Abstract

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  • corresponding author Frank Unger - Universitätskliniken für Neurochirurgie, Medizinische Universität, Graz, Österreich
  • S. Eustacchio - Universitätskliniken für Neurochirurgie, Medizinische Universität, Graz, Österreich
  • K. Feichtinger - Universitätskliniken für Strahlentherapie-Radioonkologie, Medizinische Universität, Graz, Österreich
  • G. Papaefthymiou - Universitätskliniken für Neurochirurgie, Medizinische Universität, Graz, Österreich

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMI.03.08

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0265.shtml

Published: April 23, 2004

© 2004 Unger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective

Large brain lesions are considered unfavourable for Gamma Knife treatment because of possible adverse effects. Since meningiomas and AVMs show an often slow or no growth rate, partial radiosurgical treatment in cases with risk of surgical unacceptable morbidity is an alternative.

Methods

Since April 1992, 17 patients suffering from large benign tumours (meningiomas) and 9 with AVMs considered as non-operable underwent Gamma Knife treatment at our department by staged procedures. All tumour patients had primary open surgery for partial removal or recurrent growth (1-4 times) and subsequent radiosurgical treatment. Four male and 13 female patients aged between 26 and 73 years had a tumour volume ranging from 15 to 90ccm. Marginal isodoses ranged from 10-25 Gy on 30-60%. Time interval between the radiosurgical treatments varied between 1 and 36 months. Follow-up had a range between 5 and 104 months (mean 56.4). Three female and 6 male patients with AVMs (age ranging from 10-48 years) had previous embolization and were treated with marginal doses of 15-22 Gy at 40-50% isodoses on a volume of 11-25 ccm. Time interval between radiosurgical treatments ranged between 5-36 months. Mean follow-up is 48.3 months.

Results

Neurological follow-up examinations showed a clinical improvement in 15 patients (58%), while 8 (31%) remained unchanged. Among tumour patients no deterioration, but further tumour growth in 2 patients (8%) was observed and treated with open surgery. In 8 patients (47%) tumour diameter regressed more than 30%. One AVM patient suffered from epileptic seizures and hemiparesis. Follow-up MRI, MRA and cerebral angiographies of AVMs’ residual nidus disclosed no rebleeding, but total or partial nidus obliteration in 3 (33%) / 5 (56%) of the patients, respectively.

Conclusions

For selected patients with large benign lesions staged Gamma Knife treatment may be a very useful option with no mortality and low morbidity not only regarding cranial nerve deficits.