Artikel
LINAC radiosurgery for the management of skull base meningiomas: preservation of cranial nerve function
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Autoren
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M. El-Khatib
- Klinik für Neurochirurgie, Heinrich Heine Universität, Düsseldorf
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H. Treuer
- Klinik für Stereotaxie und funktionelle Neurochirurgie, Klinikum der Universität zu Köln
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H.P. Müller
- Klinik für Strahlentherapie, Klinikum der Universität zu Köln
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W. Stummer
- Klinik für Neurochirurgie, Heinrich Heine Universität, Düsseldorf
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V. Sturm
- Klinik für Stereotaxie und funktionelle Neurochirurgie, Klinikum der Universität zu Köln
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M. Maarouf
- Klinik für Stereotaxie und funktionelle Neurochirurgie, Klinikum der Universität zu Köln
| Veröffentlicht: | 20. Mai 2009 |
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Gliederung
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Objective: The therapy of skull base meningiomas especially with involvement of the cavernous sinus or cranial nerves is still a challenge for neurosurgery. Previous surgical studies showed high morbidity of cranial nerves if total resection is performed. The combined therapy of meningiomas by subtotal resection and salvage radiosurgery seems to be an appropriate therapeutic option. We present our results of LINAC radiosurgery for the treatment of skull base meningiomas. The function of cranial nerves after radiosurgery is evaluated.
Methods: 96 skull base meningiomas in 94 patients were treated by radiosurgery using a modified linear accelerator (LINAC-RS) in the period between 1990 and 2003. 41 (42.7%) meningiomas were treated with primary radiosurgery. In these cases the diagnosis of a meningioma was based on MRI criteria. The remaining 55 cases were diagnosed by previous surgical treatment. 49 (51%) showed histological findings of a grade I, 4 of a grade II and 2 of a grade III meningioma. The mean age at time of treatment was 51 years with a median age of 52 years (range 9.7–80.2 years). 72 of 96 skull base meningiomas involved the cavernous sinus. Regarding the localisation 74 were located at the sphenoid wing, 10 at the petrous bone, 6 at the clivus, 5 at the cribriform plate and one at the optic sheath.
Results: Tumour shrinkage was seen in 46/96 (47.9%) meningiomas and stable disease in 46/96 (47.9%). 4/96 (4.2%) showed local tumour progression. The overall progression free survival rate was 96%, 95%, 91% after 3, 5, 10 years. The corresponding local tumour control rate was 95% at 3, 5 and 10 years. Clinical symptoms improved in 44 (46.8%), were unchanged in 46 (48.9%), and deteriorated in 4 (4.3%). With special regard to the cranial nerves 142 deficits were registered. 48 (33.8%) resolved completely, 26 (18.3%) improved, 65 (45.8%) were unchanged and 3 (2.1%) deteriorated.
Conclusions: Our study shows that radiosurgery is safe and effective, yielding high tumour control rates and low morbidity when applied as the sole as well as a salvage therapy after subtotal resection. Moreover this study reveals that cranial nerve deficits can resolve completely or improve in more than 50% of the cases.
