Article
Long-term experience in 121 patients after gamma knife radiosurgery for benign skull base meningiomas
Langzeitergebnisse bei 121 Patienten nach Radiochirurgie bei benignen Schädelbasismeningeomen
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Published: | May 4, 2005 |
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Outline
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Objective
Microsurgical excision with preservation of juxtaposed neuro-vascular structures is considered the treatment of choice for skull base meningiomas, but there exists a great controversy regarding surgical resectability, potential risk for subsequent postoperative cranial nerve deficit (CND) and the role of adjuvant or adjunctive treatment options. In this study we evaluated the effect of gamma knife radiosurgery (GKRS) in 121 patients with benign basal meningiomas after a follow-up of 6 to 10 years.
Methods
Sixty patients had undergone open resections prior to radiosurgical treatment and 61 patients received GKRS as primary treatment. Tumour volumes of 0.5 to 89.9 ccm (median 6.8 ccm) received a median marginal dose of 13 Gy (range 7-25 Gy) at the covering 25% to 80% isodose volume curves (median 45%).
Results
Neuroradiological controls demonstrated decreased tumour size in 73 patients (60.3%), stable meningioma volume in 47 cases (38.9%) and tumour enlargement in one patient (0.8%). The tumour control rate was 98.3%. Clinically, 54 patients (44.6%) improved and 61 cases (50.4%) remained unchanged. Four patients (3.3%) showed temporary and two patients (1.7%) permanent neurological deterioration (unrelated to tumour or treatment in one patient). Two patients (1.7%) developed radiation-induced new or aggravated pre-existent CND (1 transient, 1 permanent) and two patients (1.7%) required further surgical resection.
Conclusions
Radiosurgery performed with current techniques proved to be an effective method for growth control of skull base meningiomas with both a low mortality rate and a good quality of life. An increasing percentage of patients will undergo radiosurgery as accessibility to this alternative increases, and more data regarding long-term follow-up are available. It is a postoperative complementary treatment for partially removed tumours. Accordingly, radiosurgery is a useful method for the management of properly selected patients.