Article
The combined neurosurgical approach in a long-term study: Gamma Knife radiosurgery after resection of skull base meningioma
Neurochirurgische Kombinationsbehandlung im Langzeitverlauf: Gamma Knife nach Mikrochirurgie von Meningiomen der Schädelbasis
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Published: | May 8, 2006 |
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Objective: To determine the long-term outcome after Gamma Knife radiosurgery of skull base meningioma with respect to tumour control and potential complications. The emphasis is on strategies to optimize a combined neurosurgical approach with planned resection and radiosurgery in order to reduce potential morbidity of either technique.
Methods: 40 consecutive patients with skull base meningioma, treated with Gamma Knife radiosurgery at the Karolinska Hospital, Stockholm were retrospectively analyzed. Anaplastic meningiomas were excluded. 22 patients (55%) had been operated before radiosurgery at various international centers. The median tumour diameter at the time of radiosurgery was 24 mm (10-60). Median prescription dose was 16 Gy. Dose plans were reviewed and dose parameters reviewed with regard to follow-up information.
Results: Clinical follow-up was available in 36/40 cases at median of 9.5 years (4.3-14.2) after Gamma Knife radiosurgery (median radiological follow-up: 8.6 years). Tumour control was achieved in 91% of cases (31/34). 6% (2/34) developed distant tumor recurrence outside the radiation field. 14% (5/36) developed secondary treatment related symptoms. Very few side effects were seen when modern dose planning and imaging standards with respect to threshold doses for sensitive structures were applied.
Conclusions: This retrospective analysis is one of the so far longest follow-up series of meningiomas treated with Gamma Knife radiosurgery. The data support the results from several short-term studies after radiosurgery and document the safe tumour control after Gamma Knife radiosurgery for meningioma even in the long-term perspective. The results emphasize the necessity for a cooperative neurosurgical management with a planned strategy consisting of microsurgery and radiosurgery. The complication rate is low when modern treatment strategies are applied.