Artikel
Petroclival meningiomas: Clinical management including micro- and radiosurgery in 102 consecutive cases over a period of 15 years
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Veröffentlicht: | 8. Juni 2016 |
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Objective: Petroclival meningiomas remain a clinical challenge due to their critical location adjacent to brain stem, cranial nerves, and vascular structures. Thus, out of 777 meningioma patients treated during a 15-year period by radiosurgery (Gamma Knife, Cyber Knife) those harbouring petroclival meningiomas were identified, and their local control, clinical symptomatology, as well as early or late toxicity related to radiosurgery were assessed.
Method: From 2001-2015 a total of 102 consecutive patients (76 females/26 males) with a mean age of 57.9 (range: 34-87) years underwent radiosurgery for petroclival/ cavernous sinus meningiomas. In 37 patients (36.4 %) radiosurgery was applied aiming at control of tumor remnants after incomplete microsurgical resection, whereas in 65 patients (63.6%) radiosurgery was the first treatment of petroclival lesions. Tumor volumes ranged from 0.7 to 14.4 cm3 (mean: 5.45 cm3). Marginal dose was in the range of 12 to 16 Gy prescribed to the 43-64% isodose line (median 50).
Results: After a median follow-up period of 78 months (range: 6-180 months) 94 of the 102 patients (92.2 %) were clinically stable and new neurological deficits occurred in 6 patients (5.9%). Local tumor progression was observed in eight patients (7.8 %) during periodic MRI control examinations. One patient received secondary radiosurgery as salvage treatment resulting in local control until today. No relevant early toxicity was noted and four patients developed an increase in pre-existing cranial nerve deficits. Only one grade III late toxicity was noted for a patient with locally progressing tumor under repeat radiotherapy.
Conclusions: Radiosurgery is a non-invasive and effective treatment option within the management of petroclival and cavernous sinus meningiomas. It should be considered as both, a primary treatment option in smaller volume petroclival meningiomas and an adjunct after incomplete resection, since local control rate and stabilization of clinical symptoms can be achieved in more than 90% of patients.