gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Petroclival meningiomas: Clinical management including micro- and radiosurgery in 102 consecutive cases over a period of 15 years

Meeting Abstract

  • Robert Wolff - Klinik für Neurochirurgie, Goethe Universität, Frankfurt, Germany; Saphir Radiochirurgie, Goethe Universität, Frankfurt, Germany
  • Maja Krause - Klinik für Neurochirurgie, Goethe Universität, Frankfurt, Germany
  • Oliver Blanck - Saphir Radiochirurgie, Goethe Universität, Frankfurt, Germany
  • Volker Seifert - Klinik für Neurochirurgie, Goethe Universität, Frankfurt, Germany
  • Marie-Therese Forster - Klinik für Neurochirurgie, Goethe Universität, Frankfurt, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.03.04

doi: 10.3205/16dgnc103, urn:nbn:de:0183-16dgnc1032

Published: June 8, 2016

© 2016 Wolff et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

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.