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Stereotactic radiosurgery for anterior foramen magnum meningiomas
N Muthukumar1, D Kondziolka, L D Lunsford
1Center for Image-Guided Neurosurgery, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Background:
Total microsurgical resection is the procedure of choice for growing and symptomatic foramen magnum meningiomas. We hypothesized that for patients with advanced age, complicating medical conditions, or residual or recurrent meningiomas at the foramen magnum, stereotactic radiosurgery would be a useful adjunctive (n = 2) or alternative (n = 3) treatment.
Methods:
We report our experience in five elderly patients (73-84 years) who underwent gamma knife radiosurgery. The median tumor volume was 10.5 ml and the tumor margin dose varied from 10 to 16 Gy. Because of the irregular tumor volumes along the inferior clivus, multiple isocenters of irradiation were required (range, 2-8; mean 4.4).
Results:
During the follow-up interval of 1-5 years (median, 3 years), one patient died of an intercurrent illness, and all remaining patients were stable without any further deterioration in their clinical condition. Follow-up imaging studies revealed a reduction in tumor volume in one patient and no further growth in the remaining four.
Conclusion:
We believe that stereotactic radiosurgery provides safe and effective management for patients who are poor candidates for resection of their foramen magnum meningiomas.
Insights
Stereotactic radiosurgery is a safe and effective treatment for elderly patients with foramen magnum meningiomas who cannot undergo surgery. Gamma Knife radiosurgery stabilized tumors in four out of five patients.
Area of Science:
- Neurosurgery
- Radiation Oncology
Background:
- Foramen magnum meningiomas often require microsurgical resection.
- Stereotactic radiosurgery (SRS) is explored as an alternative or adjunctive treatment for elderly patients or those with residual/recurrent tumors.
Observation:
- Five elderly patients (73-84 years) with foramen magnum meningiomas underwent Gamma Knife radiosurgery.
- Median tumor volume was 10.5 ml; doses ranged from 10-16 Gy, often requiring multiple isocenters due to irregular tumor shapes.
Findings:
- Over a median follow-up of 3 years, four patients remained clinically stable.
- Tumor volume decreased in one patient and remained stable in the other four; one patient died from an unrelated illness.
Implications:
- SRS offers a safe and effective management option for inoperable foramen magnum meningiomas.
- This approach is particularly valuable for elderly patients or those with complicating medical conditions.