Early complications following gamma knife radiosurgery for intracranial meningiomas

The purpose of this paper was to assess the early complications, defined as occurring within 1 year, following gamma knife radiosurgery (GKS) for the treatment of intracranial meningiomas.

Seventy-seven of 306 patients undergoing GKS in the last 2.5 years harbored meningiomas. There were 35 men and 42 women with a mean age of 32.4 years (range 10-80 years). Tumor volume ranged from 0.35 to 28.6 cm3 (mean 7.9 cm3). Gamma knife radiosurgery was the primary therapy in 28 patients and followed surgery in 49 patients. There were 50 basal and 27 nonbasal meningiomas. The most common sites were parasagittal (23 patients) and cerebellopontine angle (14 patients). Ten to 15 Gy was administered to the tumor margins. Clinical and radiological follow up with a mean duration of 122 months was available in 40 patients. Seizures and increased headache were found in five and four patients, respectively. A temporary worsening of hemiparesis was seen in two patients (both with parasagittal tumors). One patient with a cavernous sinus meningioma developed a herpes labialis eruption. Perilesional edema was demonstrated in nine patients and was symptomatic in six. Six (22%) of the 27 patients with nonbasal tumors had edema (all parasagittal) and four patients were symptomatic. Only three (6%) of the 50 basal meningiomas had edema, and only one patient was symptomatic. The occurence of edema did not correlate with tumor volume, margin or maximum dose, or with radiation received by adjacent brain. A reduction in tumor size was seen in seven patients. In one patient a new recurrent lesion developed adjacent to the previously treated tumor.

Although GKS provides good results for selected patients with meningiomas, caution is required in treating patients with parasagittal tumors as the incidence of perilesional edema is considerable.