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Gamma knife surgery for atypical meningiomas
Beate C Huffmann1, Peter C Reinacher, Joachim M Gilsbach
1Department of Neurosurgery, University Hospital Aachen, Germany. Beate.Huffmann@post.rwth-aachen.de
Object:
Complete resection is the optimal treatment for atypical meningiomas (AMs) but its feasibility depends on the tumor site. The object of this study was to assess the effect of gamma knife surgery (GKS) on AM.
Methods:
In 15 patients 21 AMs were treated by GKS. Four patients had residual lesions and 10 patients had recurrent tumors after one or more microsurgical interventions. Three patients were treated twice with GKS because of tumor tissue outside the treatment volume, either at the margin or at a distant location. The median clinical and neuroimaging follow-up period was 35 months (range 21-67 months). Ten tumors shrank 6 to 12 months after GKS, 10 remained stable, and one grew. Between 18 and 36 months after GKS, four patients had a distant recurrence, and two had a margin recurrence. In one of these cases, an additional local recurrence was demonstrated 1 year later, and the patient underwent standard radiotherapy. No patient suffered persistent adverse effects after radiosurgery.
Conclusions:
After early tumor shrinkage, high recurrence rates were demonstrated both at the treatment margin and at distant locations in cases treated for AM. There was only one recurrence within the GKS radiation field. For small- and medium-sized AMs GKS may be a safe adjunct to other treatment modalities.
Insights
Gamma Knife Surgery (GKS) showed early tumor shrinkage for atypical meningiomas (AMs). However, high recurrence rates were observed at margins and distant locations, suggesting GKS may be an adjunct for specific AM cases.
Area of Science:
- Neurosurgery
- Radiation Oncology
Background:
- Complete resection is the standard treatment for atypical meningiomas (AMs).
- Tumor location can limit the feasibility of complete surgical resection.
- Gamma Knife Surgery (GKS) is a stereotactic radiosurgery technique.
Purpose of the Study:
- To evaluate the efficacy and safety of Gamma Knife Surgery (GKS) for treating atypical meningiomas (AMs).
Main Methods:
- GKS was performed on 21 atypical meningiomas in 15 patients.
- Patients had residual or recurrent tumors after prior microsurgery.
- Follow-up included clinical and neuroimaging assessments for a median of 35 months.
Main Results:
- Tumor shrinkage occurred in 10 lesions within 12 months post-GKS; 10 remained stable.
- High recurrence rates were observed: four distant and two margin recurrences between 18-36 months.
- One recurrence occurred within the GKS radiation field; no patients experienced persistent adverse effects.
Conclusions:
- Atypical meningiomas treated with GKS showed initial shrinkage but a high rate of recurrence at margins and distant sites.
- GKS may be a safe adjunctive treatment for small- to medium-sized atypical meningiomas.
- Further research is needed to optimize GKS use in AM management.
