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The use of stereotactic radiosurgery in the management of meningiomas
Irfan Malik1, J G Rowe, L Walton
1National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield, UK.
Abstract:
This is a systematic review of a consecutive series of 309 meningiomas treated with gamma knife stereotactic radiosurgery between 1994 and 2000. There was an extreme selection bias towards lesions unfavourable for surgery, determined by the patients referred for treatment: 70% of tumours involved the skull base, 47% specifically the cavernous sinus: 15% of patients had multiple meningiomatosis or type 2 neurofibromatosis. Tumour histology was the main determinant of growth control (p < 0.001), the 5-year actuarial control rates being 87% for typical meningiomas, 49% for atypical tumours and 0% for malignant lesions. Complications from radiosurgery were rare, occurring in 3% of tumours, and were most frequently trigeminal and eye movement disturbances treating cavernous sinus meningiomas. Given the problems inherent in managing these tumours, radiosurgery is a valuable strategy and adjuvant treatment for these meningiomas.
Insights
Gamma knife radiosurgery effectively controls meningioma growth, especially typical types. This treatment is a valuable option for challenging skull base and cavernous sinus meningiomas.
Area of Science:
- Neurosurgery
- Radiation Oncology
Background:
- Meningiomas are primary tumors of the brain and spinal cord.
- Management of complex meningiomas, particularly those in the skull base, presents significant challenges.
Purpose of the Study:
- To evaluate the efficacy and safety of gamma knife stereotactic radiosurgery for meningiomas.
- To assess factors influencing treatment outcomes in a selected patient cohort.
Main Methods:
- Systematic review of 309 meningiomas treated with gamma knife stereotactic radiosurgery (1994-2000).
- Analysis of tumor histology, location (skull base, cavernous sinus), and patient factors.
- Calculation of 5-year actuarial tumor control rates based on histology.
Main Results:
- Tumor histology was a significant predictor of growth control (p < 0.001).
- 5-year control rates: 87% for typical, 49% for atypical, and 0% for malignant meningiomas.
- Complications occurred in 3% of cases, mainly trigeminal and oculomotor disturbances for cavernous sinus meningiomas.
Conclusions:
- Gamma knife stereotactic radiosurgery is an effective treatment for meningiomas, offering valuable growth control.
- Radiosurgery serves as a viable strategy and adjuvant therapy for challenging meningioma cases, including those in the skull base.
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