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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Long-Term Results of Stereotactic Radiosurgery for Skull Base Meningiomas
Or Cohen-Inbar1, Cheng-Chia Lee, David Schlesinger
1*Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia; ‡Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan; §National Yang-Ming University, Taipei, Taiwan.
Background:
Gamma knife radiosurgery (GKRS) is well established in the management of inaccessible, recurrent, or residual benign skull base meningiomas. Most series report clinical outcome parameters and complications in the short intermediate period after radiosurgery. Reports of long-term tumor control and neurological status are still lacking.
Objective:
To report the presentation, treatment, and long-term outcome of skull base meningiomas after GKRS.
Methods:
From a prospectively collected institutional review board-approved database, we selected patients with a World Health Organization grade I skull base meningioma treated with a single-session GKRS and a minimum of 60 months follow-up. One hundred thirty-five patients, 54.1% males (n = 73), form the cohort. Median age was 54 years (19-80). Median tumor volume was 4.7 cm (0.5-23). Median margin dose was 15 Gy (7.5-36). Median follow-up was 102.5 months (60.1-235.4). Patient and tumor characteristics were assessed to determine the predictors of neurological function and tumor progression.
Results:
At last follow-up, tumor volume control was achieved in 88.1% (n = 119). Post-GKRS clinical improvement or stability was reported in 61.5%. The 5-, 10-, and 15-year actuarial progression-free survival rates were 100%, 95.4%, and 68.8%, respectively. Favorable outcome (both tumor control and clinical preservation/improvement) was attained in 60.8% (n = 79). Pre-GKRS performance status (Karnofsky Performance Scale) was shown to influence tumor progression (P = .001) and post-GKRS clinical improvement/preservation (P = .003).
Conclusion:
GKRS offers a highly durable rate of tumor control for World Health Organization grade I skull base meningiomas, with an acceptably low incidence of neurological deficits. The Karnofsky Performance Scale at the time of radiosurgery serves as a reliable long-term predictor of overall outcome.
Abbreviations:
ARE, adverse radiation effectGKRS, Gamma knife radiosurgeryKPS, Karnofsky Performance ScaleWHO, World Health Organization.
