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Primary Hypofractionated Gamma Knife Radiosurgery for Giant Cavernous Sinus Hemangiomas
Manjul Tripathi1, Raghav Singla1, Renu Madan2
1Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Neurology India
|June 25, 2021
Summary
Gamma Knife Radiosurgery (GKRS) offers a new treatment for giant cavernous sinus hemangiomas. This study shows significant tumor reduction and clinical improvement in patients treated with fractionated GKRS.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Radiology
Background:
- Cavernous sinus hemangiomas (CSH) are challenging surgical targets due to their location and vascularity.
- Existing treatments for CSH have limitations, especially for large and giant tumors.
- Gamma Knife Radiosurgery (GKRS) has been used for smaller CSH, but its efficacy in giant CSH remains undocumented.
Observation:
- Two patients with giant CSH (72.2 and 99.8 cm³ volumes) were treated with frame-based fractionated GKRS (5 Gy × 5 fractions).
- Tumors engulfed optic structures, complicating surgical approaches.
- Patients experienced significant clinical improvement in headaches and visual decline within 3 months.
Findings:
- Both patients showed substantial tumor volume reduction (85.1% and 75.6%) at 6-month follow-up.
- Complete recovery of sixth nerve paresis was observed in one patient.
- No major complications were reported during the 9-month follow-up period, with transient alopecia resolving.
Implications:
- Frame-based fractionated GKRS is a potentially effective and safe alternative for managing giant CSH.
- This approach may offer significant clinical and radiological benefits for previously untreatable lesions.
- Further research is warranted to establish GKRS as a primary treatment for giant CSH.
