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Minim Invasive Neurosurg 2001; 44(4): 211-217
DOI: 10.1055/s-2001-19934
Original Article
Georg Thieme Verlag Stuttgart · New York

Gamma Knife Radiosurgery in Meningiomas of the Posterior Fossa. Experience with 62 Treated Lesions

A.  Nicolato1 , R.  Foroni1 , M.  Pellegrino1 , P.  Ferraresi1 , F.  Alessandrini1 , M.  Gerosa1 , A.  Bricolo1
  • 1Department of Neurosurgery, University Hospital, Verona, Italy
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Publication History

Publication Date:
01 February 2002 (online)

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Abstract

Objectives: This study was untertaken to assess the role of the gamma knife (GK) in the treatment of meningiomas of the posterior cranial fossa (PCF) and to statistically analyze the predictability of arbitrarily-selected prognostic factors in such treatment.

Methods: From February 1993 to November 1998, 57 patients underwent GK treatment for 62 meningiomas of the PCF (19 M/38 F; average age, 57.5 years, ranging from 25 - 82 years). Tumor sites included: foramen jugular-petrous bone (26/62), petroclival (23/62), cerebellar convexity (6/62), tentorium (6/62), and foramen magnum (1/62). Single lesions were treated in 44/62 cases while meningiomatosis was treated in the remaining 18. Post-operative residual or recurrent tumor was found in 27/62 patients and, in 7/27, histology documented characteristics of biological aggressiveness (GII/III). Indications for radiosurgery included: advanced age, high operative risk, tumor volume < 20 ml, inoperable or refused for additional surgery. The prognostic factors statistically analyzed included: meningiomatosis (yes/no), radiosurgery as primary or adjuvant treatment, GI vs. GII/III histology, and tumor volume (≤ 5 ml vs. > 5 ml).

Results: The observation periods varied from 6 to 64.3 months (median 28.7 months). At the end of the study, 53/57 patients were alive and reported to be in stable or improved neurological condition. The cause of death for the remaining 4 patients included: 2 deaths associated with tumor progression, while 2 died due to causes unrelated to the disease. Neuroradiological evaluation documented the disappearance or reduction of the meningioma mass in 34/62 (55 %) cases, a stable imaging picture in 25/62 (40 %), and a progression only in 3/62 (5 %). To date, there have been no reported cases of post-GK permanent morbidity or mortality. Side effects observed were of a transient nature due to post-radiosurgical edema (6.5 %). With regard to statistical analysis, the only factor to appear to significantly influence efficacy of radiosurgery for tumor growth control (TGC) was the biological nature of the meningioma (χ2 = 2.708). The presence of meningiomatosis, SR as a primary or adjuvant treatment nor tumor volume were shown to statistically influence tumor behavior after GK.

Conclusions: The excellent results obtained for TGC with minimal associated side effects suggest that GK is an effective therapeutic tool also for treatment of PCF meningiomas.

Key words

Meningioma - Posterior Fossa - Radiosurgery - Gamma Knife

References

  • 1 Cudlip S A, Wilkins P R, Johnston F G, Moore A J, Marsh H T, Bell B A. Posterior fossa meningiomas: surgical experience in 52 cases.  Acta Neurochir (Wien). 1998;  140 1007-1012
    CrossrefPubMedGoogle Scholar
  • 2 Yasargil M G, Mortara R W, Curcic M. Meningiomas of basal posterior cranial fossa.  In: Krayenbuhl H (ed). Advances and Technical Standards in Neurosurgery. New York: Springer-Verlag 1980 7: 3-115
    Google Scholar
  • 3 Symon L, Pell M, Singh L. Surgical management of posterior cranial fossa meningiomas.  Br J Neurosurg. 1993;  7 599-609
    PubMedGoogle Scholar
  • 4 Bricolo A, Turazzi S, Talacchi A, Cristofori L. Microsurgical removal of petroclival meningiomas: a report of 33 patients.  Neurosurgery. 1992;  31 813-828
    CrossrefPubMedGoogle Scholar
  • 5 Couldwell W T, Fukushima T, Giannotta S L, Weiss M H. Petroclival meningiomas: surgical experience in 109 cases.  J Neurosurg. 1996;  84 20-28
    CrossrefPubMedGoogle Scholar
  • 6 Hakim R, Alexander III E, Loeffler J S, Shrieve D C, Wen P, Fallon M P, Stieg P E, Black P McL. Results of linear accelerator-based radiosurgery for intracranial meningiomas.  Neurosurgery. 1998;  42 446-454
    PubMedGoogle Scholar
  • 7 Subach B R, Lunsford L D, Kondziolka D, Maitz A H, Flickinger J C. Management of petroclival meningiomas by stereotactic radiosurgery.  Neurosurgery. 1998;  42 437-445
    CrossrefPubMedGoogle Scholar
  • 8 Samii M, Tatagiba M. Experience with 36 surgical cases of petroclival meningiomas.  Acta Neurochir (Wien). 1992;  118 27-32
    CrossrefPubMedGoogle Scholar
  • 9 Tamaki N, Yin D. Surgical management of posterior fossa meningioma.  Neurosurgery Quarterly. 1998;  8 (3) 161-171
    PubMedGoogle Scholar
  • 10 Thomas N WM, King T T. Meningiomas of the cerebellopontine angle. A report of 41 cases.  Br J Neurosurg. 1996;  10 (1) 59-68
    CrossrefPubMedGoogle Scholar
  • 11 Rostomily R C, Eskridge J M, Winn HR. Tentorial meningiomas.  Neurosurg Clin N Am. 1994;  5 331-348
    PubMedGoogle Scholar
  • 12 Sekhar L N, Wright D C, Monacci W. Petroclival and foramen magnum meningiomas: surgical approaches and pitfalls.  J Neurooncol. 1996;  29 249-259
    CrossrefPubMedGoogle Scholar
  • 13 Zentner J, Meyer B, Viewerg U, Herberhold C, Schramm J. Petroclival meningiomas: is radical resection always the best option?.  J Neurol Neurosurg Psychiatry. 1997;  62 341-345
    CrossrefPubMedGoogle Scholar
  • 14 Ojemann R G. Skull-base surgery: a perspective.  J Neurosurg. 1992;  76 569-570
    PubMedGoogle Scholar
  • 15 Glaholm J, Bloom H JG, Crow J H. The role of radiotherapy in the management of intracranial meningiomas: the Royal Mardsen Hospital experience with 186 patients.  Int J Radiat Oncol Biol Phys. 1990;  18 755-761
    CrossrefPubMedGoogle Scholar
  • 16 Mathiesen T, Lindquist C, Kihlström L, Karlsson B. Recurrence of cranial base meningiomas.  Neurosurgery. 1996;  39 2-9
    CrossrefPubMedGoogle Scholar
  • 17 Mirimanoff R O, Dosoretz D E, Linggood R M, Ojemann R G, Martuza R L. Meningioma: analysis of recurrence and progression following neurosurgical resection.  J Neurosurg. 1985;  62 18-24
    CrossrefPubMedGoogle Scholar
  • 18 Taylor B W, Marcus R B, Friedman W A, Ballinger W E, Million R R. The meningioma controversy: postoperative radiation therapy.  Int J Radiat Oncol Biol Phys. 1988;  15 299-304
    PubMedGoogle Scholar
  • 19 Chang S D, Adler J R. Treatment of cranial base meningiomas with linear accelerator radiosurgery.  Neurosurgery. 1997;  41 1019-1027
    CrossrefPubMedGoogle Scholar
  • 20 Iwai Y, Yamanaka K, Yasui T, Komiyama M, Nishikawa M, Nakajima H, Kishi H. Gamma knife surgery for skull base meningiomas. The effectiveness of low-dose treatment.  Surg Neurol. 1999;  52 40-45
    CrossrefPubMedGoogle Scholar
  • 21 Muthukumar N, Kondziolka D, Lunsford L D, Flickinger J C. Stereotactic radiosurgery for tentorial meningiomas.  Acta Neurochir (Wien). 1998;  140 315-321
    CrossrefPubMedGoogle Scholar
  • 22 Muthukumar N, Kondziolka D, Lunsford L D, Flickinger J C. Stereotactic radiosurgery for anterior foramen magnum meningiomas.  Surg Neurol. 1999;  51 268-273
    CrossrefPubMedGoogle Scholar
  • 23 Nicolato A, Ferraresi P, Foroni R, Pasqualin A, Piovan E, Severi F, Masotto B, Gerosa M. Gamma knife radiosurgery in skull base meningiomas. Preliminary experience with 50 cases.  Stereotact Funct Neurosurg. 1996;  66 (suppl 1) 112-120
    Google Scholar
  • 24 Pendl G, Schröttner O, Eustacchio S, Feichtinger K, Ganz J. Stereotactic radiosurgery of skull base meningiomas.  Minim Invas Neurosurg. 1997;  40 87-90
    PubMedGoogle Scholar
  • 25 Lunsford L D. Contemporary management of meningiomas: radiation therapy as an adjuvant and radiosurgery as an alternative to surgical removal?.  J Neurosurg. 1994;  80 187-190
    PubMedGoogle Scholar
  • 26 Castellano F, Ruggiero G. Meningiomas of the posterior fossa.  Acta Radiol. 1953;  104 (Suppl) 1-157
    PubMedGoogle Scholar
  • 27 Kleihues P, Burger P C, Scheithauer B W. Histological typing of tumors of the nervous central system, WHO Blue Book, 2nd end. Heidelberg: Springer Verlag 1993: 1-37
    Google Scholar
  • 28 Hall W A. Stereotactic radiosurgery in perspective.  In: Cohen AR, Haines SJ, editors. Concepts in neurosurgery. Minimally invasive techniques in neurosurgery. Baltimore, USA: Williams & Wilkins 1995: 104-117
    Google Scholar
  • 29 Leksell L. Stereotaxis and radiosurgery. An operative system. Springfield, Ill.: Charles C Thomas 1971: 1-66
    Google Scholar
  • 30 Lunsford L D, Flickinger J C, Lindner G, Maitz A. Stereotactic radiosurgery of the brain using the first United States 201 cobalt-60 source gamma knife.  Neurosurgery. 1989;  24 151-159
    CrossrefPubMedGoogle Scholar
  • 31 Luxton G, Petrovich Z, Jozsef G, Nedzi L A, Apuzzo M LJ. Stereotactic radiosurgery: principles and comparison of treatment methods.  Neurosurgery. 1993;  32 241-259
    PubMedGoogle Scholar
  • 32 Maitz A H, Lunsford L D, Wu A, Lindner G, Flickinger J C. Shielding requirements on-site loading and acceptance testing of the Leksell gamma knife.  Int J Radiat Oncol Biol Phys. 1990;  18 469-476
    PubMedGoogle Scholar
  • 33 Karnofsky D A, Abelmann W H, Craver L F, Burchenal J H. The use of the nitrogen mustards in the palliative treatment of carcinoma with particular reference to bronchogenic carcinoma.  Cancer. 1948;  1 634-656
    CrossrefPubMedGoogle Scholar
  • 34 Order S E, Hellman S, von Essen C F, Kligerman M M. Improvement in quality of survival following whole-brain irradiation for brain metastasis.  Radiology. 1968;  91 149-153
    PubMedGoogle Scholar
  • 35 Snedecor G W, Cochram W G. Statistical methods, 7th edition. Iowa, Stata University Press, Ames, Iowa 1980
    Google Scholar
  • 36 Nelder J A, Wedderburn R WM. Generalized linear models.  J Royal Stat Soc. 1972;  135 370-384
    PubMedGoogle Scholar
  • 37 Kaplan E L, Meier P. Nonparametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  53 457-481
    CrossrefPubMedGoogle Scholar
  • 38 Breslow N. Covariance analysis of censored survival date.  Biometrics. 1974;  30 89-99
    PubMedGoogle Scholar
  • 39 Simpson D. The recurrence of intracranial meningiomas after surgical resection.  J Neurol Neurosurg Psychiatry. 1957;  201 22-39
    PubMedGoogle Scholar
  • 40 Desgeorges M, Sterkers O, Poncet J L, Rey A, Sterkers J M. Chirurgie des méningiomes de la partie postérieure de la base du crâne. 135 cas. Choix de la voie d'abord et résultats.  Neurochirurgie. 1995;  41 (4) 265-294
    PubMedGoogle Scholar
  • 41 Kakou M, Jan M. Méningiomes de la tente du cervelet. Notre expérience à propos de 20 cas.  Neurochirurgie. 1999;  45 15-23
    PubMedGoogle Scholar
  • 42 Sekhar L N, Jannetta P J, Burkhart L E, Janosky J E. Meningiomas involving the clivus: a six-year experience with 41 patients.  Neurosurgery. 1990;  27 764-781
    CrossrefPubMedGoogle Scholar
  • 43 Kratimenos G P, Crockard A H. The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumors.  Br J Neurosurg. 1993;  7 129-140
    CrossrefPubMedGoogle Scholar
  • 44 Goldsmith B J, Wara W M, Wilson C B, Larson D A. Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990.  J Neurosurg. 1994;  80 195-201
    CrossrefPubMedGoogle Scholar
  • 45 Nutting C, Brada M, Brazil L, Sibtain A, Saran F, Westbury C, Moore A, Thomas D GT, Traish D, Ashley S. Radiotherapy in the treatment of benign meningioma of the skull base.  J Neurosurg. 1999;  90 823-827
    PubMedGoogle Scholar
  • 46 Mahmood A, Qureshi N H, Malik G M. Intracranial meningiomas: analysis of recurrence after surgical treatment.  Acta Neurochir (Wien). 1994;  126 53-58
    CrossrefPubMedGoogle Scholar
  • 47 Al-Mefty O, Kersh J E, Routh A, Smith R R. The long-term side effects of radiation therapy for benign brain tumors in adults.  J Neurosurg. 1990;  73 502-512
    PubMedGoogle Scholar
  • 48 Petty A M, Kun L E, Meyer G A. Radiation therapy for incompletely resected meningiomas.  J Neurosurg. 1985;  62 502-507
    CrossrefPubMedGoogle Scholar
  • 49 Engenhart R, Kimmig B N, Höver K-H, Wowra B, Sturm V, van Kaick G, Wannenmacher M. Stereotactic single high dose radiation therapy of benign intracranial meningiomas.  Int J Radiat Oncol Biol Phys. 1990;  19 1021-1026
    PubMedGoogle Scholar
  • 50 Larson D A, Flickinger J C, Loeffler J S. The radiobiology of radiosurgery.  Int J Radiat Oncol Biol Phys. 1993;  25 557-561
    PubMedGoogle Scholar

Dr. A. Nicolato

Department of Neurosurgery

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37126 Verona

Italy

Phone: +39-45-807-3023

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