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Gamma Knife Radiosurgery of Cavernous Sinus Meningiomas: An Institutional Review

Published online by Cambridge University Press:  02 December 2014

F. A. Zeiler ,
P. J. McDonald ,
A. M. Kaufmann ,
D. Fewer ,
J. Butler ,
G. Schroeder  and
M. West
F. A. Zeiler*
Affiliation:
Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
P. J. McDonald
Affiliation:
Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
A. M. Kaufmann
Affiliation:
Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
D. Fewer
Affiliation:
Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
J. Butler
Affiliation:
Dept of Surgery, Dept of Radiation Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
G. Schroeder
Affiliation:
Dept of Surgery, Dept of Radiation Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
M. West
Affiliation:
Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
*
Section of Neurosurgery, University of Manitoba, Health Sciences Center, GB-1 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada. Email: [email protected]
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Abstract

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Introduction:

Stereotactic radiosurgery offers a unique and effective means of controlling cavernous sinus meningiomas with a low rate of complications.

Methods:

We retrospectively reviewed all cavernous sinus meningiomas treated with Gamma Knife (GK) radiosurgery between November 2003 and April 2011 at our institution.

Results:

Thirty patients were treated, four were lost to follow- up. Presenting symptoms included: headache (9), trigeminal nerve dysesthesias/paresthesias (13), abducens nerve palsy (11), oculomotor nerve palsy (8), Horner's syndrome (2), blurred vision (9), and relative afferent pupillary defect (1). One patient was asymptomatic with documented tumor growth. Treatment planning consisted of MRI and CT in 17 of 30 patients (56.7%), the remainder were planned with MRI alone (44.3%). There were 8 males (26.7%) and 22 females (73.3%). Twelve patients had previous surgical debulking prior to radiosurgery. Average diameter and volume at time of radiosurgery was 3.4 cm and 7.9 cm3 respectively. Average dose at the 50% isodose line was 13.5 Gy. Follow-up was available in 26 patients. Average follow-up was 36.1 months. Mean age 55.1 years. Tumor size post GK decreased in 9 patients (34.6%), remained stable in 15 patients (57.7%), and continued to grow in 2 (7.7%). Minor transient complications occurred in 12 patients, all resolving. Serious permanent complications occurred in 5 patients: new onset trigeminal neuropathic pain (2), frame related occipital neuralgia (1), worsening of pre-GK seizures (1), and panhypopituitarism (1).

Conclusion:

GK offers an effective treatment method for halting meningioma progression in the cavernous sinus, with an acceptable permanent complication rate.

Résumé

RÉSUMÉContexte:

La radiochirurgie stéréotaxique offre un moyen unique et efficace de contrôle des méningiomes du sinus caverneux et comporte un faible taux de complications.

Méthode:

Nous avons révisé rétrospectivement tous les dossiers de patients atteints de méningiomes du sinus caverneux traités par radiochirurgie par scalpel gamme (SG) entre novembre 2003 et avril 2011 dans notre institution.

Résultats:

Trente patients, dont 8 hommes (26,7%) et 22 femmes (73,3%), ont été traités. Cependant, 4 ont été perdus de vue en cours de suivi. Les symptômes suivants étaient présents lors de la consultation initiale: une céphalée (9), des dysesthésies/paresthésies du trijumeau (13), une paralysie du nerf moteur oculaire externe (11), une paralysie du nerf moteur oculaire commun (8), un syndrome de Horner (2), une vision floue (9) et un déficit pupillaire afférent (1). Un patient était asymptomatique malgré la présence d'une tumeur dont le diagnostique était établi. Le plan de traitement a été établi à l'aide de l'IRM et de la tomodensitométrie chez 17 des 30 patients (56,7%) et de l'IRM seule chez les autres (44,3%). Douze patients ont subi une réduction chirurgicale du volume tumoral avant la radiochirurgie. Le diamètre moyen et le volume de la tumeur au moment de la radiochirurgie étaient de 3,4 cm et 7,9 cm3 respectivement. La dose moyenne à la ligne isodose de 50% était de 13,5Gy. Le suivi était disponible chez 16 patients. La durée moyenne du suivi était de 36,1 mois et l'âge moyen des patients était de 55,1 ans. La taille de la tumeur après traitement par SG a diminué chez 9 patients (34,6%), est demeurée stable chez 15 patients (57,7%) et a continué à croître chez 2 patients (7,7%). Des complications transitoires mineures sont survenues chez 12 patients et toutes ces complications ont disparu. Cinq patients ont présenté des complications permanentes graves: une névralgie du trijumeau (2), une névralgie occipitale causée par le cadre stétéotaxique (1), une aggravation de crises convulsives préexistantes (1) et un panhypopituitarisme (1).

Conclusion:

Le SG est un mode de traitement efficace pour arrêter la progression du méningiome du sinus caverneux et son taux de complications permanentes est acceptable.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 6 , November 2012 , pp. 757 - 762
Copyright
Copyright © The Canadian Journal of Neurological 2012

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