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J Neurol Surg B Skull Base
DOI: 10.1055/a-2324-9849
Original Article

Clinical and Radiological Response Following Single-Session Gamma Knife Radiosurgery in Cavernous Sinus Hemangiomas

Ananda Kalgudi
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
,
Abhijit Goyal-Honavar 
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
,
Nishanth Sadashiva 
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
,
Kaviyarasan MP
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
,
Mohammed Nadeem
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
,
Subhas Konar
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
,
Andiperumal Raj Prabhuraj 
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
,
Vikas Vazhayil
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
,
Arivazhagan Arimappamagan
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
,
Jeeva Balukrishnan
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
,
Ponnusamy Natesan
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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Abstract

Purpose Cavernous sinus hemangiomas (CSH) represent 2 to 3% of lesions occupying the cavernous sinus. The optimal management strategy for CSH is not established, with microsurgical resection and radiosurgery employed alone or in combination. Therefore, we aimed to analyze the efficacy and safety of gamma knife radiosurgery (GKRS) for CSH in a cohort of primary and residual CSH.

Methods A retrospective analysis of 33 patients (26 primary and 7 residual CSH) that underwent single-session GKRS between 2012 and 2021 for CSH was performed. Demographic, clinical, radiological, and follow-up data were acquired, and clinicoradiological response following GKRS was assessed.

Results The mean age of the cohort was 43 ± 13.5 years (range, 10–77). There were 9 males (27.3%) and 24 females (72.7%). The median lesion volume was 6.9 cc, ranging from 1.46 to 19.06 cc. The mean dose administered to the tumor margin was 13.50 ± 1.5 Gy (range, 12 to 15 Gy). The median duration of clinical follow-up was 41 months, over which period the mean reduction in tumor volume was 87.6%. Complete response, defined as absence of tumor on follow-up imaging, occurred in 23 patients (69.7%). Twenty-three patients (69.7%) showed clinical improvement following GKRS. There were no radiation-induced complications.

Conclusion CSH have a distinct radiological appearance and a predictable response to radiosurgery. When used primarily in radiologically diagnosed CSH and as adjunctive therapy supplementing a subtotal excision, GKRS produces a high rate of volume reduction with the improvement of neurological function and minimal cranial nerve morbidity. Therefore, GKRS presents a viable alternative to surgery without the morbidity associated with surgical resection.

Keywords

gamma knife radiosurgery - cavernous sinus hemangioma - cranial nerve - outcomes

Availability of Data and Material

Data are available at request from the corresponding author (N.S.).


Ethics Approval

Ethical approval was not required as the study was retrospective, and all patient data were anonymized.


Consent to Participate

As this manuscript is based on retrospectively collected data without revealing the identity of subjects, patient consent was waived.




Publication History

Received: 22 March 2024

Accepted: 09 May 2024

Accepted Manuscript online:
13 May 2024

Article published online:
03 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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