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J Neurol Surg B Skull Base 2020; 81(02): 158-164
DOI: 10.1055/s-0039-1683430
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Stereotactic Radiosurgery of Cavernous Sinus Meningiomas

Daniel Rueß
1   Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University Hospital Cologne, Cologne, Germany
,
Fenja Fritsche
1   Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University Hospital Cologne, Cologne, Germany
,
Stefan Grau
2   Department of General Neurosurgery, Center of Neurosurgery, University Hospital Cologne, Cologne, Germany
,
Harald Treuer
1   Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University Hospital Cologne, Cologne, Germany
,
Mauritius Hoevels
1   Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University Hospital Cologne, Cologne, Germany
,
Martin Kocher
1   Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University Hospital Cologne, Cologne, Germany
,
Christian Baues
3   Department of Radiation Oncology, University Hospital Cologne, Cologne, Germany
,
Maximilian I. Ruge
1   Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University Hospital Cologne, Cologne, Germany
› Author Affiliations
Further Information

Publication History

31 October 2018

04 February 2019

Publication Date:
12 March 2019 (online)

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Abstract

Objective Microsurgical resection of cavernous sinus meningiomas (CSM) is associated with a high rate of incomplete resection, recurrence, and the risk for permanent, severe cranial nerve deficits. Stereotactic radiosurgery (SRS) has evolved as alternative treatment for primary and recurrent CSM. Here, we report about the long-term clinical and radiological follow-up (FU) of a unique cohort of patients with CSM treated with LINAC or Cyberknife based SRS.

Methods In this single-center retrospective analysis, we include all patients with CSM who underwent single fraction SRS between 1993 and 2016. Clinical and radiological tumor control were evaluated by the Kaplan–Meier method. Additionally, patient data were analyzed in terms of symptom control and incidence of side effects rated by the common terminology criteria for adverse events (CTCAE; v4.03).

Results 116 patients (female/male = 91/25; median age, 54 years; range, 33–82 years) were included. Mean tumor volume was 5.7 ± 3.3 cm3 (range, 0.6–16.2 cm3), the median marginal dose was 12.6 Gy applied to isodose levels of 75%. Median clinical FU was 55 months (range, 3–226 months). Tumor control was 98% after 2 and 5 years and 90% after 10 years. Twelve patients (10.3%) had permanent or transient radiation related toxicity (CTCAE I–III). An improvement of symptoms was observed in 26.7% of the symptomatic patients (n = 20 of 75).

Conclusion SRS for CSM provides excellent long-term tumor and symptom control without considerable permanent side effects. Thus, SRS should be considered when counseling patients suffering from CSM.

Keywords

radiosurgery - meningioma - skull base - Cyberknife
 

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