Abstract
LINAC radiosurgery has provided increasing access and changed treatment strategies in patients with benign skull base meningiomas in recent years. From January 1996 to January 2003, 37 patients with skull base meningiomas were treated with LINAC radiosurgery. A combination of the University of Florida system and the X Knife System, developed by Radionics, was used in all patients. Eight patients were treated by microsurgical resection before radiosurgery, in two patients tumor recurrence was treated and in 29 patients LINAC radiosurgery was the initial treatment procedure. The median treatment volume was 5.9 mL (0.7 to 22 mL) and the median given dose was 14.6 Gy (12.8 to 18 Gy) prescribed to the 80 percent isodose line. The follow-up period is between 12 and 96 months, median 66 months. 12 patients (32.4 %) showed a significant reduction in tumor size, in 11 patients (29.7 %) there was significantly less contrast enhancement and in 13 patients (35.1 %) the skull base meningioma was without any change. In one patient (2.8 %) there was tumor growth 48 months after radiosurgery, so the tumor control rate was 97.2 %. Two patients (5.6 %) showed neurological worsening after radiosurgery, whereas the symptoms were transient in one patient. LINAC radiosurgery offers us an effective treatment modality and changes treatment strategies in skull base meningiomas towards a less aggressive surgical approach. By combining microsurgery and radiosurgery we can achieve high tumor control rates with an acceptable low morbidity and a high level of quality of life.
Key words
LINAC radiosurgery - radiotherapy - skull base meningioma - local tumor control
References
-
1
Al Mefty O, Ayoubi S, Smith R R.
The petrosal approach: indications, techniques, and results.
Acta Neurochir (Wien).
1991;
53 (Supp1)
166-170
-
2
Carella R J, Ransohoff J, Newall J.
Role of radiation therapy in the management of meningioma.
Neurosurgery.
1982;
10
332-339
-
3
Samii M.
Experience with 36 surgical cases of petroclival meningiomas.
Acta Neurochir (Wien).
1992;
118
27-32
-
4
Chan R C, Thompson G B.
Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases.
J Neurosurg.
1984;
60
52-60
-
5
Ojeman R G.
Skull base surgery: a perspective.
J Neurosurg.
1992;
76
569-570
-
6
De Monte F, Smith H K, Al-Mefty O.
Outcome of aggressive removal of cavernous sinus meningiomas.
J Neurosurg.
1994;
81
245-251
-
7 Dolenc V V, Kregar T, Ferluga M, Fettich M, Mozrina A. Treatment of tumors invading the cavernous sinus. In: Dolenc VV (editor), The Cavernous Sinus: Multidisciplinary Approach to Vascular and Tumorous Lesions. Wien: Springer Verlag 1987: pp 377-391
-
8 Kawase T, Toya S, Shiobara R, Kimura C, Nakajima H. Skull base approaches for meningiomas invading the cavernous sinus. In: Dolenc VV (editor), The Cavernous Sinus: Multidisciplinary Approach to Vascular and Tumorous Lesions. Wien: Springer Verlag 1987: pp 346-354
-
9
Sekhar L N, Sen C N, Jho H D, Vanecka I P.
Surgical treatment of intracavernous neoplasms: A four year experience.
Neurosurgery.
1989;
24
18-30
-
10
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
-
11
Adegbite A B, Khan M I, Paine K WE, Tan L K.
The recurrence of intracranial meningiomas after surgical treatment.
J Neurosurg.
1983;
63
51-56
-
12
Carella R J, Ransohoff J, Newall J.
Role of radiation therapy in the management of meningioma.
Neurosurgery.
1982;
10
332-339
-
13
Borovich B, Doron Y.
Recurrence of intracranial meningiomas: the role played by regional multicentricity.
J Neurosurg.
1986;
64
58-63
-
14
Engerhart R, Kimmig B N, Hover K H, Wowra B, Sturm V, Kaick G van, Wannenmacher M.
Stereotactic single high dose radiation therapy of benign intracranial meningiomas.
Int J Radiat Oncol BioI Phys.
1990;
19
1021-1026
-
15
Goldsmith B J, Wara W M, Wilson C B, Larson D A.
Postoperative irradiation for subtotally resected meningiomas.
J Neurosurg.
1994;
80
195-201
-
16
Barbaro N M, Gutin P H, Wilson C B, Sheline G E, Boldrey E B, Wara W M.
Radiation therapy in the treatment of partially resected meningiomas.
Neurosurgery.
1987;
20
525-528
-
17
Hakim R, Alexander E, Loeffler J S, Shrieve D C, Wen P, Fallon M P, Stieg F E, Black P McL.
Results of linear accelerator-based radiosurgery for intracranial meningiomas.
Neurosurgery.
1998;
42
446-454
-
18
Lunsford L D, Kondziolka D, Flickinger J C.
Stereotactic radiosurgery for benign intracranial tumors.
Clin Neurosurg.
1993;
40
475-497
-
19
Petty A M, Kun L E, Meyer G A.
Radiation therapy for incompletely resected meningiomas.
J Neurosurg.
1985;
62
502-507
-
20
Taylor B W, Marcus R B, Friedman W A, Ballinger Jr W E, Million R R.
The meningioma controversy: postoperative radiation therapy.
Int J Radiat Oncol BioI Phys.
1988;
15
299-304
-
21
Mendenhall W M, Morris C G, Amdur R J, Foote K D, Friedman W A.
Radiotherapy alone or after subtotal resection for benign skull base meningiomas.
Cancer.
2003;
98
1473-1482
-
22
Yamashita J, Handa M, Iwaki K.
Recurrence of intracranial meningiomas with special reference to radiotherapy.
Surg Neurol.
1980;
14
33-40
-
23
Kondziolka D, Nathoo N, Flickinger J C, Niranjan A, Maitz A H, Lunsford L D.
Long term results after radiosurgery for benign intracranial tumors.
Neurosurgery.
2003;
53
815-821
-
24
Lee J Y, Niranjan A, McInerney J, Kondziolka D, Flickinger J C, Lunsford L D.
Stereotactic radiosurgery providing long-term tumor control cavernous sinus meningiomas.
J Neurosurg.
2002;
97
65-72
-
25
Stafford S L, Pollock B E, Foote R L, Link M J, Gorman D A, Schombe P J, Leavitt J A.
Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients.
Neurosurgery.
2001;
49
1029-1037
-
26
Villavicencio A T, Black P M, Shrieve D C, Fallon M P, Alexander E, Loeffler J S.
Linac radiosurgery for skull base meningiomas.
Acta Neurochir (Wien).
2001;
143
1141-1152
-
27
Pendl G, Eustacchio S, Unger F.
Radiosurgery as alternative treatment for skull base meningiomas.
J Clin Neurosci.
2001;
Suppl 1
12-14
-
28
Roche P H, Pellet W, Fuentes S, Thomassin J M, Regis J.
Gamma knife radiosurgical management of petroclival meningiomas results and indications.
Acta Neurochir (Wien).
2003;
145
883-888
-
29
Iwai Y, Yamanaka K, Ishiguro T.
Gamma knife radiosurgery for the treatment of cavernous sinus meningiomas.
Neurosurgery.
2003;
52
517-524
-
30
Chang J H, Chang J W, Choi J Y, Park Y G, Chung S S.
Complications after gamma knife radiosurgery for benign meningiomas.
J Neurol Neurosurg Psychiatry.
2003;
74
226-230
-
31
Spiegelmann R, Nissim O, Menhel J, Alezra D, Pfeffer M R.
Linear accelerator radiosurgery for meningiomas in and around the cavernous sinus.
Neurosurgery.
2002;
51
1373-1379
-
32
Nicolato A, Foroni R, Alessandrini F, Bricolo A, Gerosa M.
Radiosurgical treatment of cavernous sinus meningiomas: experience with 122 treated patients.
Neurosurgery.
2002;
51
1153-1159
-
33
Chang S D, Adler Jr J R.
Treatment of cranial base meningiomas with linear accelerator radiosurgery.
Neurosurgery.
1997;
41
1019-1025
-
34
Pendl G, Schroettner O, Eustacchio S, Feichtinger K, Ganz J.
Stereotactic radiosurgery of skull base meningiomas.
Minim Invas Neurosurg.
1997;
40
87-90
-
35
Liscak R, Simonova G, Vymazal J, Janouskova L, Vladyka V.
Gamma knife radiosurgery in the cavernous sinus region.
Acta Neurochir (Wien).
1999;
141
473-480
-
36
Aichholzer M, Bertalanffy A, Dietrich W, Roessler K, Pfisterer W, Ungersboeck K, Heimberger K, Kitz K.
Gamma knife radiosurgery of skull base meningiomas.
Acta Neurochir (Wien).
2000;
142
647-652
-
37
Kobayashi T, Kida Y, Mori Y.
Long term results of stereotactic gamma radiosurgery of meningiomas.
Surg Neurol.
2001;
55
325-441
-
38
Friedman W A.
Linear accelerator radiosurgery.
Clin Neurosurg.
1992;
38
445-471
-
39
Friedman W A, Bova F J.
The University of Florida radiosurgery system.
Surg Neurol.
1989;
32
334-342
-
40
Friedman W A, Bova F J.
Stereotactic radiosurgery.
Contemp Neurosurg.
1989;
11/12
1-7
-
41
Friedman W A, Bova F J, Spiegelmann R.
Linear accelerator radiosurgery at the University of Florida.
Neurosurg Clin North Am.
1992;
3
141-166
-
42
Black P McL.
Meningiomas.
Neurosurgery.
1993;
32
643-657
-
43
Couldwell W T, Fukushima T, Giannotta S L, Weiss M H.
Petroclival meningiomas: surgical experience in 109 cases.
J Neurosurg.
1996;
84
20-28
-
44 Dolenc V V. Anatomy and surgery of the cavernous sinus. Berlin, Heidelberg, New York: Springer Verlag 1989
-
45
Sekhar L N, Babu R P, Wright D C.
Surgical resection of cranial base meningiomas.
Neurosurg Clin North Am.
1994;
5
299-330
-
46
Black P McL, Villavicencio A T, Rhouddou C, Loeffler J S.
Aggressive surgery and focal radiation in the management of meningiomas of the skull base: Preservation of function with maintenance of local control.
Acta Neurochir.
2001;
143
555-562
-
47
Lundford 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
-
48
Awad l A, Kalfas I, Hahn J F, Little J R.
Intracranial meningiomas in the aged: Surgical outcome in the era of computed tomography.
Neurosurgery.
1989;
24
525-528
-
49
Chan R C, Thompson O B.
Morbidity, mortality and quality of life following surgery of intracranial meningiomas.
J Neurosurg.
1984;
60
52-60
-
50
Djindjian M, Caron J P, Athayde A A, Fevrier M J.
Intracranial meningiomas in the elderly (over 70 years old). A retrospective study of 30 surgical cases.
Acta Neurochir (Wien).
1988;
90
121-123
-
51
Mayberg M R, Symon L.
Meningiomas of the clivus and apical petrous bone: report of 35 cases.
J Neurosurg.
1986;
65
160-167
-
52
Al Mefty O, Fox J L, Smith R R.
Petrosal approach for petroclival meningiomas.
Neurosurgery.
1988;
22
510-517
-
53
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
-
54
Javed T, Sekhar L N.
Surgical management of clival meningiomas.
Acta Neurochir Suppl (Wien).
1991;
53
171-182
-
55
Samii M, Tatagiba M.
Experience with 36 cases of petroclival meningiomas.
Acta Neurochir (Wien).
1992;
118
27-32
-
56
Al Mefty O, Kersh J E, Routh A.
The long term side effects of radiation therapy for benign brain tumors in adults.
J Neurosurg.
1990;
73
502-512
-
57
Shafron D H, Friedman W A, Buatti J M, Bova F J, Mendenhall W M.
Linac radiosurgery for benign meningiomas.
lnt J Radiat Oncol BioI Phys.
1999;
43
321-327
-
58
Chang S D, Adler Jr J R, Martin D P.
LINAC radiosurgery for cavernous sinus meningiomas.
Stereotact Funct Neurosurg.
1998;
71
43-50
-
59
Roche P H, Regis J, Dufour H, Fournier H D, Delsanti C, Pellet W, Grisoli F, Peragut J C.
Gamma knife radiosurgery in the management of cavernous sinus meningioma.
J Neurosurg.
2000;
93
68-73
-
60
lwai Y, Yamanaka K, Nakajima H.
The treatment of skull base meningiomas - combining surgery and radiosurgery.
J Clin Neurosci.
2001;
8
528-533
-
61
Duma C M, Lunsford L D, Kondziolka D, Harsh G R, Flickinger J C.
Stereotactic radiosurgery of cavernous sinus meningiomas as an addition or alternative to microsurgery.
Neurosurgery.
1993;
32
699-705
-
62
Dufour H, Muracciole X, Metellus P, Regis J, Chinot O, Grisoli F.
Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with and without previous surgery: Is there an alternative to aggressive tumor removal.
Neurosurgery.
2001;
48
285-296
-
63
Kondziolka D, Levy E L, Niranjan A, Flickinger J C, Lunsford L D.
Long-term outcomes after meningioma radiosurgery: physician and patient perspective.
J Neurosurg.
1999;
91
44-50
-
64
Subach B R, Lunsford L D, Kondziolka D, Maitz A H, Flickinger J C.
Management of petroclival meningiomas by stereotactic radiosurgery.
Neurosurgery.
1998;
42
437-443
-
65
Pollock B E, Stafford S L, Link M J.
Gamma knife radiosurgery for skull base meningiomas.
Neurosurg Clin N Am.
2000;
11
659-666
-
66
Kondziolka D, Lunsford L D, Coffey R J, Flickinger J C.
Stereotactic radiosurgery of meningiomas.
J Neurosurg.
1991;
74
552-559
-
67
Pollock B E, Stafford S L, Utter A, Giannini C, Schreiner S A.
Stereotactic radiosurgery provides equivalent tumor control Simpson Grade 1 resection for patients with small- to median size meningiomas.
lnt J Radiat Oncol BioI Phys.
2003;
55
1000-1005
-
68
Muthukumar N, Kondziolka D, Lunsford L D, Flickinger J C.
Stereotactic radiosurgery for tentorial meningiomas.
Acta Neurochir (Wien).
1998;
140
315-320
-
69
Leber K A, Berglöff L, Pendl G.
Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery.
J Neurosurg.
1998;
88
43-50
-
70
Stafford S L, Pollock B E, Leavitt J A, Foote R L, Brown P D, Link M J, Gorman D A, Schomberg P l.
A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery.
lnt J Radiat Oncol BioI Phys.
2003;
55
1177-1181
-
71
Tishler R B, Loeffler J S, Lunsford L D.
Tolerance of cranial nerves of the cavernous sinus to radiosurgery.
lnt J Radiat Oncol BioI Phys.
1993;
27
215-221
-
72
Eustacchio S, Trummer M, Fuchs I, Schroettner O, Sutter B, Pendl G.
Preservation of cranial nerve function following gamma knife radiosurgery for benign skull base meningiomas: experience of 121 patients with follow up of 5 to 9.8 years.
Acta Neurochir .
2002;
84 (Suppl)
71-76
-
73
Morita A, Coffey R J, Foote R L, Schiff D, Gonnan D.
Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients.
J Neurosurg.
1999;
90
42-49
-
74
Flickinger J C, Kondziolka D, Maitz A H, Lunsford L D.
Gamma knife radiosurgery of imaging diagnosed intracranial meningioma.
Int J Radiat Oncol BioI Phys.
2003;
56
801-806
Robert Deinsberger, M. D.
Department of Neurosurgery · Zentralklinikum St. Pölten
Propst Führerstrasse 4
3100 St. Pölten
Austria
Phone: +43-2742-300-3651
Fax: +43-2742-300-3657 ·
Email: r.deinsberger@kh-st-poelten.at
