MR venography in gamma knife radiosurgery for parasagittal meningiomas: A technical note with the rationale of venous protection and a review of literature

Sushanta Sahoo; Chirag Ahuja; Sivashanmugam Dhandapani; Renu Madan; Parsee Tomar; Sushil Kumar; Manjeet Kaur

doi:10.4103/ajns.AJNS_436_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(02): 307-311
DOI: 10.4103/ajns.AJNS_436_20

Original Article

MR venography in gamma knife radiosurgery for parasagittal meningiomas: A technical note with the rationale of venous protection and a review of literature

Authors

Sushanta Sahoo

Departments of Neurosurgery, PGIMER, Chandigarh
Chirag Ahuja

¹Department of Radiodiagnosis, PGIMER, Chandigarh
Sivashanmugam Dhandapani

Departments of Neurosurgery, PGIMER, Chandigarh
Renu Madan

²Department of Radiotherapy, PGIMER, Chandigarh
Parsee Tomar

²Department of Radiotherapy, PGIMER, Chandigarh
Sushil Kumar

¹Department of Radiodiagnosis, PGIMER, Chandigarh
Manjeet Kaur

Departments of Neurosurgery, PGIMER, Chandigarh

Abstract

Postradiosurgery symptomatic brain edema may be seen with parasagittal meningioma owing to its proximity to major venous sinuses and cortical veins. Venous preservation radiosurgery planning is less described. Here, we discuss a new method of tumor volume contouring on postcontrast magnetic resonance venogram (CEMRV) images safely excluding the adjacent cortical veins and sinuses. Six cases of parasagittal meningiomas where Gamma Knife radiosurgery was planned on CEMRV sequence were studied in detail. A double-contrast injection method was used to obtain CEMRV images. The differential contrast enhancement showed the displaced and compressed sinuses and cortical veins in the vicinity of meningioma. Tumor was contoured on both contrast magnetic resonance imaging (CEMRI) and MRV image for comparative analysis. 15 Gy at 50% marginal isodose was prescribed and quantitative assessment showed reduced exposure to the adjacent veins and sinuses on the MRV plan as compared to the CEMRI plan. All patients remain asymptomatic at a mean follow-up of 34.2 months. Postcontrast MRV is a simple sequence and can delineate the adjacent venous structures in parasagittal meningiomas. Tumor contouring directly on this sequence guides the surgeon to prescribe adequate radiation dose while sparing cortical veins and sinuses in radiosurgery planning.

Key-words:

Brain edema - Gamma Knife radiosurgery - meningioma

Full Text

References

References
1 Kondziolka D, Patel AD, Kano H, Flickinger JC, Lunsford LD. Long-term Outcomes After Gamma Knife Radiosurgery for Meningiomas. Am J Clin Oncol 2016;39:453-7.
2 Conti A, Pontoriero A, Salamone I, Siragusa C, Midili F, La Torre D, et al. Protecting venous structures during radiosurgery for parasagittal meningiomas. Neurosurg Focus 2009;27:E11.
3 Patil CG, Hoang S, Borchers DJ 3rd, Sakamoto G, Soltys SG, Gibbs IC, et al. Predictors of peritumoral edema after stereotactic radiosurgery of supratentorial meningiomas. Neurosurgery 2008;63:435-40.
4 Singh VP, Kansai S, Vaishya S, Julka PK, Mehta VS. Early complications following gamma knife radiosurgery for intracranial meningiomas. J Neurosurg 2000;93 Suppl 3:57-61.
5 Tanaka M, Imhof HG, Schucknecht B, Kollias S, Yonekawa Y, Valavanis A. Correlation between the efferent venous drainage of the tumor and peritumoral edema in intracranial meningiomas: Superselective angiographic analysis of 25 cases. J Neurosurg 2006;104:382-8.
6 Dhandapani M, Gupta S, Mohanty M, Gupta SK, Dhandapani S. Prevalence and Trends in the Neuropsychological Burden of Patients having Intracranial Tumors with Respect to Neurosurgical Intervention. Ann Neurosci 2017;24:105-10.
7 Dhandapani S, Sharma K. Is “en-bloc” excision, an option for select large vascular meningiomas? Surg Neurol Int 2013;4:102.
8 Conti A, Pontoriero A, Siddi F, Iatì G, Cardali S, Angileri FF, et al. Post-treatment edema after meningioma radiosurgery is a predictable complication. Cureus 2016;8:e605.
9 Hoe Y, Choi YJ, Kim JH, Kwon DH, Kim CJ, Cho YH. Peritumoral brain edema after stereotactic radiosurgery for asymptomatic intracranial meningiomas: Risks and pattern of evolution. J Korean Neurosurg Soc 2015;58:379-84.
10 Morgan TM, Zaenger D, Switchenko JM, Eaton BR, Crocker IR, Ali AN, et al. Fractionated radiotherapy is associated with lower rates of treatment-related edema than stereotactic radiosurgery in magnetic resonance imaging-defined meningiomas. World Neurosurg 2019;121:e640-6.
11 Sheehan JP, Cohen-Inbar O, Ruangkanchanasetr R, Bulent Omay S, Hess J, Chiang V, et al. Post-radiosurgical edema associated with parasagittal and parafalcine meningiomas: A multicenter study. J Neurooncol 2015;125:317-24.
12 Bozzao A, Finocchi V, Romano A, Ferrante M, Fasoli F, Trillò G, et al. Role of contrast-enhanced MR venography in the preoperative evaluation of parasagittal meningiomas. Eur Radiol 2005;15:1790-6.
13 Sahoo SK, Ghuman MS, Salunke P, Vyas S, Bhar R, Khandelwal NK. Evaluation of anterior third of superior sagittal sinus in normal population: Identifying the subgroup with dominant drainage. J Neurosci Rural Pract 2016;7:257-61.
14 Tomasello F, Conti A, Cardali S, Angileri FF. Venous preservation-guided resection: A changing paradigm in parasagittal meningioma surgery. J Neurosurg 2013;119:74-81.