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DOI: 10.1055/s-0041-1722937
Skull Base Meningiomas in Patients with Neurofibromatosis Type 2: An International Multicenter Study Evaluating Stereotactic Radiosurgery
Funding None.![](https://www.thieme-connect.de/media/jnlsb/2022S02/lookinside/thumbnails/10-1055-s-0041-1722937_200283-1.jpg)
Abstract
Objective Meningiomas are the second most common tumors in neurofibromatosis type 2 (NF-2). Microsurgery is challenging in NF-2 patients presenting with skull base meningiomas due to the intrinsic risks and need for multiple interventions over time. We analyzed treatment outcomes and complications after primary Gamma Knife radiosurgery (GKRS) to delineate its role in the management of these tumors.
Methods An international multicenter retrospective study approved by the International Radiosurgery Research Foundation was performed. NF-2 patients with at least one growing and/or symptomatic skull base meningioma and 6-month follow-up after primary GKRS were included. Clinical and radiosurgical parameters were recorded for analysis.
Results In total, 22 NF-2 patients with 54 skull base meningiomas receiving GKRS as primary treatment met inclusion criteria. Median age at GKRS was 38 years (10–79 years). Most lesions were located in the posterior fossa (55.6%). Actuarial progression free survival (PFS) rates were 98.1% at 2 years and 90.0% at 5 and 10 years. The median follow-up time after initial GKRS was 5.0 years (0.6–25.5 years). Tumor volume at GKRS was a predictor of tumor control. Lesions >5.5 cc presented higher chances to progress after radiosurgery (p = 0.043). Three patients (13.64%) developed adverse radiation effects. No malignant transformation or death due to meningioma or radiosurgery was reported.
Conclusions GKRS is effective and safe in the management of skull base meningiomas in NF-2 patients. Tumor volume deserve greater relevance during clinical decision-making regarding the most appropriate time to treat. GKRS offers a minimally invasive approach of particular interest in this specific group of patients.
Publication History
Received: 06 August 2020
Accepted: 06 December 2020
Article published online:
19 January 2021
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References
- 1 Asthagiri AR, Parry DM, Butman JA. et al. Neurofibromatosis type 2. Lancet 2009; 373 (9679): 1974-1986
- 2 Smith MJ, Higgs JE, Bowers NL. et al. Cranial meningiomas in 411 neurofibromatosis type 2 (NF2) patients with proven gene mutations: clear positional effect of mutations, but absence of female severity effect on age at onset. J Med Genet 2011; 48 (04) 261-265
- 3 Goutagny S, Kalamarides M. Meningiomas and neurofibromatosis. J Neurooncol 2010; 99 (03) 341-347
- 4 Baser ME, Friedman JM, Aeschliman D. et al. Predictors of the risk of mortality in neurofibromatosis 2. Am J Hum Genet 2002; 71 (04) 715-723
- 5 Desai R, Bruce J. Meningiomas of the cranial base. J Neurooncol 1994; 20 (03) 255-279
- 6 Almefty R, Dunn IF, Pravdenkova S, Abolfotoh M, Al-Mefty O. True petroclival meningiomas: results of surgical management. J Neurosurg 2014; 120 (01) 40-51
- 7 Gozal YM, Alzhrani G, Abou-Al-Shaar H, Azab MA, Walsh MT, Couldwell WT. Outcomes of decompressive surgery for cavernous sinus meningiomas: long-term follow-up in 50 patients. J Neurosurg 2020; 132 (02) 380-387
- 8 Ichinose T, Goto T, Ishibashi K, Takami T, Ohata K. The role of radical microsurgical resection in multimodal treatment for skull base meningioma. J Neurosurg 2010; 113 (05) 1072-1078
- 9 Morisako H, Goto T, Ohata K. Petroclival meningiomas resected via a combined transpetrosal approach: surgical outcomes in 60 cases and a new scoring system for clinical evaluation. J Neurosurg 2015; 122 (02) 373-380
- 10 Nanda A, Javalkar V, Banerjee AD. Petroclival meningiomas: study on outcomes, complications and recurrence rates. J Neurosurg 2011; 114 (05) 1268-1277
- 11 Nanda A, Thakur JD, Sonig A, Missios S. Microsurgical resectability, outcomes, and tumor control in meningiomas occupying the cavernous sinus. J Neurosurg 2016; 125 (02) 378-392
- 12 Singh N, Singh DK, Ahmad F, Kumar R. The retrosigmoid approach: workhorse for petroclival meningioma surgery. Asian J Neurosurg 2019; 14 (01) 188-192
- 13 Cohen-Inbar O, Lee CC, Schlesinger D, Xu Z, Sheehan JP. Long-term results of stereotactic radiosurgery for skull base meningiomas. Neurosurgery 2016; 79 (01) 58-68
- 14 Sheehan JP, Williams BJ, Yen CP. Stereotactic radiosurgery for WHO grade I meningiomas. J Neurooncol 2010; 99 (03) 407-416
- 15 Patibandla MR, Lee CC, Sheehan J. Stereotactic radiosurgery of central skull base meningiomas-volumetric evaluation and long-term outcomes. World Neurosurg 2017; 108: 176-184
- 16 Starke RM, Nguyen JH, Reames DL, Rainey J, Sheehan JP. Gamma knife radiosurgery of meningiomas involving the foramen magnum. J Craniovertebr Junction Spine 2010; 1 (01) 23-28
- 17 Starke RM, Przybylowski CJ, Sugoto M. et al. Gamma knife radiosurgery of large skull base meningiomas. J Neurosurg 2015; 122 (02) 363-372
- 18 Starke RM, Williams BJ, Hiles C, Nguyen JH, Elsharkawy MY, Sheehan JP. Gamma knife surgery for skull base meningiomas. J Neurosurg 2012; 116 (03) 588-597
- 19 Goutagny S, Yang HW, Zucman-Rossi J. et al. Genomic profiling reveals alternative genetic pathways of meningioma malignant progression dependent on the underlying NF2 status. Clin Cancer Res 2010; 16 (16) 4155-4164
- 20 Bi WL, Abedalthagafi M, Horowitz P. et al. Genomic landscape of intracranial meningiomas. J Neurosurg 2016; 125 (03) 525-535
- 21 Lee S, Karas PJ, Hadley CC. et al. The role of merlin/NF2 loss in meningioma biology. Cancers (Basel) 2019; 11 (11) E1633
- 22 Goutagny S, Bah AB, Henin D. et al. Long-term follow-up of 287 meningiomas in neurofibromatosis type 2 patients: clinical, radiological, and molecular features. Neuro-oncol 2012; 14 (08) 1090-1096
- 23 Walker AJ, Ruzevick J, Malayeri AA. et al. Postradiation imaging changes in the CNS: how can we differentiate between treatment effect and disease progression?. Future Oncol 2014; 10 (07) 1277-1297
- 24 Patibandla MR, Lee CC, Tata A, Addagada GC, Sheehan JP. Stereotactic radiosurgery for WHO grade I posterior fossa meningiomas: long-term outcomes with volumetric evaluation. J Neurosurg 2018; 129 (05) 1249-1259
- 25 Mehta GU, Zenonos G, Patibandla MR. et al. Outcomes of stereotactic radiosurgery for foramen magnum meningiomas: an international multicenter study. J Neurosurg 2018; 129 (02) 383-389
- 26 Aboukais R, Zairi F, Baroncini M. et al. Intracranial meningiomas and neurofibromatosis type 2. Acta Neurochir (Wien) 2013; 155 (06) 997-1001 , discussion 1001
- 27 Li P, Wu T, Wang Y. et al. Clinical features of newly developed NF2 intracranial meningiomas through comparative analysis of pediatric and adult patients. Clin Neurol Neurosurg 2020; 194: 105799
- 28 Evers S, Verbaan D, Sanchez E, Peerdeman S. 3D volumetric measurement of neurofibromatosis type 2-associated meningiomas: association between tumor location and growth rate. World Neurosurg 2015; 84 (04) 1062-1069
- 29 Bassiouni H, Asgari S, Stolke D. Tuberculum sellae meningiomas: functional outcome in a consecutive series treated microsurgically. Surg Neurol 2006; 66 (01) 37-44 , discussion 44–45
- 30 D'Amico RS, Banu MA, Petridis P. et al. Efficacy and outcomes of facial nerve-sparing treatment approach to cerebellopontine angle meningiomas. J Neurosurg 2017; 127 (06) 1231-1241
- 31 Nanda A, Jawahar A, Sathyanarayana S. Microsurgery for potential radiosurgical skull base lesions: a retrospective analysis and comparison of results. Skull Base 2003; 13 (03) 131-138
- 32 Giammattei L, Starnoni D, Levivier M, Messerer M, Daniel RT. Surgery for clinoidal meningiomas: case series and meta-analysis of outcomes and complications. World Neurosurg 2019; 129: e700-e717
- 33 Guduk M, Yener U, Sun HI, Hacihanefioglu M, Ozduman K, Pamir MN. Pterional and unifrontal approaches for the microsurgical resection of olfactory groove meningiomas: experience with 61 consecutive patients. Turk Neurosurg 2017; 27 (05) 707-715
- 34 Goto T, Ohata K. Surgical resectability of skull base meningiomas. Neurol Med Chir (Tokyo) 2016; 56 (07) 372-378
- 35 Aichholzer M, Bertalanffy A, Dietrich W. et al. Gamma knife radiosurgery of skull base meningiomas. Acta Neurochir (Wien) 2000; 142 (06) 647-652 , discussion 652–653
- 36 Bir SC, Ambekar S, Ward T, Nanda A. Outcomes and complications of gamma knife radiosurgery for skull base meningiomas. J Neurol Surg B Skull Base 2014; 75 (06) 397-401
- 37 Black PM, Villavicencio AT, Rhouddou C, Loeffler JS. Aggressive surgery and focal radiation in the management of meningiomas of the skull base: preservation of function with maintenance of local control. Acta Neurochir (Wien) 2001; 143 (06) 555-562
- 38 Couldwell WT, Cole CD, Al-Mefty O. Patterns of skull base meningioma progression after failed radiosurgery. J Neurosurg 2007; 106 (01) 30-35
- 39 Eustacchio S, Trummer M, Fuchs I, Schröttner O, Sutter B, Pendl G. Preservation of cranial nerve function following gamma knife radiosurgery for benign skull base meningiomas: experience in 121 patients with follow-up of 5 to 9.8 years. Acta Neurochir Suppl (Wien) 2002; 84: 71-76
- 40 Han JH, Kim DG, Chung HT. et al. Gamma knife radiosurgery for skull base meningiomas: long-term radiologic and clinical outcome. Int J Radiat Oncol Biol Phys 2008; 72 (05) 1324-1332
- 41 Hayashi M, Chernov M, Tamura N. et al. Gamma knife robotic microradiosurgery for benign skull base meningiomas: tumor shrinkage may depend on the amount of radiation energy delivered per lesion volume (unit energy). Stereotact Funct Neurosurg 2011; 89 (01) 6-16
- 42 Igaki H, Maruyama K, Koga T. et al. Stereotactic radiosurgery for skull base meningioma. Neurol Med Chir (Tokyo) 2009; 49 (10) 456-461
- 43 Iwai Y, Yamanaka K, Ikeda H. Gamma knife radiosurgery for skull base meningioma: long-term results of low-dose treatment. J Neurosurg 2008; 109 (05) 804-810
- 44 Iwai Y, Yamanaka K, Nakajima H, Yasui T, Kishi H. [Gamma knife radiosurgery for skull base meningiomas: the treatment results and patient satisfaction expressed in answers to a questionnaire]. No Shinkei Geka 2000; 28 (05) 411-415
- 45 Iwai Y, Yamanaka K, Shimohonji W, Ishibashi K. Staged gamma knife radiosurgery for large skull base meningiomas. Cureus 2019; 11 (10) e6001
- 46 Joshi KC, Raghavan A, Muhsen B. et al. Fractionated gamma knife radiosurgery for skull base meningiomas: a single-institution experience. Neurosurg Focus 2019; 46 (06) E8
- 47 Kreil W, Luggin J, Fuchs I, Weigl V, Eustacchio S, Papaefthymiou G. Long term experience of gamma knife radiosurgery for benign skull base meningiomas. J Neurol Neurosurg Psychiatry 2005; 76 (10) 1425-1430
- 48 Liscák R, Kollová A, Vladyka V, Simonová G, Novotný Jr J. Gamma knife radiosurgery of skull base meningiomas. Acta Neurochir Suppl (Wien) 2004; 91: 65-74
- 49 Metellus P, Regis J, Muracciole X. et al. Evaluation of fractionated radiotherapy and gamma knife radiosurgery in cavernous sinus meningiomas: treatment strategy. Neurosurgery 2005; 57 (05) 873-886 , discussion 873–886
- 50 Morita A, Coffey RJ, Foote RL, Schiff D, Gorman D. Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients. J Neurosurg 1999; 90 (01) 42-49
- 51 Nakaya K, Chernov M, Kasuya H. et al. Risk factors for regrowth of intracranial meningiomas after gamma knife radiosurgery: importance of the histopathological grade and MIB-1 index. Minim Invasive Neurosurg 2009; 52 (5-6): 216-221
- 52 Nicolato A. 111Indium-octreotide brain scintigraphy: a prognostic factor in skull base meningiomas treated with gamma knife radiosurgery. Q J Nucl Med Mol Imaging 2004; 48 (01) 26-32
- 53 Nicolato A, Ferraresi P, Foroni R. et al. Gamma knife radiosurgery in skull base meningiomas. Preliminary experience with 50 cases. Stereotact Funct Neurosurg 1996; 66 (Suppl. 01) 112-120
- 54 Nicolato A, Giorgetti P, Foroni R. et al. Gamma knife radiosurgery in skull base meningiomas: a possible relationship between somatostatin receptor decrease and early neurological improvement without tumour shrinkage at short-term imaging follow-up. Acta Neurochir (Wien) 2005; 147 (04) 367-374 , discussion 374–375
- 55 Park HR, Lee JM, Park KW. et al. Fractionated gamma knife radiosurgery as initial treatment for large skull base meningioma. Exp Neurobiol 2018; 27 (03) 245-255
- 56 Pendl G, Eustacchio S, Unger F. Radiosurgery as alternative treatment for skull base meningiomas. J Clin Neurosci 2001; 8 (Suppl. 01) 12-14
- 57 Pendl G, Schröttner O, Eustacchio S, Feichtinger K, Ganz J. Stereotactic radiosurgery of skull base meningiomas. Minim Invasive Neurosurg 1997; 40 (03) 87-90
- 58 Pendl G, Schröttner O, Friehs GM, Feichtinger H. Stereotactic radiosurgery of skull base meningiomas. Stereotact Funct Neurosurg 1995; 64 (Suppl. 01) 11-18
- 59 Pollock BE, Stafford SL, Link MJ. Gamma knife radiosurgery for skull base meningiomas. Neurosurg Clin N Am 2000; 11 (04) 659-666
- 60 Reynolds MR, Hawasli AH, Murphy RK. et al. Acute hemorrhage following gamma knife radiosurgery to a clival meningioma. J Spine Neurosurg 2013; 2 (02) 108
- 61 Su CF, Liu DW, Lee CC, Chiu TL. Volume-staged gamma knife surgery for the treatment of large skull base meningioma surrounding the optical apparatus: a snowman-shape design. J Chin Med Assoc 2017; 80 (11) 697-704
- 62 Takanashi M, Fukuoka S, Hojyo A, Sasaki T, Nakagawara J, Nakamura H. Gamma knife radiosurgery for skull-base meningiomas. Prog Neurol Surg 2009; 22: 96-111
- 63 Vermeulen S, Young R, Li F. et al. A comparison of single fraction radiosurgery tumor control and toxicity in the treatment of basal and nonbasal meningiomas. Stereotact Funct Neurosurg 1999; 72 (Suppl. 01) 60-66
- 64 Liu A, Kuhn EN, Lucas Jr JT, Laxton AW, Tatter SB, Chan MD. Gamma knife radiosurgery for meningiomas in patients with neurofibromatosis Type 2. J Neurosurg 2015; 122 (03) 536-542
- 65 Gao F, Li M, Wang Z, Shi L, Lou L, Zhou J. Efficacy and safety of gamma knife radiosurgery for meningiomas in patients with neurofibromatosis type 2: a long-term follow-up single-center study. World Neurosurg 2019; 125: e929-e936
- 66 Minniti G, Amichetti M, Enrici RM. Radiotherapy and radiosurgery for benign skull base meningiomas. Radiat Oncol 2009; 4: 42
- 67 Birckhead B, Sio TT, Pollock BE, Link MJ, Laack NN. Gamma knife radiosurgery for neurofibromatosis type 2-associated meningiomas: a 22-year patient series. J Neurooncol 2016; 130 (03) 553-560
- 68 Kondziolka D, Mathieu D, Lunsford LD. et al. Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 2008; 62 (01) 53-58 , discussion 58–60
- 69 DiBiase SJ, Kwok Y, Yovino S. et al. Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 2004; 60 (05) 1515-1519
- 70 Flickinger JC, Kondziolka D, Maitz AH, Lunsford LD. Gamma knife radiosurgery of imaging-diagnosed intracranial meningioma. Int J Radiat Oncol Biol Phys 2003; 56 (03) 801-806
- 71 Kane AJ, Sughrue ME, Rutkowski MJ. et al. Anatomic location is a risk factor for atypical and malignant meningiomas. Cancer 2011; 117 (06) 1272-1278