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A new classification and clinical results of Gamma Knife radiosurgery for cavernous sinus hemangiomas: a report of 53 cases

  • Clinical Article - Brain Tumors
  • Published:
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Abstract

Background

Cavernous sinus hemangiomas (CaSHs) are rare vascular lesions in the cavernous sinus(CS). Gamma Knife radiosurgery (GKS) provides a treatment modality alternative to microsurgery. This study was conducted to describe a new classification of CaSHs based on their magnetic resonance (MR) imaging findings and determine the efficacy and safety of GKS in a large series of CaSH patients.

Methods

From April 2007 to November 2012, 53 patients harboring CaSHs were treated using Leksell Gamma Knife model C (before April 2012) or Perfexion (from May 2012 ) at the Gamma Knife Center of Huashan Hospital. Of the 53 patients, 15 with definitive histopathologic diagnoses after surgery, 38 were diagnosed based on their MR imaging findings. There were 15 male and 38 female patients with a mean age of 52 (range, 25–76) years old. The characteristics of MR images of CaSHs were their extremely high homogeneous intensity on T2-weighted and FLAIR images: as bright as cerebrospinal fluid signal. According to the relationship between the carotid line and their location, CaSHs were classified into three types: the intrasellar, parasellar and mixed type. The mean volume of the tumors was 13.2 ± 8.2 cm3 (range, 1–41 cm3). A mean marginal dose of 13.3 Gy (range, 8–15 Gy) was directed to the 49 %–64 % isodose line (mean 53 %).

Results

Of the 53 tumors, 6 (11 %) were classified as intrasellar type. Eight (15 %) were parasellar type and the other 39 cases(74 %) mixed type. The mean radiological and clinical follow-up time of this study was 24 (range, 2–67 months) and 34 months (range, 2–73 months), respectively. The tumor control rate was 100 %. The mean tumor volume reduction was 79.5 % (range, 16.5 %–100 %) compared with the pre-GKS volume. Six months after GKS, MR imaging revealed an average of 60.2 % tumor volume reduction (range, 16.5 %–89.2 %). Twenty-nine cases (55 %) showed a >80 % tumor volume decrease. Neurologically, only two of these patients showed clinical deterioration, and 33 patients demonstrated an obvious improvement in ocular or endocrine disorders. At last follow-up, there were no more complications related to GKS, and none of the tumors progressed.

Conclusions

Our study showed that GKS is a useful and safe therapeutic method for CaSHs as both a primary and adjuvant treatment. The new classification of CaSHs may help predict their clinical course during tumor development and treatment response after GKS. Further studies with long-term follow-up and larger numbers of cases are necessary to optimize the treatment conditions and verify the benefit of this treatment.

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Acknowledgments

The authors are very grateful to Prof. Ying Mao, Wei Zhu, and Liang Chen, Department of Neurosurgery, Huashan Hospital, for their support in the surgical cases. The authors also thank Dr. Wenjing Cao, Lichen Wei, Hua Jiang, and Yanchao Zhu, Department of Radiology, Shanghai Gamma Hospital, for the pre- and postradiosurgical MR images for most cases. Finally, the authors express their sincere gratitude to Yongyan Ni for her outstanding help with the schematic work in Fig. 2.

Disclosure

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this paper.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Shanghai Gamma Hospital, Gamma Knife Centre of Huashan Hospital, Shanghai, 200235, China

    Xuqun Tang, Hanfeng Wu, Binjiang Wang, Nan Zhang, YaFei Dong, Jianbo Ding, Jiazhong Dai, Tonggang Yu & Li Pan

  2. Department of Neurosurgery, Huashan Hospital of Fudan University, Middle Wulumuqi Road 12, Shanghai, 200040, China

    Binjiang Wang, Nan Zhang, Jiazhong Dai, Tonggang Yu & Li Pan

Authors
  1. Xuqun Tang
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  2. Hanfeng Wu
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  3. Binjiang Wang
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  4. Nan Zhang
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  7. Jiazhong Dai
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  8. Tonggang Yu
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  9. Li Pan
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Corresponding author

Correspondence to Li Pan.

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Comment

This comprehensive review of a large cohort of patients harboring cavernous sinus pathology is highly valuable for neurosurgeons. As the authors point out, based on MRI one can be reasonably sure about the pathology, and I would add that in any case the residual uncertainty has only little impact on management. Very large tumors may benefit from partial, latero/superior partial resection, but in case of hemangiomas this is even less attractive than for meningiomas: these highly vascular tumors can pose a surgical challenge even for partial resection attempts.

On the other hand, it is precisely the high vascularity that makes hemangiomas so well suited to Gamma Knife treatment: this has been a well-established experience of radiosurgeons with other tumors, e.g., glomus jugulare tumors. This review underlines the importance of considering radiosurgery as an integral part of the neurosurgical armamentarium and the collaboration between microsurgical and radiosurgical approaches.

Andras Kemeny

Sheffield, UK

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Tang, X., Wu, H., Wang, B. et al. A new classification and clinical results of Gamma Knife radiosurgery for cavernous sinus hemangiomas: a report of 53 cases. Acta Neurochir 157, 961–969 (2015). https://doi.org/10.1007/s00701-015-2417-5

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  • DOI: https://doi.org/10.1007/s00701-015-2417-5

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