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Gamma Knife radiosurgery for meningiomas of the confluence of the falx and tentorium

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Abstract

Purpose

Meningiomas arising from the confluence of the falx and tentorium (CFT) are a rare and challenging subset of meningiomas. Gamma Knife radiosurgery (GKRS) is well-established as a safe and effective management strategy for intracranial meningiomas, but its role in treating CFT meningiomas is not well-described. This paper reports the largest series focused exclusively on the outcomes of GKRS for CFT meningiomas.

Methods

We retrospectively identified 20 CFT meningiomas out of 2031 meningioma patients who underwent GKRS at our institution between 1987 and 2021. Tumor control, overall survival (OS), and complications were recorded and analyzed. The median tumor margin dose was 13 Gy at the 50% isodose line. The median tumor volume treated was 4.4 cc (IQR 3.5–7.7). The median patient age was 58 years (range 33–83), the median MRI surveillance duration was 59 months (IQR 34–92), and the median overall follow-up duration was 92 months (IQR 42–201).

Results

The local tumor control rate (PFS) at 5 and 10-years were 100% (N=10) and 83% (N=4), respectively. Eight patients had stable tumor volumes and 11 patients had regression. One patient with a twice-operated tumor had delayed progression at 7.5 years and was retreated with GKRS. No patient had adverse radiation effects during the period of MRI surveillance. The 5 and 10-year OS were 100% (N=13) and 100% (N=7), respectively.

Conclusions

GKRS is a valuable therapeutic strategy for patients with newly diagnosed CFT meningiomas or progressive residual tumors after surgical resection.

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Acknowledgements

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. Hussein M. Abdallah and Arka N. Mallela have contributed equally to this work.

Authors and Affiliations

  1. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Hussein M. Abdallah & Zhishuo Wei

  2. Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Arka N. Mallela, Hussam Abou-Al-Shaar, Ajay Niranjan & L. Dade Lunsford

  3. Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA

    Arka N. Mallela

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  1. Hussein M. Abdallah
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Contributions

ANM, HA, AN, LDL designed the study. HMA and ZW collected the data. HMA and AM performed data analysis and prepared the figures. HMA, ANM, HA and ZW wrote the main manuscript text. LDL and AN edited the manuscript. LDL and ANM oversaw the study.

Corresponding author

Correspondence to Arka N. Mallela.

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Competing interests

Dr Lunsford is a stockholder in Elekta AB. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

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This study was approved by our institution’s IRB.

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Abdallah, H.M., Mallela, A.N., Wei, Z. et al. Gamma Knife radiosurgery for meningiomas of the confluence of the falx and tentorium. J Neurooncol 161, 225–233 (2023). https://doi.org/10.1007/s11060-022-04125-1

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