Safety and efficacy of single-fraction gamma knife radiosurgery for benign confined cavernous sinus tumors: our experience and literature review
- 217 Downloads
Gamma knife radiosurgery (GKRS) has emerged as a suitable primary treatment option for confined cavernous sinus tumors (CSTs) and residual/recurrent benign tumors extending from the surrounding neighborhood. The aim of this review was to further investigate the safety and efficacy of single-fraction GKRS for primary confined CSTs (hemangioma, meningioma, and schwannoma). This was a retrospective analysis of 16 patients of CSTs, primarily treated with GKRS between 2009 and 2017. The patients underwent follow-up clinical and radiological evaluation at a regular interval. Data on clinical and imaging parameters were analyzed. The published literature on GKRS for CSTs was reviewed. There were total 16 patients (eight meningiomas, seven hemangiomas, and one schwannoma). Patients presented with a headache (56.3%), ptosis (50%), and/or restricted extraocular movements (50%). There was 46.6% tumor volume (TV) reduction after single-fraction GKRS. Hemangiomas showed best TV reduction (64% reduction at > 3-year follow-up) followed by schwannoma (41.5%) and meningioma (25.4%). 56.3% of patients developed transient hypoesthesia in trigeminal nerve distribution. 44.4% of patients became completely pain-free. Among cranial nerves, the superior division of the oculomotor nerve showed best outcome (ptosis 62.5%) followed by an improved range of EOM. There was no adverse event in the form of new-onset deficit, vascular complication, or malignant transformation except for one out of the field failures. Among available treatment options, GKRS is the most suitable option by virtue of its minimally invasive nature, optimal long-term tumor control, improvement in cranial neuropathies, cost-effectiveness, favorable risk-benefit ratio, and minimal long-term complications.
KeywordsCavernous Gamma knife Hemangioma Meningioma Schwannoma Radiosurgery
We would like to acknowledge and thank late Professor Kanchan Kumar Mukherjee for his clinical work and treatment of these patients of cavernous sinus tumors.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Institute Ethics Committee, Postgraduate Institute of Medical Education and Research, Chandigarh, India) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 3.Borruat FX, Schatz NJ, Glaser JS et al (1996) Radiation optic neuropathy: report of cases, role of hyperbaric oxygen therapy, and literature review. Neuroophthalmology 16:255–266Google Scholar
- 4.Bristol R, Santoro A, Fantozzi L, Delfini R (1997) Cavernoma of the cavernous sinus: case report. Surg Neurol 48:160–163Google Scholar
- 15.Hayashi M, Chernov M, Tamura N, Tamura M, Horiba A, Konishi Y et al (2012) Gamma knife radiosurgery for benign cavernous sinus tumors: treatment concept and outcomes in 120 cases. Neurol Med Chir (Tokyo) 52:714–723Google Scholar
- 16.Ivanov P, Chernov M, Hayashi M, Nakaya K, Izawa M, Murata N, Kubo O, Ujiie H, Muragaki Y, Nakamura R, Iseki H, Hori T, Takakura K (2008) Low dose gamma knife radiosurgery for cavernous sinus hemangioma: a report of 3 cases and literature review. Minim Invasive Neurosurg 51:140–146PubMedGoogle Scholar
- 17.Iwai Y, Yamanka K, Nakajima H, Yasui T (1999) Stereotactic radiosurgery for cavernous sinus hemangioma—a case report. Neurol Med Chir (Tokyo) 39:288–290Google Scholar
- 18.Iwai Y, Yamanaka K, Ishiguro T (1996) Gamma knife radiosurgery for treatment of cavernous sinus meningiomas. Neurosurgery 38:434–444Google Scholar
- 23.Leavitt JA, Stafford SL, Link ML, Pollock BE (2013) Long-term evaluation of radiation-induced optic neuropathy after single fraction stereotactic radiosurgery. Int J Radiation Once Biol Phys 87:524–527Google Scholar
- 35.Mayo C, Nartel MK, Mark LB et al (2010) Radiation dose-volume effects of optic nerves and chiasm. Int J Radiat Once Biol Phys 76:S28–S35Google Scholar
- 40.Niranjan A, Kano H, Lunsford LD (2013) Gamma knife radio surgery for brain vascular malformations. Prog Neurol Surg 27:119–129Google Scholar
- 43.Roche PH, Regis J, Dufour H et al (2002) Gamma knife radiosurgery in the management of cavernous sinus meningiomas. J Neurosurg 93:68–73Google Scholar
- 44.Rong HT, Hui XH, Ju Y, Ma L, Zhang Q, Chen J (2013) Gamma knife radiosurgery for cavernous sinus tumor: a case report of 84 cases. Neurosurg Q 23:239–243Google Scholar
- 49.Song SW, Kim DG, Chung HT, Paek SH, Han JH, Kim YH, Kim JW, Kim YH, Jung HW (2014) Stereotactic radiosurgery for cavernous sinus hemangioma. J Neuro-Oncol 118:163–168Google Scholar
- 52.Wang X, Mei G, Liu X, Dai J, Li P, Wang E (2012) The role of stereotactic radiosurgery in cavernous sinus hemangioma: a systematic review and meta-analysis. J Neuro-Oncol 107:239–245Google Scholar