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Journal of Neuro-Oncology

, Volume 139, Issue 2, pp 341–348 | Cite as

Cranial nerve outcomes after primary stereotactic radiosurgery for symptomatic skull base meningiomas

  • Andrew Faramand
  • Hideyuki KanoEmail author
  • Ajay Niranjan
  • Stephen A. Johnson
  • Mohab Hassib
  • Kyung-Jae Park
  • Yoshio Arai
  • John C. Flickinger
  • L. Dade Lunsford
Clinical Study
First Online:

Abstract

Objective

To evaluate cranial nerve (CN) outcomes after primary stereotactic radiosurgery (SRS) for petroclival, cavernous sinus, and cerebellopontine angle meningiomas.

Methods

From our prospectively maintained database of 2022 meningioma patients who underwent Leksell stereotactic radiosurgery (SRS) during a 30-year interval, we found 98 patients with petroclival, 242 with cavernous sinus, and 55 patients with cerebellopontine angle meningiomas. Primary radiosurgery was performed in 245 patients. Patients included in this report had at least one CN deficit at the time of initial presentation and a minimum of 12 month follow up. Median age at the time of SRS was 58 years. Median follow up was 58 months (range 12–300 months), Median tumor volume treated with SRS was 5.9 cm3 (range 0.5–37.5 cm3), and median margin dose was 13 Gy (range 9–20Gy).

Results

Tumor control was achieved in 229 patients (93.5%) at a median follow up of 58 months. Progression free survival rate (PFS) after SRS was 98.7% at 1 year, 96.4% at 3 years, 93.7% at 5 years, and 86.4% at 10 years Overall, 114 of the 245 patients (46.5%) reported improvement of CN function. Patients with CP angle meningiomas demonstrated lower rates of CN improvement compared to petroclival and cavernous sinus meningioma patients. Deterioration of CN function after SRS developed in 24 patients (10%). The rate of deterioration was 2.8% at 1 year, 5.2% at 3 years, and 8% at 10 years.

Conclusion

Primary SRS provides effective tumor control and favorable rate of improvement of preexisting CN deficit.

Keywords

Radiosurgery Skull base Meningioma Cranial nerve 
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Notes

Compliance with ethical standards

Disclosures

Dr. Lunsford is a consultant for and stockholder in Elekta AB.

References

  1. 1.
    Al-Mefty O, Fox JL, Smith RR (1988) Petrosal approach for petroclival meningiomas. Neurosurgery 22(3):510–517CrossRefPubMedGoogle Scholar
  2. 2.
    Bambakidis NC, Kakarla UK, Kim LJ et al (2008) Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery 62(6 Suppl 3):1182–1191PubMedGoogle Scholar
  3. 3.
    Cusimano MD, Sekhar LN, Sen CN et al (1995) The results of surgery for benign tumors of the cavernous sinus. Neurosurgery 37(1):1–9 (Discussion 9–10)CrossRefPubMedGoogle Scholar
  4. 4.
    Sheehan JP, Starke RM, Kano H et al (2015) Gamma Knife radiosurgery for posterior fossa meningiomas: a multicenter study. J Neurosurg 122(6):1479–1489CrossRefPubMedGoogle Scholar
  5. 5.
    Starke R, Kano H, Ding D et al (2014) Stereotactic radiosurgery of petroclival meningiomas: a multicenter study. J Neurooncol 119(1):169–176CrossRefPubMedGoogle Scholar
  6. 6.
    Flannery TJ, Kano H, Lunsford LD et al (2010) Long-term control of petroclival meningiomas through radiosurgery. J Neurosurg 112(5):957–964CrossRefPubMedGoogle Scholar
  7. 7.
    Park SH, Kano H, Niranjan A, Flickinger JC, Lunsford LD (2014) Stereotactic radiosurgery for cerebellopontine angle meningiomas. J Neurosurg 120(3):708–715CrossRefPubMedGoogle Scholar
  8. 8.
    Lee JY, Niranjan A, McInerney J, Kondziolka D, Flickinger JC, Lunsford LD (2002) Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurg 97(1):65–72CrossRefPubMedGoogle Scholar
  9. 9.
    Kano H, Awan NR, Flannery TJ et al (2011) Stereotactic radiosurgery for patients with trigeminal neuralgia associated with petroclival meningiomas. Stereotact Funct Neurosurg 89(1):17–24CrossRefPubMedGoogle Scholar
  10. 10.
    Gardner G, Robertson JH (1988) Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 97(1):55–66CrossRefPubMedGoogle Scholar
  11. 11.
    Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL (2000) Gamma Knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47(4):1013–1019CrossRefPubMedGoogle Scholar
  12. 12.
    Bindal R, Goodman JM, Kawasaki A, Purvin V, Kuzma B (2003) The natural history of untreated skull base meningiomas. Surg Neurol 59(2):87–92 (Discussion 92).CrossRefPubMedGoogle Scholar
  13. 13.
    Couldwell WT, Heros R, Dolenc V (2011) Skull base meningiomas. Neurosurg Focus 30(5):1p prior to E1.Google Scholar
  14. 14.
    Nanda A, Thakur JD, Sonig A, Missios S (2016) Microsurgical resectability, outcomes, and tumor control in meningiomas occupying the cavernous sinus. J Neurosurg 125(2):378–392CrossRefPubMedGoogle Scholar
  15. 15.
    Nanda A, Javalkar V, Banerjee AD (2011) Petroclival meningiomas: study on outcomes, complications and recurrence rates. J Neurosurg 114(5):1268–1277CrossRefPubMedGoogle Scholar
  16. 16.
    Scheitzach J, Schebesch KM, Brawanski A, Proescholdt MA (2014) Skull base meningiomas: neurological outcome after microsurgical resection. J Neurooncol 116(2):381–386CrossRefPubMedGoogle Scholar
  17. 17.
    Li D, Tang J, Ren C, Wu Z, Zhang LW, Zhang JT (2016) Surgical management of medium and large petroclival meningiomas: a single institution’s experience of 199 cases with long-term follow-up. Acta Neurochir (Wien) 158(3):409–425 (Discussion 425).CrossRefGoogle Scholar
  18. 18.
    Sekhar LN, Jannetta PJ (1984) Cerebellopontine angle meningiomas. Microsurgical excision and follow-up results. J Neurosurg 60(3):500–505CrossRefPubMedGoogle Scholar
  19. 19.
    Kane AJ, Sughrue ME, Rutkowski MJ, Berger MS, McDermott MW, Parsa AT (2011) Clinical and surgical considerations for cerebellopontine angle meningiomas. J Clin Neurosci 18(6):755–759CrossRefPubMedGoogle Scholar
  20. 20.
    Sindou M, Wydh E, Jouanneau E, Nebbal M, Lieutaud T (2007) Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone. J Neurosurg 107(5):937–944CrossRefPubMedGoogle Scholar
  21. 21.
    DeMonte F, Smith HK, al-Mefty O (1994) Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 81(2):245–251CrossRefPubMedGoogle Scholar
  22. 22.
    Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, McDermott MW, Parsa AT (2010) Factors affecting outcome following treatment of patients with cavernous sinus meningiomas. J Neurosurg 113(5):1087–1092CrossRefPubMedGoogle Scholar
  23. 23.
    Natarajan SK, Sekhar LN, Schessel D, Morita A (2007) Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up. Neurosurgery 60(6):965–979 (Discussion 979–981).CrossRefPubMedGoogle Scholar
  24. 24.
    Zentner J, Meyer B, Vieweg U, Herberhold C, Schramm J (1997) Petroclival meningiomas: is radical resection always the best option? J Neurol Neurosurg Psychiatry 62(4):341–345CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kim JW, Kim DG, Se YB et al (2017) Gamma Knife radiosurgery for petroclival meningioma: long-term outcome and failure pattern. Stereotact Funct Neurosurg 95(4):209–215CrossRefPubMedGoogle Scholar
  26. 26.
    Kano H, Park KJ, Kondziolka D et al (2013) Does prior microsurgery improve or worsen the outcomes of stereotactic radiosurgery for cavernous sinus meningiomas? Neurosurgery 73(3):401–410CrossRefPubMedGoogle Scholar
  27. 27.
    Ding D, Starke RM, Kano H et al (2014) Gamma Knife radiosurgery for cerebellopontine angle meningiomas: a multicenter study. Neurosurgery 75(4):398–408 (quiz 408).CrossRefPubMedGoogle Scholar
  28. 28.
    Morita A, Coffey RJ, Foote RL, Schiff D, Gorman D (1999) Risk of injury to cranial nerves after Gamma Knife radiosurgery for skull base meningiomas: experience in 88 patients. J Neurosurg 90(1):42–49CrossRefPubMedGoogle Scholar
  29. 29.
    Nicolato A, Foroni R, Alessandrini F, Bricolo A, Gerosa M (2002) Radiosurgical treatment of cavernous sinus meningiomas: experience with 122 treated patients. Neurosurgery 51(5):1153–1159 (Discussion 1159–1161).CrossRefPubMedGoogle Scholar
  30. 30.
    Pollock BE, Stafford SL (2005) Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 62(5):1427–1431CrossRefPubMedGoogle Scholar
  31. 31.
    Kondziolka D, Mathieu D, Lunsford LD et al (2008) Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 62(1):53–60CrossRefPubMedGoogle Scholar
  32. 32.
    Pollock BE, Stafford SL, Utter A, Giannini C, Schreiner SA (2003) Stereotactic radiosurgery provides equivalent tumor control to Simpson Grade 1 resection for patients with small- to medium-size meningiomas. Int J Radiat Oncol Biol Phys 55(4):1000–1005CrossRefPubMedGoogle Scholar
  33. 33.
    Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20(1):22–39CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Chung LK, Mathur I, Lagman C et al (2017) Stereotactic radiosurgery versus fractionated stereotactic radiotherapy in benign meningioma. J Clin Neurosci 36:1–5CrossRefPubMedGoogle Scholar
  35. 35.
    Metellus P, Batra S, Karkar S et al (2010) Fractionated conformal radiotherapy in the management of cavernous sinus meningiomas: long-term functional outcome and tumor control at a single institution. Int J Radiat Oncol Biol Phys 78(3):836–843CrossRefPubMedGoogle Scholar
  36. 36.
    Kaul D, Budach V, Misch M, Wiener E, Exner S, Badakhshi H (2014) Meningioma of the skull base: long-term outcome after image-guided stereotactic radiotherapy. Cancer Radiother 18(8):730–735CrossRefPubMedGoogle Scholar
  37. 37.
    Solda F, Wharram B, De Ieso PB, Bonner J, Ashley S, Brada M (2013) Long-term efficacy of fractionated radiotherapy for benign meningiomas. Radiother Oncol 109(2):330–334CrossRefPubMedGoogle Scholar
  38. 38.
    Nicolato A, Foroni R, Alessandrini F, Maluta S, Bricolo A, Gerosa M (2002) The role of Gamma Knife radiosurgery in the management of cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 53(4):992–1000CrossRefPubMedGoogle Scholar
  39. 39.
    Azar M, Kazemi F, Jahanbakhshi A et al (2017) Gamma Knife radiosurgery for cavernous sinus meningiomas: analysis of outcome in 166 patients. Stereotact Funct Neurosurg 95(4):259–267CrossRefPubMedGoogle Scholar
  40. 40.
    Spiegelmann R, Cohen ZR, Nissim O, Alezra D, Pfeffer R (2010) Cavernous sinus meningiomas: a large LINAC radiosurgery series. J Neurooncol 98(2):195–202CrossRefPubMedGoogle Scholar
  41. 41.
    Hasegawa T, Kida Y, Yoshimoto M, Koike J, Iizuka H, Ishii D (2007) Long-term outcomes of Gamma Knife surgery for cavernous sinus meningioma. J Neurosurg 107(4):745–751CrossRefPubMedGoogle Scholar
  42. 42.
    Huang CF, Tu HT, Liu WS, Lin LY (2008) Gamma Knife surgery for trigeminal pain caused by benign brain tumors. J Neurosurg 109:154–159PubMedGoogle Scholar
  43. 43.
    Williams BJ, Yen CP, Starke RM et al (2011) Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival. J Neurosurg 114(6):1571–1577CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Andrew Faramand
    • 1
  • Hideyuki Kano
    • 1
    • 3
    Email author
  • Ajay Niranjan
    • 1
  • Stephen A. Johnson
    • 1
  • Mohab Hassib
    • 1
  • Kyung-Jae Park
    • 2
  • Yoshio Arai
    • 1
  • John C. Flickinger
    • 1
  • L. Dade Lunsford
    • 1
  1. 1.Department of Neurological Surgery and Radiation OncologyUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Department of Neurosurgery, College of MedicineKorea UniversitySeoulSouth Korea
  3. 3.Department of Neurological SurgeryUniversity of PittsburghPittsburghUSA

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