Summary
I-125 seeds were permanently implanted into 25 parasellar-clival meningiomas (median age of patients, 56 y) and 19 globoid meningiomas in the elderly (median age of patients, 77 y) using stereotactic technique and 3-D dose planning. Total dose at the tumour margin was increased during the series from 100 Gy to 150 Gy. The procedure caused no mortality and no serious bleeding, but injury to the III cranial nerve due to puncture occurred in one (4%) of the 25 parasellar-clival meningiomas. In two (4.5%) of the 44 cases the postoperative CT scan showed a misplaced seed, located at the tumour surface. Nonenhancing hypodense rings developed around the seeds (‘hot spots’) with a median diameter of 10.5 mm at 12 months corresponding to a median initial activity of 8.7 mCi. In general, meningiomas responded by slow reduction in volume.
The parasellar-clival meningiomas were followed-up for a median of 19 months (6–32), and so far 4 tumours have shrunk moderately, 13 slightly, and 5 not at all. Pre-operative III, V or VI cranial nerve signs were present in 17 patients and subsided in 8 of them. On the other hand, facial numbness developed or increased in 9 of the 25 patients, indicating that the V nerve is rather sensitive to this type of irradiation.
In the 19 meningiomas of the elderly, the median follow-up time was 14 months (5–26). The median relative tumour volume was 46% at 12 months. Accounting for tumour-related deaths only, the actuarial survival rate was 78% at 12 months and 62% at 24 months. In general, brain oedema persisted despite reduction in tumour volume.
Stereotactic implantation of I-125 seeds into intracranial meningiomas is relatively safe. Interstitial radiotherapy represents a potential tool in the control of medium-sized intracranial meningiomas with minimal brain oedema, but its long-term impact and untoward effects remain to be followed-up.
Similar content being viewed by others
References
Al-Mefty O, Fox JL, Smith RR (1988) Petrosal approach for petroclival meningiomas. Neurosurgery 22: 510–517
Arienta C, Caroli M, Crotti F, Villani R (1990) Treatment of intracranial meningiomas in patients over 70 years old. Acta Neurochir (Wien) 107: 47–55
Awad IA, Kalfas I, Hahn JF, Little JR (1989) Intracranial meningiomas in the aged: surgical outcome in the era of computed tomography. Neurosurgery 24: 557–560
Cornu P, Chatellier G, Dagreou F, Clemenceau S, Foncin JF, Rivierez M, Philippon J (1990) Intracranial meningiomas in elderly patients. Postoperative morbidity and mortality. Factors predictive of outcome. Acta Neurochir (Wien) 102: 98–102
DeMonte F, Smith HK, Al-Mefty O (1994) Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 81: 245–251
Gademann G, Engenhart R, Schlegel W, Kimmig BN, Höver KH, Lorenz W, Wannenmacher M (1994) Results and comparison of single dose and fractionated stereotactic radiotherapy in 87 low grade meningiomas. Proceedings of the 35th Annual Meeting of the American Society for Therapeutic Radiology and Oncology. Int J Radiat Oncol Biol Phys 27: 153–154 (abstr)
Gutin PH, Leibel SA, Hosobuchi Y, Crumley RL, Edwards MSB, Wilson CB, Lamb S, Weaver KA (1987) Brachytherapy of recurrent tumors of the skull base and spine with Iodine-125 sources. Neurosurgery 20: 938–945
Jääskeläinen J (1986) Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis. Surg Neurol 26: 461–469
Tumors of the meninges (1993) In: Kleihues P, Burger PC, Scheithauer BW (s) WHO histologie typing of tumours of the central nervous system. Springer, Berlin Heidelberg New York Tokyo, pp 33–42
Kondziolka D, Lunsford LD, Coffey RJ, Flickinger JC (1991) Stereotactic radiosurgery of meningiomas. J Neurosurg 74: 552–559
Kreth FW, Faist M, Warnke PC, Rossner R, Volk B, Ostertag CB (1995) Interstitial radiosurgery of low-grade gliomas. J Neurosurg 82: 418–429
Kumar PP, Good RR, Leibrock LG, Mawk JR, Yonkers AJ, Ogren FP (1988) High activity iodine 125 endocurietherapy for recurrent skull base tumors. Cancer 61: 1518–1527
Kumar PP, Good RR, Patil AA, Leibrock LG (1989) Permanent high-activity iodine-125 in the management of petroclival meningiomas: case reports. Neurosurgery 25: 436–442
Kumar PP, Patil AA, Leibrock LG, Chu W-K, Syh J, McCaul GF, Reeves MA (1991) Brachytherapy: a viable alternative in the management of basal meningiomas. Neurosurgery 29: 676–680
Kumar PP, Patil AA, Leibrock LG, Chu W-K, Syh H-W, McCaul GF, Reeves MA (1993) Continuous low dose rate brachytherapy with high activity iodine-125 seeds in the management of meningiomas. Int J Radiat Oncol Biol Phys 25: 325–328
Kumar PP, Patil AA, Syh H-W, Chu W-K, Reeves MA (1993) Role of brachytherapy in the management of skull base meningiomas. Treatment of skull base meningiomas. Cancer 71: 3726–3731
Ling CC, Schell MC, Yorke ED, Palos BB, Kubiatowicz DO (1985) Two-dimensional dose distribution of I-125 seeds. Med Phys 12: 652–655
Ling CC, Chui CS (1993) Stereotactic treatment of brain tumors with radioactive or external photon beams: radiobiophysical aspects. Radiother Oncol 26: 11–18
Loeffler JS, Dunbar SF, Tardell N, Kooy HM, Black PM, Alexander E (1994) Early experience with stereotactic radiation therapy in the management of intracranial lesions: the first 1200 treatments. Proceedings of the 35th Annual Meeting of the American Society for Therapeutic Radiology and Oncology. Int J Radiat Oncol Biol Phys 27: 153–154 (abstract)
Maurice-Williams RS, Kitchen ND (1992) Intracranial tumours in the elderly: the effect of age on the outcome of first time surgery for meningiomas. Br J Neurosurg 6: 131–137
Ogunrinde OK, Lunsford LD, Flickinger JC, Kondziolka D (1994) Stereotactic radiosurgery for acoustic nerve tumors in patients with useful preoperative hearing: results at 2-year follow-up examination. J Neurosurg 80: 1011–1017
Ostertag CB (1991) Experimental central nervous system injury from implanted isotopes. In: Gutin PH, Leibel SA, Sheline GE (eds) Radiation injury of the nervous system. Raven, New York, pp 183–192
Samii M, Ammirati M, Mahran A, Bini W, Sepehrnia A (1989) Surgery of petroclival meningiomas: report of 24 cases. Neurosurgery 24: 12–17
Sekhar LN, Altschuler EM (1991) Meningiomas of the cavernous sinus. In: Al-Mefty O (ed) Meningiomas. Raven, New York, pp 445–460
Sekhar LN, Swamy NKS, Jaiswal V, Rubinstein E, Hirsch Jr. WE, Wright DC (1994) Surgical excision of meningiomas involving the clivus: preoperative and intraoperative features as predictors of postoperative functional deterioration. J Neurosurg 81: 860–868
Spetzler RF, Daspit CP, Pappas CTE (1992) The combined supra- and infratentorial approach for lesions of the petrous and clivai regions: experience with 46 cases. J Neurosurg 76: 588–599
Vance ML (1994) Hypopituitarism. N Engl J Med 330: 1651–1662
Weaver KA (1986) The dosimetry of I-125 seed eye plaques. Med Phys 13: 78–83
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Vuorinen, V., Heikkonen, J., Brander, A. et al. Interstitial radiotherapy of 25 parasellar/clival meningiomas and 19 meningiomas in the elderly. Acta neurochir 138, 495–508 (1996). https://doi.org/10.1007/BF01411167
Issue Date:
DOI: https://doi.org/10.1007/BF01411167