Skip to main content
Log in

Intradural extramedullary benign spinal lesions radiosurgery. Medium- to long-term results from a single institution experience

  • Clinical Article - Spine
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Surgery represents the first-choice treatment for spinal intradural tumours. On the other hand, whether it is most appropriate in the setting of recurrences, residual or multiple lesions remains an open question. Moreover, some patients are less than ideal candidates for surgery. In this study we report about our own radiosurgery experience in the treatment of benign intradural extramedullary tumours of the spine.

Methods

In our study we analyzed the outcomes for 18 patients (21 lesions) treated for benign intradural extramedullary lesions, with a minimum follow-up period of 32 months. The lesions included 11 meningiomas, 9 schwannomas and 1 neurofibroma.

Results

The mean follow-up was 43 months (32–73 months). The median tumour volume was 2 cc (0.2–17.7 cc). Eleven lesions underwent single-fraction treatment (mean prescribed dose ranging from 10 to 13 Gy). The others received a multisession radiosurgery treatment (4–6 fractions) with a mean prescription dose ranging from 18.5 to 25 Gy. The maximum dose to the spinal cord ranged from 9.2 to 26 Gy. During the follow-up period, none of the lesions showed radiological evidence of progression. Neurological status was preserved or improved and no permanent sequelae were observed. Significant and durable pain relief was observed.

Conclusions

Although surgical excision remains the primary treatment option for most intradural tumours, radiosurgery offers a real alternative therapeutic modality, especially in case of recurrent and residual lesions or when surgery is contraindicated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Adler JR Jr, Murphy MJ, Chang SD, Hancock SL (1999) Image guided robotic radiosurgery. Neurosurgery 44:1299–1307

    PubMed  Google Scholar 

  2. Asazuma T, Toyama Y, Maruiwa H, Fujimura Y, Hirabayashi K (2004) Surgical strategy for cervical dumbbell tumors based on a three-dimensional classification. Spine 29:E10–E14

    Article  PubMed  Google Scholar 

  3. Benzil DL, Saboori M, Mogilner AY, Rochio R, Moorthy CR (2004) Safety and efficacy of stereotactic radiosurgery for tumors of the spine. J Neurosurg 101:413–418

    PubMed  Google Scholar 

  4. Bilsky MH, Yamada Y, Yenice KM, Lovelock M, Hunt M, Gutin PH, Leibel SA (2004) Intensity-modulated stereotactic radiotherapy of paraspinal tumors: a preliminary report. Neurosurgery 54:823–830

    Article  PubMed  Google Scholar 

  5. Cancer Therapy Evaluation Program. Common terminology criteria for adverse events, Version 3.0 (2003) DCTD, NCI, NIH, DHHS. http://ctep.cancer.gov. Accessed 9 August 2006

  6. Chang EL, Shiu AS, Lii MF, Rhines LD, Mendel E, Mahajan A, Weinberg JS, Mathews LA, Brown BW, Maor MH, Cox JD (2004) Phase I clinical evaluation of near-simultaneous computed tomography image guided stereotactic body radiotherapy for spinal metastases. Int J Radiat Oncol Biol Phys 59:1288–1294

    Article  PubMed  Google Scholar 

  7. Cohen-Gadol AA, Zikel OM, Koch CA, Scheithauer BW, Krauss WE (2003) Spinal meningiomas in patients younger than 50 years of age: a 21-year experience. J Neurosurg 98(3 suppl):258–263

    PubMed  Google Scholar 

  8. Conti P, Pansini G, Mouchaty H, Capuano C, Conti R (2004) Spinal neurinomas retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature. Surg Neurol 61:34–43

    Article  PubMed  Google Scholar 

  9. Degen JV, Gagnon GJ, Voyadzis JM, McRae DA, Lunsden M, Dieterich S, Molzahn I, Henderson FC (2005) Cyberknife steretactic radiosurgical treatment of spinal tumors for pain control and quality of life. J Neurosurg Spine 2(5):540–549

    Article  PubMed  Google Scholar 

  10. Desalles AA, Pedroso A, Medin P, Agazaryan N, Solberg T, Cabatan-Awang C, Epinosa DM, Ford J, Selch MT (2004) Spinal lesions treated with Novalis shaped beam Intensity modulated radiosurgery and stereotactic radiotherapy. J Neurosurg 101:435–440

    Article  Google Scholar 

  11. Gagnon GJ, Nasr NM, Liao JJ, Molzahn I, Marsh D, McRae D, Henderson FC Sr (2009) Treatment of spinal tumors using cyberknife fractionated stereotactic radiosurgery: pain and quality-of-life assessment after treatment in 200 patients. Neurosurgery 64(2):297–306

    Article  PubMed  Google Scholar 

  12. Gerszten PC, Burton SA, Ozhasoglu C, McCue KJ, Quinn AE (2008) Radiosurgery for benign intradural spinal tumors. Neurosurgery 62(4):887–895

    Article  PubMed  Google Scholar 

  13. Gerszten PC, Quader M, Novotny J, Flickinger JC (2012) Radiosurgery for benign tumors of the spine: clinical experience and current trends. Technol Cancer Res Treat 11(2):133–139

    PubMed  Google Scholar 

  14. Gerszten PC, Welch WC (2004) CyberKnife radiosurgery for metastatic spine tumors. Neurosurg Clin N Am 15:491–501

    Article  PubMed  Google Scholar 

  15. Gibbs IC, Patil C, Gerszten PC, Adler JR Jr, Burton SA (2009) Delayed radiation-induced myelopathy after spinal radiosurgery. Neurosurgery 64(2 Suppl):A67–A72

    Article  PubMed  Google Scholar 

  16. Guidetti B, Fortuna A (1975) Differential diagnosis of intramedullary and extramedullary tumours. In: Vinken PJ, Bruyn JW (eds) Handbook of clinical neurology. Elsevier, Amsterdam, pp 51–75

    Google Scholar 

  17. Guidetti B, Mercuri S, Vagnozzi R (1981) Long term results of the surgical treatment of 129 intramedullary spinal gliomas. J Neurosurg 54:323–330

    Article  PubMed  CAS  Google Scholar 

  18. Ho AK, Fu D, Cotrutz C, Hancock SL, Chang SD, Gibbs IC, Maurer CR Jr, Adler JR Jr (2007) A study of the accuracy of cyberknife spinal radiosurgery using skeletal structure tracking. Neurosurgery 60(2 Suppl 1):ONS147–ONS156

    PubMed  Google Scholar 

  19. Kirkpatrick JP, van der Kogel AJ, Schultheiss TE (2010) Radiation dose-volume effects in the spinal cord. Int J Radiat Oncol Biol Phys 76(3 Suppl):S42–S49

    Article  PubMed  Google Scholar 

  20. Klekamp J, Samii M (1998) Surgery of spinal nerve sheath tumors with special reference to neurofibromatosis. Neurosurgery 42(2):279–289

    Article  PubMed  CAS  Google Scholar 

  21. Kondziolka D, Nathoo N, Flickinger JC (2003) Long term results after radiosurgery for benign intracranial tumors. Neurosurgery 53:815–822

    PubMed  Google Scholar 

  22. Marcus RB Jr, Million R (1990) The incidence of myelitis after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys 19:3–8

    Article  PubMed  Google Scholar 

  23. McCormick P (1996) Surgical management of dumbbell and paraspinal tumors of the thoracic and lumbar spine. Neurosurgery 38:67–74

    Article  PubMed  CAS  Google Scholar 

  24. McCormick P (1996) Surgical management of dumbbell tumors of the cervical spine. Neurosurgery 38:294–300

    Article  PubMed  CAS  Google Scholar 

  25. Milker-Zabel S, Zabel A, Thilmann C, Schlegel W, Wannenmacher M, Debus J (2003) Clinical results of retreatment of vertebral bone metastases by stereotactic conformal radiotherapy and intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 55:162–167

    Article  PubMed  Google Scholar 

  26. Muacevic A, Staehler M, Drexler C, Wowra B, Reiser M, Tonn JC (2006) Technical description, phantom accuracy, and clinical feasibility for fiducial-free frameless real-time image-guided spinal radiosurgery. J Neurosurg Spine 5(4):303–312

    Article  PubMed  Google Scholar 

  27. Murphy ES, Barnett GH, Vogelbaum MA, Neyman G, Stevens GH, Cohen BH, Elson P, Vassil AD, Suh JH (2011) Long-term outcomes of Gamma Knife radiosurgery in patients with vestibular schwannomas. J Neurosurg 114(2):432–440

    Article  PubMed  Google Scholar 

  28. Murphy MJ, Adler JR, Bodduluri M, Dooley J, Forster K, Hai J, Le Q, Luxton G, Martin D, Poen J (2000) Image guided radiosurgery for the spine and pancreas. Comput Aided Surg 5(4):278–288

    Article  PubMed  CAS  Google Scholar 

  29. Murphy MJ, Chang S, Gibbs I, Le QT, Martin D, Kim D (2001) Image guided radiosurgery in the treatment of spinal metastases. Neurosurg Focus 11(6):e6

    Article  PubMed  CAS  Google Scholar 

  30. Nieder C, Grosu AL, Andratschke NH, Molls M (2005) Proposal of human spinal cord reirradiation dose based on collection of data from 40 patients. Int J Radiat Oncol Biol Phys 61:851–855

    Article  PubMed  Google Scholar 

  31. Parsa A, Lee J, Parney I, Weinstein P, McCormick M, Ames C (2004) Spinal cord and intradural–extraparenchymal spinal tumors: current best care practices and strategies. J Neurooncol 69:291–318

    Article  PubMed  Google Scholar 

  32. Rampling R, Symonds P (1998) Radiation myelopathy. Curr Opin Neurol 11:627–632

    Article  PubMed  CAS  Google Scholar 

  33. Rock JP, Ryu S, Yin FF (2004) Novalis radiosurgery for metastatic spine tumors. Neurosurg Clin N Am 15:503–509

    Article  PubMed  Google Scholar 

  34. Romanelli P, Schaal DW, Adler JR (2006) Image-guided radiosurgical ablation of intra- and extra-cranial lesions. Technol Cancer Res Treat 5(4):421–428

    PubMed  Google Scholar 

  35. Roux F, Nataf F, Pinaudeau M, Borne G, Devaux B, Meder J (1996) Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management. Surg Neurol 46:458–463

    Article  PubMed  CAS  Google Scholar 

  36. Ryu S, Fang Yin F, Rock J, Zhu J, Chu A, Kagan E, Rogers L, Ajlouni M, Rosenblum M, Kim JH (2003) Image guided and intensity modulated radiosurgery for patients with spinal metastasis. Cancer 97:2013–2018

    Article  PubMed  Google Scholar 

  37. Ryu SI, Chang SD, Kim DH, Murphy MJ, Le QT, Martin DP, Adler JR (2001) Image guided hypo-fractioned stereotactic radiosurgery to spinal lesions. Neurosurgery 49(4):838–846

    PubMed  CAS  Google Scholar 

  38. Sachdev S, Dodd RL, Chang SD, Soltys SG, Adler JR, Luxton G, Choi CY, Tupper L, Gibbs IC (2011) Stereotactic radiosurgery yields long-term control for benign intradural, extramedullary spinal tumors. Neurosurgery 69(3):533–539

    Article  PubMed  Google Scholar 

  39. Sahgal A, Chou D, Ames C, Ma L, Lamborn K, Huang K, Chuang C, Aiken A, Petti P, Weinstein P, Larson D (2007) Image-guided robotic stereotactic body radiotherapy for benign spinal tumors: the University of California San Francisco preliminary experience. Technol Cancer Res Treat 6(6):595–604

    PubMed  CAS  Google Scholar 

  40. Santacroce A, Walier M, Régis J, Liščák R, Motti E, Lindquist C, Kemeny A, Kitz K, Lippitz B, Martínez Álvarez R, Pedersen PH, Yomo S, Lupidi F, Dominikus K, Blackburn P, Mindermann T, Bundschuh O, van Eck AT, Fimmers R, Horstmann GA (2012) Long-term tumor control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients. Neurosurgery 70(1):32–39

    Article  PubMed  Google Scholar 

  41. Schultheiss T, Kun L, Ang K, Stephens L (1995) Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys 31:1093–1112

    Article  PubMed  CAS  Google Scholar 

  42. Selch MT, Lin K, Agazaryan N, Tenn S, Gorgulho A, DeMarco JJ, DeSalles AA (2009) Initial clinical experience with image-guided linear accelerator-based spinal radiosurgery for treatment of benign nerve sheath tumors. Surg Neurol 72(6):668–674

    Article  PubMed  Google Scholar 

  43. Seppala M, Haltia M, Sankila R, Jääskeläinen J, Heiskanen O (1995) Long-term outcome after removal of spinal neurofibroma. J Neurosurg 82(4):572–577

    Article  PubMed  CAS  Google Scholar 

  44. Seppala M, Haltia M, Sankila R, Jääskeläinen J, Heiskanen O (1995) Long term outcome after removal of spinal schwannoma A clinicopathological study of 187 cases. J Neurosurg 83(4):621–626

    Article  PubMed  CAS  Google Scholar 

  45. Tamura M, Carron R, Yomo S, Arkha Y, Muraciolle X, Porcheron D, Thomassin JM, Roche PH, Régis J (2009) Hearing preservation after gamma knife radiosurgery for vestibular schwannomas presenting with high-level hearing. Neurosurgery 64(2):289–296

    Article  PubMed  Google Scholar 

  46. Weinstein JN, McLain RF (1992) Tumor of the spine. In: Rothman RH, Simeone FA (eds) The spine, vol 1. WB Saunders, Philadephia, pp 1639–1654

    Google Scholar 

  47. Yu C, Main W, Taylor D, Kuduvalli G, Apuzzo ML, Adler JR Jr (2004) An anthropomorphic phantom study of the accuracy of Cyberknife spinal radiosurgery. Neurosurgery 55(5):1138–1149

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Dr. David W. Schaal, Accuray Incorporated, for technical and editorial assistance.

Conflicts of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marcello Marchetti.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marchetti, M., De Martin, E., Milanesi, I. et al. Intradural extramedullary benign spinal lesions radiosurgery. Medium- to long-term results from a single institution experience. Acta Neurochir 155, 1215–1222 (2013). https://doi.org/10.1007/s00701-013-1756-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1756-3

Keywords

Navigation