Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Hong CK, Hong JB, Park H, Moon JH, Chang JH, Lee KS, Park SW (2016) Surgical treatment for falcotentorial meningiomas. Yonsei Med J 57:1022–1028. https://doi.org/10.3349/ymj.2016.57.4.1022

    Article  PubMed  PubMed Central  Google Scholar 

  2. Okami N, Kawamata T, Hori T, Takakura K (2001) Surgical treatment of falcotentorial meningioma. J Clin Neurosci 8(Suppl 1):15–18. https://doi.org/10.1054/jocn.2001.0870

    Article  PubMed  Google Scholar 

  3. Raco A, Agrillo A, Ruggeri A, Gagliardi FM, Cantore G (2004) Surgical options in the management of falcotentorial meningiomas: report of 13 cases. Surg Neurol 61:157–164. https://doi.org/10.1016/s0090-3019(03)00573-1

    Article  PubMed  Google Scholar 

  4. Zhao X, Belykh E, Przybylowski CJ, Borba Moreira L, Gandhi S, Tayebi Meybodi A, Cavallo C, Valli D, Wicks RT, Nakaji P (2019) Surgical treatment of falcotentorial meningiomas: a retrospective review of a single-institution experience. J Neurosurg. https://doi.org/10.3171/2019.4.JNS19208

    Article  PubMed  PubMed Central  Google Scholar 

  5. Franco DeMonte MWM, Al-Mefty O (2012) Falcotentorial meningiomas. Al-Mefty’s Meningiomas, 2nd edn. Thieme Medical Publishers, Stuttgart

    Google Scholar 

  6. Agarwal V, McCutcheon BA, Hughes JD, Carlson ML, Glasgow AE, Habermann EB, Nguyen QB, Link MJ, Van Gompel JJ (2017) Trends in management of intracranial meningiomas: analysis of 49,921 cases from modern cohort. World Neurosurg 106:145–151. https://doi.org/10.1016/j.wneu.2017.06.127

    Article  PubMed  Google Scholar 

  7. Sheehan J, Pikis S, Islim AI, Chen CJ, Bunevicius A, Peker S, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad RM, Delabar V, Mathieu D, Lee CC, Yang HC, Liscak R, Hanuska J, Alvarez RM, Patel D, Kondziolka D, Moreno NM, Tripathi M, Speckter H, Albert C, Bowden GN, Benveniste RJ, Lunsford LD, Jenkinson MD (2022) An international multicenter matched cohort analysis of incidental meningioma progression during active surveillance or after stereotactic radiosurgery: the IMPASSE study. Neuro Oncol 24:116–124. https://doi.org/10.1093/neuonc/noab132

    Article  PubMed  Google Scholar 

  8. Quinones-Hinojosa A, Chang EF, Chaichana KL, McDermott MW (2009) Surgical considerations in the management of falcotentorial meningiomas: advantages of the bilateral occipital transtentorial/transfalcine craniotomy for large tumors. Neurosurgery. https://doi.org/10.1227/01.NEU.0000344642.98597.A7

    Article  PubMed  Google Scholar 

  9. Quinones-Hinojosa A, Chang EF, McDermott MW (2003) Falcotentorial meningiomas: clinical, neuroimaging, and surgical features in six patients. Neurosurg Focus 14:e11. https://doi.org/10.3171/foc.2003.14.6.11

    Article  PubMed  Google Scholar 

  10. Flickinger JC, Kondziolka D, Niranjan A, Maitz A, Voynov G, Lunsford LD (2004) Acoustic neuroma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 60:225–230. https://doi.org/10.1016/j.ijrobp.2004.02.019

    Article  PubMed  Google Scholar 

  11. Bonnal J, Brotchi J (1978) Surgery of the superior sagittal sinus in parasagittal meningiomas. J Neurosurg 48:935–945. https://doi.org/10.3171/jns.1978.48.6.0935

    CAS  Article  PubMed  Google Scholar 

  12. Giombini S, Solero CL, Lasio G, Morello G (1984) Immediate and late outcome of operations for parasagittal and falx meningiomas. Report of 342 cases. Surg Neurol 21:427–435. https://doi.org/10.1016/0090-3019(84)90446-4

    CAS  Article  PubMed  Google Scholar 

  13. Schmid-Elsaesser R, Steiger HJ, Yousry T, Seelos KC, Reulen HJ (1997) Radical resection of meningiomas and arteriovenous fistulas involving critical dural sinus segments: experience with intraoperative sinus pressure monitoring and elective sinus reconstruction in 10 patients. Neurosurgery. https://doi.org/10.1097/00006123-199711000-00001

    Article  PubMed  Google Scholar 

  14. Sindou M (2001) Meningiomas invading the sagittal or transverse sinuses, resection with venous reconstruction. J Clin Neurosci 8(Suppl 1):8–11. https://doi.org/10.1054/jocn.2001.0868

    Article  PubMed  Google Scholar 

  15. Asari S, Maeshiro T, Tomita S, Kawauchi M, Yabuno N, Kinugasa K, Ohmoto T (1995) Meningiomas arising from the falcotentorial junction. Clinical features, neuroimaging studies, and surgical treatment. J Neurosurg 82:726–738. https://doi.org/10.3171/jns.1995.82.5.0726

    CAS  Article  PubMed  Google Scholar 

  16. Konovalov AN, Spallone A, Pitzkhelauri DI (1996) Meningioma of the pineal region: a surgical series of 10 cases. J Neurosurg 85:586–590. https://doi.org/10.3171/jns.1996.85.4.0586

    CAS  Article  PubMed  Google Scholar 

  17. Piatt JH Jr, Campbell GA (1983) Pineal region meningioma: report of two cases and literature review. Neurosurgery 12:369–376. https://doi.org/10.1227/00006123-198304000-00002

    Article  PubMed  Google Scholar 

  18. Goto T, Ohata K, Morino M, Takami T, Tsuyuguchi N, Nishio A, Hara M (2006) Falcotentorial meningioma: surgical outcome in 14 patients. J Neurosurg 104:47–53. https://doi.org/10.3171/jns.2006.104.1.47

    Article  PubMed  Google Scholar 

  19. Bowden G, Faramand A, Mallella A, Wei Z, Patel K, Niranjan A, Lunsford LD (2021) Does the timing of radiosurgery after grade 1 meningioma resection affect long-term outcomes? Stereotact Funct Neurosurg 99:506–511. https://doi.org/10.1159/000517427

    Article  PubMed  Google Scholar 

  20. Park KJ, Kano H, Iyer A, Liu X, Tonetti DA, Lehocky C, Faramand A, Niranjan A, Flickinger JC, Kondziolka D, Lunsford LD (2018) Gamma Knife stereotactic radiosurgery for cavernous sinus meningioma: long-term follow-up in 200 patients. J Neurosurg. https://doi.org/10.3171/2018.2.JNS172361

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kondziolka D, Madhok R, Lunsford LD, Mathieu D, Martin JJ, Niranjan A, Flickinger JC (2009) Stereotactic radiosurgery for convexity meningiomas. J Neurosurg 111:458–463. https://doi.org/10.3171/2008.8.JNS17650

    Article  PubMed  Google Scholar 

  22. Ha MH, Jang WY, Jung TY, Kim IY, Lim SH, Moon KS, Jung S (2020) Treatment outcome of Gamma Knife radiosurgery for petroclival meningiomas: retrospective analysis of a single institution experience. Brain Tumor Res Treat 8:83–92. https://doi.org/10.14791/btrt.2020.8.e16

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sadik ZHA, Lie ST, Leenstra S, Hanssens PEJ (2018) Volumetric changes and clinical outcome for petroclival meningiomas after primary treatment with Gamma Knife radiosurgery. J Neurosurg 129:1623–1629. https://doi.org/10.3171/2017.7.JNS17380

    Article  PubMed  Google Scholar 

  24. Kim JW, Kim DG, Se YB, Kim SK, Chung HT, Paek SH, Jung HW (2017) Gamma Knife radiosurgery for petroclival meningioma: long-term outcome and failure pattern. Stereotact Funct Neurosurg 95:209–215. https://doi.org/10.1159/000475763

    Article  PubMed  Google Scholar 

  25. Harrison G, Kano H, Lunsford LD, Flickinger JC, Kondziolka D (2016) Quantitative tumor volumetric responses after Gamma Knife radiosurgery for meningiomas. J Neurosurg 124:146–154. https://doi.org/10.3171/2014.12.JNS141341

    Article  PubMed  Google Scholar 

  26. Bassiouni H, Asgari S, Konig HJ, Stolke D (2008) Meningiomas of the falcotentorial junction: selection of the surgical approach according to the tumor type. Surg Neurol. https://doi.org/10.1016/j.surneu.2007.02.029

    Article  PubMed  Google Scholar 

  27. Samii M, Carvalho GA, Tatagiba M, Matthies C, Vorkapic P (1996) Meningiomas of the tentorial notch: surgical anatomy and management. J Neurosurg 84:375–381. https://doi.org/10.3171/jns.1996.84.3.0375

    CAS  Article  PubMed  Google Scholar 

  28. Ge Y, Liu D, Zhang Z, Li Y, Lin Y, Wang G, Zong Y, Liu E (2019) Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients. Neurosurg Focus 46:E7. https://doi.org/10.3171/2019.3.FOCUS1956

    Article  PubMed  Google Scholar 

  29. Chang JH, Chang JW, Choi JY, Park YG, Chung SS (2003) Complications after gamma knife radiosurgery for benign meningiomas. J Neurol Neurosurg Psychiatry 74:226–230. https://doi.org/10.1136/jnnp.74.2.226

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. Champeaux-Depond C, Weller J, Froelich S, Resche-Rigon M (2021) A nationwide population-based study on overall survival after meningioma surgery. Cancer Epidemiol 70:101875. https://doi.org/10.1016/j.canep.2020.101875

    Article  PubMed  Google Scholar 

  31. Kreil W, Luggin J, Fuchs I, Weigl V, Eustacchio S, Papaefthymiou G (2005) Long term experience of Gamma Knife radiosurgery for benign skull base meningiomas. J Neurol Neurosurg Psychiatry 76:1425–1430. https://doi.org/10.1136/jnnp.2004.049213

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  32. Kondziolka D, Patel AD, Kano H, Flickinger JC, Lunsford LD (2016) Long-term outcomes after Gamma Knife radiosurgery for meningiomas. Am J Clin Oncol 39:453–457. https://doi.org/10.1097/COC.0000000000000080

    Article  PubMed  Google Scholar 

  33. DiBiase SJ, Kwok Y, Yovino S, Arena C, Naqvi S, Temple R, Regine WF, Amin P, Guo C, Chin LS (2004) Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys 60:1515–1519. https://doi.org/10.1016/j.ijrobp.2004.05.073

    Article  PubMed  Google Scholar 

  34. Brodbelt AR, Barclay ME, Greenberg D, Williams M, Jenkinson MD, Karabatsou K (2019) The outcome of patients with surgically treated meningioma in England: 1999–2013. A cancer registry data analysis. Br J Neurosurg 33:641–647. https://doi.org/10.1080/02688697.2019.1661965

    Article  PubMed  Google Scholar 

  35. Ostrom QT, Gittleman H, Liao P, Vecchione-Koval T, Wolinsky Y, Kruchko C, Barnholtz-Sloan JS (2017) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2010–2014. Neuro Oncol 19:v1–v88. https://doi.org/10.1093/neuonc/nox158

    Article  PubMed  PubMed Central  Google Scholar 

  36. Holleczek B, Zampella D, Urbschat S, Sahm F, von Deimling A, Oertel J, Ketter R (2019) Incidence, mortality and outcome of meningiomas: a population-based study from Germany. Cancer Epidemiol 62:101562. https://doi.org/10.1016/j.canep.2019.07.001

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

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

Author information

Authors and Affiliations

Authors

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.

Ethics declarations

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.

Ethical approval

This study was approved by our institution’s IRB.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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 (2022). https://doi.org/10.1007/s11060-022-04125-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11060-022-04125-1

Keywords

  • Meningioma
  • Falcotentorial
  • Confluence of the falx and tentorium
  • Stereotactic radiosurgery
  • Gamma Knife radiosurgery
  • Kaplan-Meier survival