Skip to main content
SpringerLink
Log in

The Evolving Role of Stereotactic Radiosurgery for Patients with Skull Base Tumors

  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Tumors located at the base of the skull are among the most difficult problems that neurosurgeons encounter. Management of patients with skull base tumors must take into account that complete tumor removal is not possible with acceptable morbidity in many patients. Therefore, radiation therapy and stereotactic radiosurgery are commonly performed. The use of radiosurgery for patients with skull base tumors has increased significantly over the past three decades and we now possess a better understanding of the expectations of skull base radiosurgery. For properly selected patients with benign tumours (meningiomas, schwannomas, glomus tumors), tumor control rates between 90 and 100% have been reported. Local control rates for chordomas and chondrosarcomas have ranged from 50 to 70%, but tumor growth adjacent to the treated area (marginal failure) remains a significant problem.Radiosurgery is also commonly performed for patients with malignant skull base tumors as a palliative treatment and symptom relief is common, especially for patients with facial pain related to their tumor. Follow-up beyond 10 years is still needed to better define long-term results of radiosurgery and the incidence of radiation-induced neoplasms after radiosurgery.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Linskey ME: Stereotactic radiosurgery versus stereotactic radiotherapy for patients with vestibular schwannomas: a Leksell Gamma Knife Society 2000 debate. J Neurosurg 93 (Suppl 3): 90–95, 2000

    Google Scholar 

  2. Cushing H, Eisenhardt L: Meningiomas: their classifica-tion, regional behavior, life history, and surgical end results. Charles C. Thomas, Springfield, Il, 1938

  3. Condra KS, Buatti JM, Mendenhall WM, Friedman WA: Benign meningiomas: primary treatment selection affects survival. Int J Radiat Oncol Biol Phys 39: 427–436, 1997

    CAS  PubMed  Google Scholar 

  4. Mathiesen T, Lindquist C, Kihlstro¨m L, Karlsson B: Recurrence of cranial base meningiomas. Neurosurgery 39: 2–9, 1996

    CAS  PubMed  Google Scholar 

  5. Stafford SL, Perry A, Suman VJ, Meyer FB, Scheithauer BW, Lohse CM, Shaw EG: Primarily resected meningiomas: outcome and prognostic factors in 581 Mayo Clinic patients, 1978 through 1988. Mayo Clin Proc 73: 936–942, 1998

    CAS  PubMed  Google Scholar 

  6. Goldsmith BJ, Wara WM, Wilson CB, Larson DA: Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 80: 195–201, 1994

    CAS  PubMed  Google Scholar 

  7. Chang SD, Adler JR Jr: Treatment of cranial base meningiomas with linear accelerator radiosurgery. Neurosurgery 41: 1019–1025, 1997

    CAS  PubMed  Google Scholar 

  8. Hakim R, Alexander E III, Loeffler JS, Shrieve DC, Wen P, Fallon MP, Steig PE, Black PM: Results of linear accelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 42: 446–453, 1998

    CAS  PubMed  Google Scholar 

  9. Iwai Y, Yamanaka K, Ishiguro T: Gamma knife radio-surgery for the treatment of cavernous sinus meningiomas. Neurosurgery 52: 517–524, 2003

    PubMed  Google Scholar 

  10. Kondziolka D, Levy EI, Niranjan A, Flickinger JC, Lunsford LD: Long-term outcomes after meningioma radiosurgery: physician and patient perspectives. J Neurosurg 91: 44–50, 1999

    CAS  PubMed  Google Scholar 

  11. Lee JYK, Niranjan A, McInerney J, Kondziolka D, Flickinger JC, Lunsford LD: Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurg 97: 65–72, 2002

    PubMed  Google Scholar 

  12. Morita A, Coffey R, Foote R, Schiff D, Gorman DA: Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients. J Neurosurg 90: 42–49, 1999

    CAS  Google Scholar 

  13. Spiegelmann R, Nissim O, Menhel J, Alezra D, Pfeffer MR: Linear accelerator radiosurgery for meningiomas in and around the cavernous sinus. Neurosurgery 51: 1373–1380, 2002

    PubMed  Google Scholar 

  14. Stafford SL, Pollock BE, Foote RL, Link MJ, Gorman DA, Schomberg PJ, Leavitt JA: Meningioma radiosurgery: tumor control, outcomes, and complications in 190 consecutive patients. Neurosurgery 49: 1029–1038, 2001

    CAS  PubMed  Google Scholar 

  15. Ojemann SG, Sneed PK, Larson DA, Gutin PH, Berger MS, Verhey L, Smith V, Petti P, Wara W, Park E, McDermott MW: Radiosurgery for malignant meningioma: results in 22 patients. J Neurosurg (Suppl 3) 93: 62–67, 2000

    Google Scholar 

  16. Pollock BE, Stafford SL, Utter A, Giannini C, Schreiner SA: Stereotactic radiosurgery provides equivalent tumor control to a Simpson Grade 1 resection for patients with small-to medium-sized meningiomas. Int J Radiat Oncol Biol Phys 55: 1000–1005, 2003

    PubMed  Google Scholar 

  17. Karpinos M, The BS, Zeck O, Carpenter LS, Phan C, Mai WY, Lu HH, Chiu JK, Butler EB, Gormley WB, Woo SY: Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys 54: 1410–1421, 2002

    PubMed  Google Scholar 

  18. Regis J, Pellet W, Delsanti C, Dufour H, Roche PH, Thomassin JM, Zanarat M, Peragut JC: Functional outcome after gamma knife or microsurgery for vestibular schwannomas. J Neurosurg 97: 1091–1100, 2002

    PubMed  Google Scholar 

  19. Flickinger JC, Kondziolka D, Pollock BE, Lunsford LD: Evolution in technique for vestibular schwannoma radiosurgery and effect on outcome. Int J Radiat Oncol Biol Phys 36: 275–280, 1996

    CAS  PubMed  Google Scholar 

  20. Flickinger JC, Kondziolka D, Niranjan A, Lunsford LD: Results of acoustic neuroma radiosurgery: an analysis of 5 years’ experience using current methods. J Neurosurg 94: 1–6, 2001

    CAS  Google Scholar 

  21. Foote KD, Freidman WA, Buatti JM, Meeks SL, Bova FJ, Kubilis PS: Analysis of risk factors associated with radiosurgery for vestibular schwannoma. J Neurosurg 95: 440–449, 2001

    CAS  PubMed  Google Scholar 

  22. Petit JH, Hudes RS, Chen TT, Eisenberg HM, Simard JM, Chin LS: Reduced-dose radiosurgery for vestibular schwannomas. Neurosurgery 49: 1299–1306, 2001

    CAS  PubMed  Google Scholar 

  23. Pollock BE, Lunsford LD, Noren G: Vestibular schwannoma management in the next century: a radiosurgical perspective. Neurosurgery 43: 475–483, 1998

    Article  CAS  PubMed  Google Scholar 

  24. Andrews DW, Suarez O, Goldman HW, Downes MB, Bednarz G, Corn BW, Werner-Wasik M, Rosenstock J, Curran WJ Jr: Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution. Int J Radiat Oncol Biol Phys 50: 1265–1278, 2001

    CAS  PubMed  Google Scholar 

  25. Williams JA: Fractionated stereotactic radiotherapy for acoustic neuromas. Int J radiat Oncol Biol Phys 54: 500–504, 2002

    PubMed  Google Scholar 

  26. Nikolopoulos TP, O’Donoghue GM: Acoustic neuroma management: an evidence-based medicine approach. Otol Neurotol 23: 534–541, 2002

    PubMed  Google Scholar 

  27. Gjuric M, Rudiger Wolf S, Wigand ME, Weidenbecher M: Cranial nerve and hearing function after combined-approach surgery for glomus jugulare tumors. Ann Otol Rhinol Laryngol 105: 949–954, 1996

    CAS  PubMed  Google Scholar 

  28. Green JD Jr, Brackmann DE, Nguyen CD, Arriaga MA, Telischi FF, De la Cruz A: Surgical management of previously untreated glomus jugulare tumors. Laryngoscope 104: 917–921, 1994

    PubMed  Google Scholar 

  29. Gstoettner W, Matula C, Hamzavi J, Kornfehl J, Czerny C: Long-term results of different treatment modalities in 37 patients with glomus jugulare tumors. Eur Arch Otorhinolaryngol 256: 351–355, 1999

    CAS  PubMed  Google Scholar 

  30. Cole JM, Beiler D: Long-term results of treatment for glomus jugulare and glomus vagale tumors with radio-therapy. Laryngoscope 104: 1461–1465, 1994

    CAS  PubMed  Google Scholar 

  31. Larner JM, Hahn SS, Spaulding CA, Constable WC: Glomus jugulare tumors. Long-term control by radiation therapy. Cancer 69: 1813–1817, 1992

    CAS  PubMed  Google Scholar 

  32. Schild SE, Foote RL, Buskirk SJ, Robinow JS, Bock FF, Cupps RE, Earle JD: Results of radiotherapy for chemodectomas. Mayo Clin Proc 67: 537–540, 1992

    CAS  PubMed  Google Scholar 

  33. Skolyszewski J, Korzeniowski S, Pszon J: Results of radiotherapy in chemodectoma of the temporal bone. Acta Oncol 30: 847–849, 1991

    CAS  PubMed  Google Scholar 

  34. Eustacchio S, Leber K, Trummer M, Unger F, Pendl G: Gamma knife radiosurgery for glomus jugulare tumours. Acta Neurochir 141: 811–818, 1999

    CAS  Google Scholar 

  35. Foote RL, Pollock BE, Gorman DA, Schomberg PJ, Stafford SL, Link MJ, Kline RW, Strome SE, Kasperbauer JL, Olsen KD: Glomus jugulare tumor: tumor control and complications after stereotactic radiosurgery. Head Neck 24: 332–339, 2002

    Article  PubMed  Google Scholar 

  36. Jordan JA, Roland PS, McManus C, Weiner RL, Giller CA: Stereotactic radiosurgery for glomus jugulare tumors. Laryngoscope 110: 35–38, 2000

    CAS  PubMed  Google Scholar 

  37. Liscak R, Vladyka V, Wowra B, Kemeny A, Forster D, Burzacu TA, Martinez R, Eustacchio S, Pendl G, Regis J, Pellet W: Gamma Knife radiosurgery of the glomus jugulare tumour-early multicentre experience. Acta Neu-rochir 141: 1141–1146, 1999

    CAS  Google Scholar 

  38. Austin-Seymour M, Munzenrider J, Goitein M, Verhay L, Urie M, Gentry R, Birnbaum S, Ruotolo D, McManus P, Skates S: Fractionated proton radiation therapy of chordoma and low-grade chondrosarcoma of the base of the skull. J Neurosurg 70: 13–17, 1989

    CAS  PubMed  Google Scholar 

  39. Hug EB, Loredo LN, Slater JD, DeVries A, Grove RI, Schaeler RA, Rosenberg AE, Slater JM: Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg 91: 432–439, 1999

    CAS  PubMed  Google Scholar 

  40. Miller RC, Foote RL, Coffey RJ, Gorman DA, Earle JD, Schomberg PJ, Kline RW: The role of stereotactic radiosurgery in the treatment of malignant skull base tumors. Int J Radiat Oncol Biol Phys 39: 977–981, 1997

    CAS  PubMed  Google Scholar 

  41. Muthukumar N, Kondziolka D, Lunsford LD, Flickinger JC: Stereotactic radiosurgery for chordoma and chondro-sarcoma:further experiences. Int J Radiat Oncol Biol Phys 41: 387–392, 1998

    CAS  PubMed  Google Scholar 

  42. Noel G, Habrand JL, Mammar H, Ponvert D, Haie-Meder C, Hasboun D, Moisson P, Ferrand R, Beaudre A, Boisserie G, Gaboriaud G, Mazal A, Kerody K, Schlienger M, Mazeron JJ: Combination of photon and proton radiation therapy for chordomas and chondrosarcomas of the skull base: the Centre de Protontherapie D’Orsay experience. Int J Radiat Oncol Biol Phys 51: 392–398, 2001

    CAS  PubMed  Google Scholar 

  43. Slater JD, Austin-Seymour M, Munzenrider J, Birnbaum S, Carroll R, Klibanski A, Riskind P, Urie M, Verhay L, Goitein M: Endocrine function following high dose proton therapy for tumors of the upper clivus. Int J Radiat Oncol Biol Phys 15: 607–611, 1988

    CAS  PubMed  Google Scholar 

  44. Pai HH, Thornton A, Katznelson L, Finkelstein DM, Adams JA, Fullerton BC, Loeffler JS, Leibsch NJ, Klibanski A, Munzenrider JE: Hypothalamic/pituitary function following high-dose conformal radiotherapy to the base of skull: demonstration of a dose-effect relationship using dose-volume histogram analysis. Int J Radiat Oncol Biol Phys 49: 1079–1092, 2001

    CAS  PubMed  Google Scholar 

  45. Glosser G, McManus P, Munzenrider J, Austin-Seymour M, Fullerton B, Adams J, Urie MM: Neuropsychological function in adults after high dose fractionated radiation therapy of skull base tumors. Int J Radiat Oncol Biol Phys 38: 231–239, 1997

    CAS  PubMed  Google Scholar 

  46. Huang CF, Kondziolka D, Flickinger JC, Lunsford LD: Stereotactic radiosurgery for trigeminal schwannomas. Neurosurgery 45: 11–16, 1999

    CAS  PubMed  Google Scholar 

  47. Mabanta SR, Buatti JM, Friedman WA, Meeks SR, Mendenhall SL, Bova FJ: Linear accelerator radiosurgery for nonacoustic schwannomas. Int J Radiat Oncol Biol Phys 43: 545–548, 1999

    CAS  PubMed  Google Scholar 

  48. Muthukumar N, Kondziolka D, Lunsford LD, Flickinger JC: Stereotactic radiosurgery for jugular foramen schwannomas. Surg Neurol 52: 172–179, 1999

    CAS  PubMed  Google Scholar 

  49. Pollock BE, Foote RL, Stafford SL: Stereotactic radiosurgery: the preferred management for patients with non-vestibular schwannomas?Int J Radiat Oncol Biol Phys 52: 1002–1007, 2002

    PubMed  Google Scholar 

  50. Chen HJ, Leung SW, Su CY: Linear accelerator based radiosurgery as a salvage treatment for skull base and intracranial invasion of recurrent nasopharyngeal carcinomas. Am J Clin Oncol 24: 255–258, 2001

    CAS  PubMed  Google Scholar 

  51. Habermann W, Zanarotti U, Groell R, Wolf G, Stammberger H, Sutter B, Pendl G: Combination surgery and gamma knife radiosurgery-a therapeutic option for patients with tumors of the nasal cavity or paranasal sinuses in filtrating the skull base. Acta Otorhinolaryngol Ital 22: 74–79, 2002

    CAS  PubMed  Google Scholar 

  52. Lee N, Millender LE, Larson DA, Wara WM, McDermott MW, Kaplan MT, Sneed PK: Gamma knife radiosurgery for recurrent salivary gland malignancies involving the base of the skull. Head Neck 25: 210–216, 2003

    PubMed  Google Scholar 

  53. Kondziolka D, Nathoo N, Flickinger JC, Niranjan A, Maitz AH, Lunsford LD: Long term results of radiosurgery for benign intracranial tumors. Neurosurgery 53: 815–822, 2003

    PubMed  Google Scholar 

  54. Roche P, Re’gis J, Dufour H, Fournier H, Delsanti C, Pellet W, Grisoli F, Peragut J: Gamma knife radiosurgery in the management of cavernous sinus meningiomas. J Neurosurg (Suppl 3) 93: 68–73, 2000

    Google Scholar 

  55. Tobias S, Prayson RA, Lee JH: Necrotizing neurosarcoidosis of the cranial base resembling an en plaque sphenoid wing meningioma: case report. Neurosurgery 51: 1290–1294, 2002

    PubMed  Google Scholar 

  56. Loeffler JS, Niemierko A, Chapman PH: Second tumors after radiosurgery: tip of the iceberg or a bump in the road?Neurosurgery 52: 1436–1442, 2003

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Surgery; Division of Radiation Oncology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Bruce E. Pollock

  2. Division of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA

    Robert L. Foote

Authors
  1. Bruce E. Pollock
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert L. Foote
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pollock, B.E., Foote, R.L. The Evolving Role of Stereotactic Radiosurgery for Patients with Skull Base Tumors. J Neurooncol 69, 199–207 (2004). https://doi.org/10.1023/B:NEON.0000041883.22235.15

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:NEON.0000041883.22235.15

Search

Navigation