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Stereotactic Radiosurgery for Cavernous Sinus Meningiomas

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Stereotactic Radiosurgery for the Treatment of Central Nervous System Meningiomas

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Abstract

Due to the close proximity of cavernous sinus meningiomas (CSMNs) to vital intracranial neurovascular structures, complete surgical resection may not always be possible. Hence, stereotactic radiosurgery (SRS) has been proposed as a primary, adjuvant and/or salvage treatment option for the management of such cases. The aims of this study were to assess the long-term outcomes of SRS on a large patient series and to identify any prognosticators significantly influencing local tumour control (LTC).

Materials and Methods: From February 1993 to December 2007, 200 patients with CSMN underwent Leksell Gamma Knife Radiosurgery (LGKRS) at our department. All selected patients (51 males and 149 females, mean age 53.7 years, age range 25–83) were followed up for at least 10 years. CSMNs were classified as limited to cavernous sinus (CS) or involving the nearby skull base. LGKRS was delivered as either primary therapy (for unresectable tumours) in 91/200 (45.5%) patients, adjuvant therapy (for residual tumour after subtotal resection) in 77/200 (38.5%) or salvage therapy (for observed progression in residual disease) in 32/200 (16.0%). Stereo-CT scan was used in 69 patients and MRI stereotactic localization in 131 CSMNs. Mean LGKRS dose planning parameters were as follows: gross target volume (GTV) 9.88 cc, range 1.4–42.6; prescription dose (PD) 14.2 Gy, range 10–22.5; prescription isodose (PI) 48.3%, range 30–60; maximum dose (MD) 29.8 Gy, range 16.9–66.7; integral dose (ID)169.7 mJ, range 26–713; and number of shots 13.8, range 3–35. Uni- and multivariate logistic regression analysis was performed to evaluate which of the independent variables (age, sex, GTV, PD, stereo-CT scan vs. stereo-MRI, CS only vs. nearby spread, primary vs. adjuvant/salvage radiosurgery and WHO classification Grade I vs. II/III) could potentially influence the LTC (end point).

Results: The median survival was 165.9 months (137.0–256.0). LTC was achieved in 171/200 patients (85.5%) with actuarial LTC rates of 91% and 89% at 10 years and 15 years, respectively. Neurological status was stable (52/200) or improved (121/200) in 173 patients (86.5%), irrespective of tumour shrinkage. Among the 27/200 patients with neurological deterioration, 22 worsened due to tumour progression. Slight LGKRS-associated permanent fifth and/or sixth cranial nerve deficit was observed in five cases (2.5%). Upon statistical analysis, the only independent variables which significantly influenced LTC were primary vs. adjuvant/salvage SRS (p = 0.037) and histology (p = 0.019).

Conclusions: LGKRS is an effective and safe treatment for CSMN with excellent long-term LTC. Primary vs. adjuvant/salvage treatment and WHO grade affect LGKRS outcome in such patients.

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Abbreviations

AVM:

Arteriovenous malformation

CISS:

Constructive interference in steady state

CS:

Cavernous sinus

CSMN:

Cavernous sinus meningioma

CT:

Computed tomography

GTV:

Gross target volume

Gy:

Gray

ID:

Integral dose

LGKRS:

Leksell Gamma Knife radiosurgery

Linac:

Linear accelerator

LTC:

Local tumour control

MD:

Maximum dose

MN:

Meningioma

MRI:

Magnetic resonance imaging

MT:

Malignant transformation

NHS:

National Health Service

PD:

Prescription dose

PI:

Prescription isodose

RIT:

Radiation-induced tumorigenesis

RT:

Radiotherapy

SRS:

Stereotactic radiosurgery

WHO:

World Health Organization

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Authors and Affiliations

  1. USO Radiochirurgia e Neurochirurgia Stereotassica, UOC Neurochirurgia B, Dipartimento ad Attività Integrata (DAI) di Neuroscienze, Verona, Italy

    Michele Longhi, Giorgia Bulgarelli, Anna D’Amico & Antonio Nicolato

  2. UOC Fisica Sanitaria, DAI Patologia e Diagnostica, Verona, Italy

    Roberto Foroni, Emanuele Zivelonghi & Paolo Polloniato

  3. UOC Neuroradiologia, DAI Patologia e Diagnostica, Verona, Italy

    Giuseppe Kenneth Ricciardi

  4. UOC Radioterapia, DAI di Chirurgia e Oncologia, Verona, Italy

    Anna D’Amico

  5. UOC Neurochirurgia B, DAI di Neuroscienze, Verona, Italy

    Jacopo Lardani & Francesco Sala

  6. UOC Neurochirurgia A, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy

    Giampietro Pinna

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  1. Michele Longhi
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Correspondence to Michele Longhi .

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Editors and Affiliations

  1. Department of Neuroscience, Radiosurgery and Stereotactic Neurosurgery Section – Neurosurgery B Unit, University Hospital, Verona, Italy

    Michele Longhi

  2. Department of Neurological Sciences, Neurosurgery, University of Milan GVM Care & Research – Maria Cecilia Hospital, Cotignola, Italy

    Enrico D. F. Motti

  3. Department of Neuroscience, Radiosurgery and Stereotactic Neurosurgery Section – Neurosurgery B Unit, University Hospital, Verona, Italy

    Antonio Nicolato

  4. Director of Functional Neurosurgery & Gamma Knife Unit, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy

    Piero Picozzi

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Longhi, M. et al. (2021). Stereotactic Radiosurgery for Cavernous Sinus Meningiomas. In: Longhi, M., Motti, E.D.F., Nicolato, A., Picozzi, P. (eds) Stereotactic Radiosurgery for the Treatment of Central Nervous System Meningiomas. Springer, Cham. https://doi.org/10.1007/978-3-030-79419-4_7

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