Skip to main content
SpringerLink
Log in

Long-term outcomes of stereotactic radiosurgery for skull base tumors involving the cavernous sinus

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

Abstract

Purpose

Stereotactic radiosurgery (SRS) is an effective and less invasive therapeutic option for cavernous sinus (CS) tumors. However, its long-term effectiveness and neurological outcomes have yet to be fully elucidated. We aimed to examine the long-term outcomes of SRS for CS tumors.

Methods

Overall, a cohort of 113 patients with benign CS tumors, including 91 with meningioma, 14 with trigeminal schwannoma (TS), and eight with cavernous hemangioma, treated with SRS at our institution from 1990 to 2018, was included. Tumor control and functional preservation/recovery were evaluated in detail.

Results

The median post-SRS follow-up period was 77 months (interquartile range, 39–177). Progression-free survival (PFS) was 97% at 5 years, 89% at 10 years, and 87% at 15 years for the entire cohort; 96% at 5 years and 87% at 10 years for meningiomas; and 100% at 10 years for the other tumors. No significant difference was observed between meningiomas and non-meningiomas (log-rank test, p = 0.107). Improvement in cranial nerve (CN) function was observed in 35 (27%) patients. TSs tended to show CN improvements more often than meningiomas did (total improvements, 62% vs. 23%; p = 0.004; eye movement function, 100% vs. 20%; p = 0.002). CN deterioration or development of new CN deficits was observed in 11 (10%) patients.

Conclusion

SRS provides good tumor control and acceptable long-term outcome with sufficient preservation of CN function in patients with benign CS tumors.

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

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. McCormick PC, Bello JA, Post KD (1988) Trigeminal schwannoma. Surgical series of 14 cases with review of the literature. J Neurosurg 69:850–860. https://doi.org/10.3171/jns.1988.69.6.0850

    Article  CAS  PubMed  Google Scholar 

  2. Tagle P, Huete I, Méndez J, del Villar S (1986) Intracranial cavernous angioma: presentation and management. J Neurosurg 64:720–723. https://doi.org/10.3171/jns.1986.64.5.0720

    Article  CAS  PubMed  Google Scholar 

  3. Adegbite AB, Khan MI, Paine KW, Tan LK (1983) The recurrence of intracranial meningiomas after surgical treatment. J Neurosurg 58:51–56. https://doi.org/10.3171/jns.1983.58.1.0051

    Article  CAS  PubMed  Google Scholar 

  4. Rennert RC, Ravina K, Strickland BA, Bakhsheshian J, Fredrickson VL, Russin JJ (2018) Complete cavernous sinus resection: an analysis of complications. World Neurosurg 119:89–96. https://doi.org/10.1016/j.wneu.2018.07.206

    Article  PubMed  Google Scholar 

  5. Nanda A, Thakur JD, Sonig A, Missios S (2016) Microsurgical resectability, outcomes, and tumor control in meningiomas occupying the cavernous sinus. J Neurosurg 125:378–392. https://doi.org/10.3171/2015.3.JNS142494

    Article  PubMed  Google Scholar 

  6. O’Sullivan MG, van Loveren HR, Tew JM, Jr (1997) The surgical resectability of meningiomas of the cavernous sinus. Neurosurgery 40:238–244; discussion 245–237. https://doi.org/10.1097/00006123-199702000-00003

  7. Tishler RB, Loeffler JS, Lunsford LD, Duma C, Alexander E 3rd, Kooy HM, Flickinger JC (1993) Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27:215–221. https://doi.org/10.1016/0360-3016(93)90230-s

    Article  CAS  PubMed  Google Scholar 

  8. Leber KA, Berglöff J, Pendl G (1998) Dose–response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 88:43–50. https://doi.org/10.3171/jns.1998.88.1.0043

    Article  CAS  PubMed  Google Scholar 

  9. Liu AL, Wang C, Sun S, Wang M, Liu P (2005) Gamma knife radiosurgery for tumors involving the cavernous sinus. Stereotact Funct Neurosurg 83:45–51. https://doi.org/10.1159/000085544

    Article  PubMed  Google Scholar 

  10. Tripathi M, Batish A, Kumar N, Ahuja CK, Oinam AS, Kaur R, Narayanan R, Gurnaani J, Kaur A (2020) Safety and efficacy of single-fraction gamma knife radiosurgery for benign confined cavernous sinus tumors: our experience and literature review. Neurosurg Rev 43:27–40. https://doi.org/10.1007/s10143-018-0975-8

    Article  PubMed  Google Scholar 

  11. Starke RM, Williams BJ, Hiles C, Nguyen JH, Elsharkawy MY, Sheehan JP (2012) Gamma knife surgery for skull base meningiomas. J Neurosurg 116:588–597. https://doi.org/10.3171/2011.11.JNS11530

    Article  PubMed  Google Scholar 

  12. Huang CF, Kondziolka D, Flickinger JC, Lunsford LD (1999) Stereotactic radiosurgery for trigeminal schwannomas. Neurosurgery 45:11–16; discussion 16. https://doi.org/10.1097/00006123-199907000-00002

  13. Sheehan J, Yen CP, Arkha Y, Schlesinger D, Steiner L (2007) Gamma Knife surgery for trigeminal schwannoma. J Neurosurg 106:839–845. https://doi.org/10.3171/jns.2007.106.5.839

    Article  Google Scholar 

  14. Sun J, Zhang J, Yu X, Qi S, Du Y, Ni W, Hu Y, Tian Z (2013) Stereotactic radiosurgery for trigeminal schwannoma: a clinical retrospective study in 52 cases. Stereotact Funct Neurosurg 91:236–242. https://doi.org/10.1159/000345258

    Article  PubMed  Google Scholar 

  15. Ryu J, Lee SH, Choi SK, Lim YJ (2018) Gamma knife radiosurgery for trigeminal schwannoma: a 20-year experience with long-term treatment outcome. J Neurooncol 140:89–97. https://doi.org/10.1007/s11060-018-2934-1

    Article  PubMed  Google Scholar 

  16. Snyder MH, Shepard MJ, Chen CJ, Sheehan JP (2018) Stereotactic radiosurgery for trigeminal schwannomas: a 28-year single-center experience and review of the literature. World Neurosurg 119:e874–e881. https://doi.org/10.1016/j.wneu.2018.07.289

    Article  PubMed  Google Scholar 

  17. Pomeraniec IJ, Taylor DG, Cohen-Inbar O, Xu Z, Lee Vance M, Sheehan JP (2019) Radiation dose to neuroanatomical structures of pituitary adenomas and the effect of gamma knife radiosurgery on pituitary function. J Neurosurg 132:1499–1506. https://doi.org/10.3171/2019.1.JNS182296

    Article  PubMed  Google Scholar 

  18. Shin M, Kurita H, Sasaki T, Kawamoto S, Tago M, Kawahara N, Morita A, Ueki K, Kirino T (2001) Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas. J Neurosurg 95:435–439. https://doi.org/10.3171/jns.2001.95.3.0435

    Article  CAS  PubMed  Google Scholar 

  19. Shinya Y, Hasegawa H, Shin M, Sugiyama T, Kawashima M, Takahashi W, Iwasaki S, Kashio A, Nakatomi H, Saito N (2019) Long-term outcomes of stereotactic radiosurgery for vestibular schwannoma associated with neurofibromatosis Type 2 in comparison to sporadic schwannoma. Cancers 11:1498. https://doi.org/10.3390/cancers11101498

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, Degroot J, Wick W, Gilbert MR, Lassman AB, Tsien C, Mikkelsen T, Wong ET, Chamberlain MC, Stupp R, Lamborn KR, Vogelbaum MA, van den Bent MJ, Chang SM (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28:1963–1972. https://doi.org/10.1200/JCO.2009.26.3541

    Article  PubMed  Google Scholar 

  21. Nagano O, Higuchi Y, Serizawa T, Ono J, Matsuda S, Yamakami I, Saeki N (2008) Transient expansion of vestibular schwannoma following stereotactic radiosurgery. J Neurosurg 109:811–816. https://doi.org/10.3171/JNS/2008/109/11/0811

    Article  PubMed  Google Scholar 

  22. Mindermann T, Schlegel I (2014) How to distinguish tumor growth from transient expansion of vestibular schwannomas following gamma knife radiosurgery. Acta Neurochir 156:1121–1123. https://doi.org/10.1007/s00701-014-2063-3

    Article  PubMed  Google Scholar 

  23. Kano H, Niranjan A, Kondziolka D, Flickinger JC, Dade Lunsford L (2009) Stereotactic radiosurgery for trigeminal schwannoma: tumor control and functional preservation Clinical article. J Neurosurg 110:553–558. https://doi.org/10.3171/2008.7.jns0812

    Article  PubMed  Google Scholar 

  24. Albano L, Losa M, Nadin F, Barzaghi LR, Parisi V, Del Vecchio A, Bolognesi A, Mortini P (2019) Safety and efficacy of multisession gamma knife radiosurgery for residual or recurrent pituitary adenomas. Endocrine 64:639–647. https://doi.org/10.1007/s12020-019-01876-2

    Article  CAS  PubMed  Google Scholar 

  25. Lee WJ, Cho KR, Choi JW, Kong DS, Seol HJ, Nam DH, Lee JI (2020) Gamma knife radiosurgery as a primary treatment for nonfunctioning pituitary adenoma invading the cavernous sinus. Stereotact Funct Neurosurg 98:371–377. https://doi.org/10.1159/000508737

    Article  PubMed  Google Scholar 

  26. Yu J, Li Y, Quan T, Li X, Peng C, Zeng J, Liang S, Huang M, He Y, Deng Y (2020) Initial gamma knife radiosurgery for nonfunctioning pituitary adenomas: results from a 26-year experience. Endocrine 68:399–410. https://doi.org/10.1007/s12020-020-02260-1

    Article  CAS  PubMed  Google Scholar 

  27. Lee CC, Sheehan JP, Kano H, Akpinar B, Martinez-Alvarez R, Martinez-Moreno N, Guo WY, Lunsford LD, Liu KD (2017) Gamma knife radiosurgery for hemangioma of the cavernous sinus. J Neurosurg 126:1498–1505. https://doi.org/10.3171/2016.4.JNS152097

    Article  PubMed  Google Scholar 

  28. Wang Y, Li P, Zhang XJ, Xu YY, Wang W (2016) Gamma knife surgery for cavernous sinus hemanginoma: A report of 32 cases. World Neurosurg 94:18–25. https://doi.org/10.1016/j.wneu.2016.06.094

    Article  PubMed  Google Scholar 

  29. Lee CC, Trifiletti DM, Sahgal A, DeSalles A, Fariselli L, Hayashi M, Levivier M, Ma L, Álvarez RM, Paddick I, Regis J, Ryu S, Slotman B, Sheehan J (2018) Stereotactic radiosurgery for benign (World Health Organization Grade I) cavernous sinus meningiomas-international stereotactic radiosurgery society (ISRS) practice guideline: a systematic review. Neurosurgery 83:1128–1142. https://doi.org/10.1093/neuros/nyy009

    Article  PubMed  Google Scholar 

  30. Nicolato A, Foroni R, Alessandrini F, Bricolo A, Gerosa M (2002) Radiosurgical treatment of cavernous sinus meningiomas: experience with 122 treated patients. Neurosurgery 51:1153–1159; discussion 1159–1161. https://doi.org/10.1097/00006123-200211000-00009

  31. Maruyama K, Shin M, Kurita H, Kawahara N, Morita A, Kirino T (2004) Proposed treatment strategy for cavernous sinus meningiomas: a prospective study. Neurosurgery 55:1068–1075. https://doi.org/10.1227/01.neu.0000140839.47922.5a

    Article  PubMed  Google Scholar 

  32. Williams BJ, Yen CP, Starke RM, Basina B, Nguyen J, Rainey J, Sherman JH, Schlesinger D, Sheehan JP (2011) Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival. J Neurosurg 114:1571–1577. https://doi.org/10.3171/2011.1.JNS091939

    Article  PubMed  Google Scholar 

  33. Zeiler FA, McDonald PJ, Kaufmann AM, Fewer D, Butler J, Schroeder G, West M (2012) Gamma Knife radiosurgery of cavernous sinus meningiomas: an institutional review. Can J Neurol Sci 39:757–762. https://doi.org/10.1017/s0317167100015572

    Article  CAS  PubMed  Google Scholar 

  34. Pollock BE, Stafford SL, Link MJ, Garces YI, Foote RL (2013) Single-fraction radiosurgery of benign cavernous sinus meningiomas. J Neurosurg 119:675–682. https://doi.org/10.3171/2013.5.JNS13206

    Article  PubMed  Google Scholar 

  35. Fariselli L, Biroli A, Signorelli A, Broggi M, Marchetti M, Biroli F (2016) The cavernous sinus meningiomas’ dilemma: surgery or stereotactic radiosurgery? Rep Pract Oncol Radiother 21:379–385. https://doi.org/10.1016/j.rpor.2015.05.002

    Article  PubMed  Google Scholar 

  36. Leroy HA, Tuleasca C, Reyns N, Levivier M (2018) Radiosurgery and fractionated radiotherapy for cavernous sinus meningioma: a systematic review and meta-analysis. Acta Neurochir 160:2367–2378. https://doi.org/10.1007/s00701-018-3711-9

    Article  PubMed  Google Scholar 

  37. 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 130:1799–1808. https://doi.org/10.3171/2018.2.JNS172361

    Article  Google Scholar 

  38. Hung YC, Lee CC, Guo WY, Shiau CY, Chang YC, Pan DH, Sheehan JP, Chung WY (2019) Gamma knife radiosurgery for the treatment of cavernous sinus meningiomas: post-treatment long-term clinical outcomes, complications, and volume changes. J Neurooncol 143:261–270. https://doi.org/10.1007/s11060-019-03090-6

    Article  PubMed  Google Scholar 

  39. Hafez RF, Morgan MS, Fahmy OM (2015) Stereotactic gamma knife surgery safety and efficacy in the management of symptomatic benign confined cavernous sinus meningioma. Acta Neurochir 157:1559–1564. https://doi.org/10.1007/s00701-015-2509-2

    Article  Google Scholar 

  40. Kano H, Park KJ, Kondziolka D, Iyer A, Liu X, Tonetti D, Flickinger JC, Lunsford LD (2013) Does prior microsurgery improve or worsen the outcomes of stereotactic radiosurgery for cavernous sinus meningiomas? Neurosurgery 73:401–410. https://doi.org/10.1227/01.neu.0000431471.64289.3d

    Article  PubMed  Google Scholar 

  41. Sun S, Liu A, Zhang Y (2019) Long-term follow-up studies of gamma knife radiosurgery for postsurgical nonfunctioning pituitary adenomas. World Neurosurg 24:e715–e723. https://doi.org/10.1016/j.wneu.2019.01.009

    Article  PubMed  Google Scholar 

  42. Wang X, Zhu H, Knisely J, Mei G, Liu X, Dai J, Mao Y, Pan L, Qin Z, Wang E (2018) Hypofractionated stereotactic radiosurgery: a new treatment strategy for giant cavernous sinus hemangiomas. J Neurosurg 128:60–67. https://doi.org/10.3171/2016.10.JNS16693

    Article  PubMed  Google Scholar 

  43. Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, McDermott MW, Parsa AT (2010) Factors affecting outcome following treatment of patients with cavernous sinus meningiomas. J Neurosurg 113:1087–1092. https://doi.org/10.3171/2010.3.JNS091807

    Article  PubMed  Google Scholar 

  44. Graffeo CS, Link MJ, Stafford SL, Parney IF, Foote RL, Pollock BE (2020) Risk of internal carotid artery stenosis or occlusion after single-fraction radiosurgery for benign parasellar tumors. J Neurosurg 133:1388–1395. https://doi.org/10.3171/2019.8.JNS191285

    Article  Google Scholar 

  45. Pikis S, Bunevicius A, Sheehan J (2021) Internal carotid artery stenosis and risk of cerebrovascular ischemia following stereotactic radiosurgery for recurrent or residual pituitary adenomas. Pituitary 24:574–581. https://doi.org/10.1007/s11102-021-01134-7

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None

Funding

This work was supported by JSPS KAKENHI (Grant Number 19K24042 to Yuki Shinya).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, 113-8655, Japan

    Motoyuki Umekawa, Yuki Shinya, Hirotaka Hasegawa, Masahiro Shin, Mariko Kawashima & Nobuhito Saito

  2. Department of Radiology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan

    Atsuto Katano

Authors
  1. Motoyuki Umekawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuki Shinya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hirotaka Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masahiro Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mariko Kawashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Atsuto Katano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nobuhito Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: MU and YS; Methodology: MU and YS; Formal analysis and investigation: MU and YS; Writing—original draft preparation: MU; Writing—review and editing: YS, HH, MS, MK, AK, and NS; Funding acquisition: YS; Resources: YS, HH, SM, MK, and AK; Supervision: MS and NS.

Corresponding author

Correspondence to Yuki Shinya.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical approval

The study was approved by the Institutional Review Board of our institution (#2231) and performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

All patients provided written informed consent for study participation.

Additional information

Publisher's Note

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

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 35 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Umekawa, M., Shinya, Y., Hasegawa, H. et al. Long-term outcomes of stereotactic radiosurgery for skull base tumors involving the cavernous sinus. J Neurooncol 156, 377–386 (2022). https://doi.org/10.1007/s11060-021-03921-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-021-03921-5

Keywords

Search

Navigation