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Goyal-Honavar A, Pateriya V, Chauhan S, Sadashiva N, Vazhayil V, Konar S, Beniwal M, Ar P, Arimappamagan A, B J, Natesan P. Factors Influencing Long-Term Outcomes of Single-Session Gamma Knife Radiosurgery in Large-Volume Meningiomas >10 cc. Stereotact Funct Neurosurg 2024; 102:109-119. [PMID: 38432224 DOI: 10.1159/000536409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Meningiomas are the most common primary intracranial tumour. Gamma knife radiosurgery (GKRS) is a frequently employed non-invasive method of treatment, with good remission rates and low morbidity in literature. However, the role of GKRS in the management of "large" meningiomas is unclear, with reported outcomes that vary by centre. We aimed to assess the factors that influence long-term outcomes following GKRS in meningiomas >10 cc in volume. METHODS A retrospectively analysed all patients with meningiomas exceeding 10 cc in volume who underwent GKRS between January 2006 and December 2021 at the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. Demographic, clinical, radiological, and follow-up data were acquired, and factors associated with progression following GKRS were assessed. RESULTS The cohort comprised 76 patients 29 males (38.2%) and 47 females (61.8%) with a mean age of 46.3 ± 11.02 years. Thirty-nine patients had been previously operated (51.3%). Meningiomas were most frequently located in the parasagittal region (26 tumours, 34.2%) and sphenopetroclival region (23 tumours, 30.3%), with mean lesion volume of 12.55 ± 5.22 cc, ranging 10.3 cc-25 cc. The mean dose administered to the tumour margin was 12.5 Gy ± 1.2 Gy (range 6-15 Gy). The median duration of clinical follow-up was 48 months, over which period radiological progression occurred in 14 cases (20%), with unchanged tumour volume in 20 cases (28.6%) and reduction in size of the tumour in 36 cases (51.4%). Progression-free survival after GKRS was 72% at 5 years, was significantly poorer among meningiomas with tumour volume >14 cc (log-rank test p = 0.045), tumours presenting with limb motor deficits (log-rank test p = 0.012), and tumours that underwent prior Simpson grade 3 or 4 excision (log-rank test p = 0.032). CONCLUSIONS Meningiomas >10 cc in volume appear to display a high rate of progression and subsequent need for surgery following GKRS. Primary surgical resection, when not contraindicated, may be considered with GKRS serving an adjuvant role, especially in tumours exceeding 14 cc in volume, and presenting with limb motor deficits. Long-term clinical and radiological follow-up is essential following GKRS as the response of large meningiomas may be unpredictable.
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Affiliation(s)
- Abhijit Goyal-Honavar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vibhor Pateriya
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sonal Chauhan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Manish Beniwal
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Prabhuraj Ar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jeeva B
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Ponnusamy Natesan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Ratnayake G, Huo M, Mehta A, Ramachandran P, Pinkham MB, Law P, Watkins T, Olson S, Hall B, Brown S, Lusk R, Jones C, O’Mahoney E, McGill G, Foote MC. Utility of 68Ga-DOTATATE PET-MRI for Gamma Knife® stereotactic radiosurgery treatment planning for meningioma. Br J Radiol 2024; 97:180-185. [PMID: 38263827 PMCID: PMC11027229 DOI: 10.1093/bjr/tqad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES To investigate the impact of adding 68Ga-DOTATATE PET/MRI to standard MRI for target volume delineation in Gamma Knife® stereotactic radiosurgery (GKSRS) for meningioma. METHODS Seventeen patients with 18 lesions undergoing GKSRS for WHO grade 1 meningioma were enrolled in a prospective study. All patients underwent pre-treatment 68Ga-DOTATATE PET/MRI examination in addition to standard procedures. Five clinicians independently contoured the gross tumour volume (GTV) based on standard MRI (GTVMRI) and PET/MRI (GTVPET/MRI) on separate occasions. Interobserver agreement was evaluated using Cohen's Kappa statistic (CKS), Dice similarity coefficient (DC), and Hausdorff distance (HD). Statistical analysis was performed with paired t-test and Wilcoxon signed rank test. RESULTS The addition of PET/MRI significantly increased GTV contour volume (mean GTVPET/MRI 3.59 cm3 versus mean GTVMRI 3.18 cm3, P = .008). Using the treating clinician's pre-treatment GTVMRI as the reference, median CKS (87.2 vs 77.5, P = .006) and DC (87.2 vs 77.4, P = .006) were significantly lower, and median HD (25.2 vs 31.0, P = .001) was significantly higher with the addition of PET/MRI. No significant difference was observed in interobserver contouring reproducibility between GTVMRI and GTVPET/MRI. CONCLUSION The addition of 68Ga-DOTATATE PET/MRI for target volume delineation in GKSRS for meningioma is associated with an increase in GTV volume and greater interobserver variation. PET/MRI did not affect interobserver contouring reproducibility. ADVANCES IN KNOWLEDGE This study provides novel insights into the impact of 68Ga-DOTATATE PET/MRI on GTV delineation and interobserver agreement in meningioma GKSRS, highlighting its potential for improving GKSRS treatment accuracy.
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Affiliation(s)
- Gishan Ratnayake
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Michael Huo
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Akash Mehta
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Prabhakar Ramachandran
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Mark B Pinkham
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Phillip Law
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Trevor Watkins
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Sarah Olson
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane 4102, Australia
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Bruce Hall
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane 4102, Australia
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Simon Brown
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane 4102, Australia
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Ryan Lusk
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Catherine Jones
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Eoin O’Mahoney
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - George McGill
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Matthew C Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
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Shinya Y, Hasegawa H, Shin M, Kawashima M, Umekawa M, Katano A, Ikemura M, Ushiku T, Ohara K, Okano A, Teranishi Y, Miyawaki S, Saito N. Long-Term Outcomes of Stereotactic Radiosurgery for Postoperative World Health Organization Grade I Skull Base Meningioma: Utility of Ki-67 Labeling Index as a Prognostic Indicator. Neurosurgery 2023; 93:1144-1153. [PMID: 37283526 DOI: 10.1227/neu.0000000000002546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/06/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Gross total resection, without causing neurological deficits, is challenging in skull base meningioma (SBM). Therefore, stereotactic radiosurgery (SRS) is an important approach for SBMs; however, it is difficult to predict the long-term prognosis. OBJECTIVE To identify the predictive factors for tumor progression after SRS for World Health Organization (WHO) grade I SBMs, focusing on the Ki-67 labeling index (LI). METHODS In this single-center retrospective study, factors affecting progression-free survival rates (PFSs) and neurological outcomes in patients undergoing SRS for postoperative SBMs were evaluated. Based on the Ki-67 LI, patients were classified into 3 groups: low (<4%), intermediate (4%-6%), and high LI (>6%). RESULTS In the 112 patients enrolled, the cumulative 5- and 10-year PFSs were 93% and 83%, respectively. The PFSs were significantly higher in the low LI group (95% at 10 years) compared with the other groups (intermediate LI, 60% at 10 years, P = .007; high LI, 20% at 10 years, P = .001). Multivariable Cox proportional hazard analysis demonstrated that the Ki-67 LI was significantly associated with the PFSs (low vs intermediate LI; hazard ratio, 6.00; 95% CI, 1.41-25.54; P = .015; low vs high LI; hazard ratio, 31.90; 95% CI, 5.59-181.77; P = .001). CONCLUSION Ki-67 LI may be a useful predictor of long-term prognosis in SRS for postoperative WHO grade I SBM. SRS provides excellent long- and mid-term PFSs in SBMs with Ki-67 LIs <4% or 4% to 6%, with a low risk of radiation-induced adverse events.
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Affiliation(s)
- Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo , Japan
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo , Japan
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo , Japan
| | - Mariko Kawashima
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo , Japan
| | - Motoyuki Umekawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo , Japan
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Tokyo , Japan
| | - Masako Ikemura
- Department of Pathology, The University of Tokyo Hospital, Tokyo , Japan
| | - Tetsuo Ushiku
- Department of Pathology, The University of Tokyo Hospital, Tokyo , Japan
| | - Kenta Ohara
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo , Japan
| | - Atsushi Okano
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo , Japan
| | - Yu Teranishi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo , Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo , Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo , Japan
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Lee EJ, Chung HT, Park H, Kim JW, Kim DG, Paek SH. Factors associated with radiation toxicity and long-term tumor control more than 10 years after Gamma Knife surgery for non-skull base, nonperioptic benign supratentorial meningiomas. J Neurosurg 2023; 138:1580-1590. [PMID: 36208439 DOI: 10.3171/2022.8.jns22422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gamma Knife surgery (GKS) is a well-established treatment for benign intracranial meningiomas; however, the dosimetric factors associated with long-term GKS efficacy and safety remain to be elucidated. Using data obtained with at least 10 years of follow-up, the authors aimed 1) to analyze GKS efficacy and safety for the treatment of benign meningiomas confined to non-skull base, nonperioptic supratentorial locations and 2) to determine the radiation dose window that allows for long-term efficacy and safety, namely the minimum dose to achieve long-term local control (LC) and the maximum safe dose to avoid adverse radiation effects (AREs). METHODS A retrospective analysis was performed on patients who underwent GKS for benign meningiomas in the abovementioned location at the authors' institution between 1998 and 2010 and who received follow-up for more than 10 years. The authors meticulously extracted the values of various dosimetric factors by using a dose-volume histogram. Cox proportional hazard regression analyses were performed to investigate the dosimetric factors associated with LC and ARE. RESULTS Fifty-five patients (male/female ratio 1:4.2) with 68 tumors were enrolled. The median (range) gross target volume and marginal dose were 4.2 (0.2-31.7) cm3 and 14.3 (9-20) Gy, respectively. In total, 23.5% of tumors progressed at an average of 72 months, with 10- and 15-year progression-free survival rates of 80.9% and 73.5%, respectively. In univariate analysis, higher marginal dose, coverage (%), Dmin, D98%, Dmean, D2%, Dmax, and Paddick conformity index were significantly associated with LC. In multivariate analysis, D98% was the significant factor, with a cutoff value of 11 Gy (HR 0.754, p < 0.001). Symptomatic AREs occurred in 7 patients at an average of 7 months after GKS. AREs were significantly associated with the volume of normal tissue irradiated with more than 14 Gy (nV14Gy), with a cutoff value of 0.66 cm3 (HR 2.459, p = 0.002). CONCLUSIONS D98% was a barometer of the minimum required dose associated with long-term LC, and nV14Gy was related to symptomatic AREs. The authors recommend a marginal dose ranging from 11 to 14 Gy to achieve long-term efficacy and safety in patients with non-skull base, nonperioptic benign supratentorial meningiomas, with the assumption of thorough tumor coverage.
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Affiliation(s)
- Eun Jung Lee
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Hyun-Tai Chung
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Hangeul Park
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Jin-Wook Kim
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Dong Gyu Kim
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Sun Ha Paek
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
- 3Advanced Institutes of Convergence Technology, Seoul National University, Suwon-si, Gyeonggi-do, Republic of Korea
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Gamma Knife radiosurgery for meningiomas of the confluence of the falx and tentorium. J Neurooncol 2023; 161:225-233. [PMID: 36125641 DOI: 10.1007/s11060-022-04125-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
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.
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Santacroce A, Tuleasca C, Liščák R, Motti E, Lindquist C, Radatz M, Gatterbauer B, Lippitz BE, Martínez Álvarez R, Martínez Moreno N, Kamp MA, Sandvei Skeie B, Schipmann S, Longhi M, Unger F, Sabin I, Mindermann T, Bundschuh O, Horstmann GA, van Eck AJ, Walier M, Berres M, Nakamura M, Steiger HJ, Hänggi D, Fortmann T, Alsofy SZ, Régis J, Ewelt C. Stereotactic Radiosurgery for Benign Cavernous Sinus Meningiomas: A Multicentre Study and Review of the Literature. Cancers (Basel) 2022; 14:cancers14164047. [PMID: 36011041 PMCID: PMC9406912 DOI: 10.3390/cancers14164047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/17/2022] [Accepted: 07/02/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Meningiomas are the most common tumours of the central nervous system (CNS). Despite their benign histology, proximity to critical neurovascular structures may lead to significant morbidity with tumour growth. This is the case for cavernous sinus meningiomas (CSMs), as their growth may surround critical neuro-vascular structures and cause significant morbidity. Radical microsurgical resection carries a high risk of additional neurological deficits, as well as the risk of death. Current management of these tumours, where treatment is indicated, has moved away from radical surgery towards radiotherapy/radiosurgery. This is particularly the case for patients who have residual or recurring tumours after previous surgery. There are many reports that describe the effectiveness of using stereotactic radiosurgery (SRS) for CSMs; however, large cohort analyses are lacking. This multicentre analysis reports the outcome data of over 1000 patients with CSMs who were treated with SRS. SRS shows a high local tumour control rate with few complications. These results agree with previous reports in the literature. SRS is a valuable primary or adjuvant treatment option for CSMs. Abstract Cavernous sinus meningiomas (CSMs) remain a surgical challenge due to the intimate involvement of their contained nerves and blood vessels. Stereotactic radiosurgery (SRS) is a safe and effective minimally invasive alternative for the treatment of small- to medium-sized CSMs. Objective: To assess the medium- to long-term outcomes of SRS for CSMs with respect to tumour growth, prevention of further neurological deterioration and improvement of existing neurological deficits. This multicentric study included data from 15 European institutions. We performed a retrospective observational analysis of 1222 consecutive patients harbouring 1272 benign CSMs. All were treated with Gamma Knife stereotactic radiosurgery (SRS). Clinical and imaging data were retrieved from each centre and entered into a common database. All tumours with imaging follow-up of less than 24 months were excluded. Detailed results from 945 meningiomas (86%) were then analysed. Clinical neurological outcomes were available for 1042 patients (85%). Median imaging follow-up was 67 months (mean 73.4, range 24–233). Median tumour volume was 6.2 cc (+/−7), and the median marginal dose was 14 Gy (+/−3). The post-treatment tumour volume decreased in 549 (58.1%), remained stable in 336 (35.6%) and increased in only 60 lesions (6.3%), yielding a local tumour control rate of 93.7%. Only 27 (2.8%) of the 60 enlarging tumours required further treatment. Five- and ten-year actuarial progression-free survival (PFS) rates were 96.7% and 90.1%, respectively. Tumour control rates were higher for women than men (p = 0.0031), and also for solitary sporadic meningiomas (p = 0.0201). There was no statistically significant difference in outcome for imaging-defined meningiomas when compared with histologically proven WHO Grade-I meningiomas (p = 0.1212). Median clinical follow up was 61 months (mean 64, range 6–233). Permanent morbidity occurred in 5.9% of cases at last follow-up. Stereotactic radiosurgery is a safe and effective method for treating benign CSM in the medium term to long term.
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Affiliation(s)
- Antonio Santacroce
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, 59073 Hamm, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
- Correspondence:
| | - Constantin Tuleasca
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
- Faculté de Biologie et de Médecine (FBM), Université de Lausanne (Unil), 1005 Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5), Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland
- Faculté de Médecine, Sorbonné Université, 70513 Paris, France
- Assisstance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Centre Hospitalier Universitaire Bicêtre, Service de Neurochirurgie, 94270 Le Kremlin-Bicêtre, France
| | - Roman Liščák
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, 15000 Prague, Czech Republic
| | - Enrico Motti
- Dipartimento di Neuroscienze, Neurochirurgia, Università degli Studi di Milano, 20122 Milano, Italy; Villa Maria Cecilia Hospital, 48033 Cotignola, Italy
| | | | - Matthias Radatz
- National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | | | - Bodo E. Lippitz
- Interdisciplinary Centre for Radiosurgery (ICERA), Radiological Alliance, 22767 Hamburg, Germany
| | | | | | - Marcel A. Kamp
- Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Bente Sandvei Skeie
- Department of Neurosurgery, Haukeland University Hospital, 5021 Bergen, Norway
| | - Stephanie Schipmann
- Department of Neurosurgery, Haukeland University Hospital, 5021 Bergen, Norway
| | - Michele Longhi
- Unit of Radiosurgery and Stereotactic Neurosurgery, Department of Neurosciences, Azienda Ospedaliera Universitaria, 37126 Verona, Italy
| | - Frank Unger
- Department of Neurosurgery, Medical University Graz, 8036 Graz, Austria
| | - Ian Sabin
- Gamma Knife Unit, Wellington Hospital (Platinum Medical Centre), London NW8 7JA, UK
| | - Thomas Mindermann
- Gamma Knife Center Zurich, Klinik Im Park Hirslanden, 8002 Zurich, Switzerland
| | | | | | | | - Maja Walier
- Institute of Medical Biometry, Epidemiology and Informatics, University Medical Center of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
- Department of Mathematics and Technology, University of Applied Sciences Koblenz, Joseph-Rovan-Allee 2, 53424 Remagen, Germany
| | - Manfred Berres
- Institute of Medical Biometry, Epidemiology and Informatics, University Medical Center of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
- Department of Mathematics and Technology, University of Applied Sciences Koblenz, Joseph-Rovan-Allee 2, 53424 Remagen, Germany
| | - Makoto Nakamura
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
- Department of Neurosurgery, Academic Hospital Köln-Merheim, 51058 Köln, Germany
| | - Hans Jakob Steiger
- Department of Neurosurgery, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - Thomas Fortmann
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, 59073 Hamm, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Samer Zawy Alsofy
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, 59073 Hamm, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Jean Régis
- Service de Neurochirurgie Fonctionnelle et Stereotaxique, Hôpital D’adulte de la Timone, 13354 Marseille, France
| | - Christian Ewelt
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, 59073 Hamm, Germany
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Munster, Germany
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Isolan GR, Wayhs SY, Araújo RLD, de Aguiar PHP, Pinto JAR, Marques VMO. Abordajes quirúrgicos de meningiomas petroclivales parte 1: anatomía microquirúrgica. Surg Neurol Int 2022; 13:277. [PMID: 36101859 PMCID: PMC9465442 DOI: 10.25259/sni_413_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 11/04/2022] Open
Abstract
Antecedentes:
Los meningiomas petroclivales son tumores benignos cuyo tratamiento microquirúrgico es uno de los mayores retos de la neurocirugía. El conocimiento profundo de la anatomía microquirúrgica y los abordajes quirúrgicos para el tratamiento de estos tumores es la primera etapa de aprendizaje para un manejo ideal. Este artículo se divide en dos partes: la primera parte presentará los resultados de la anatomía microquirúrgica relevantes para el manejo de los meningiomaspetroclivales. En la segunda parte, los autores correlacionan esta anatomía con 30 casos de meningiomas petroclivales operados por el autor principal (GRI).
Métodos:
Se disecaron ocho cabezas de cadáveres utilizando un microscopio quirúrgico en el laboratorio de microcirugía de la University of Arkansas for Medical Sciences. En los cerebros y en todas las cabezas, se inyectó silicona de colores para resaltar la diferencia entre las arterias y las venas. Los cadáveres fueron colocados en un fijador craneal tipo Mayfield, simulando el posicionamiento quirúrgico de los abordajes craneo-órbito-cigomatico, petrosectomía anterior y posterior y retrosigmoideo. Otras ocho cabezas de cadáveres fueron formolizadas y con los vasos inyectados con silicona de colores. Se realizaron los abordajes petroso anterior, petroso posterior y craneo-órbito-cigomático.
Resultados:
En el manejo de los meningiomas petroclivales se utilizan tres abordajes quirúrgicos principales: abordaje pterional y sus variantes, abordaje petroso y sus variantes y abordaje retrosigmoideo. Los abordajes endonasales endoscópicos extendidos tienen factores limitantes para su uso en este tipo de procedimiento. Para racionalizar la elección del abordaje quirúrgico, dividimos el clivus en tercios superior, medio e inferior.
Conclusíon:
Varios abordajes quirúrgicos dan acceso a la regiónpetroclival. El conocimiento práctico de la anatomía de esta región adquirido en el laboratorio de microcirugía es parte fundamental del cirujano que se propone operar meningiomas petroclivales.
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Affiliation(s)
- Gustavo Rassier Isolan
- Department of Neurosurgery, Center for Advanced Neurology and Neurosurgery, Porto Alegre, Brazil
| | - Sâmia Yasin Wayhs
- Department of Neurosurgery, Center for Advanced Neurology and Neurosurgery, Porto Alegre, Brazil
| | - Ricardo Lopes de Araújo
- Department of Neurosurgery, Center for Advanced Neurology and Neurosurgery, Porto Alegre, Brazil
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8
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Ruiz-Garcia H, Trifiletti DM, Mohammed N, Hung YC, Xu Z, Chytka T, Liscak R, Tripathi M, Arsanious D, Cifarelli CP, Caceres MP, Mathieu D, Speckter H, Mehta GU, Lekovic GP, Sheehan JP. Skull Base Meningiomas in Patients with Neurofibromatosis Type 2: An International Multicenter Study Evaluating Stereotactic Radiosurgery. Skull Base Surg 2022; 83:e173-e180. [PMID: 35832959 DOI: 10.1055/s-0041-1722937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Objective Meningiomas are the second most common tumors in neurofibromatosis type 2 (NF-2). Microsurgery is challenging in NF-2 patients presenting with skull base meningiomas due to the intrinsic risks and need for multiple interventions over time. We analyzed treatment outcomes and complications after primary Gamma Knife radiosurgery (GKRS) to delineate its role in the management of these tumors. Methods An international multicenter retrospective study approved by the International Radiosurgery Research Foundation was performed. NF-2 patients with at least one growing and/or symptomatic skull base meningioma and 6-month follow-up after primary GKRS were included. Clinical and radiosurgical parameters were recorded for analysis. Results In total, 22 NF-2 patients with 54 skull base meningiomas receiving GKRS as primary treatment met inclusion criteria. Median age at GKRS was 38 years (10-79 years). Most lesions were located in the posterior fossa (55.6%). Actuarial progression free survival (PFS) rates were 98.1% at 2 years and 90.0% at 5 and 10 years. The median follow-up time after initial GKRS was 5.0 years (0.6-25.5 years). Tumor volume at GKRS was a predictor of tumor control. Lesions >5.5 cc presented higher chances to progress after radiosurgery ( p = 0.043). Three patients (13.64%) developed adverse radiation effects. No malignant transformation or death due to meningioma or radiosurgery was reported. Conclusions GKRS is effective and safe in the management of skull base meningiomas in NF-2 patients. Tumor volume deserve greater relevance during clinical decision-making regarding the most appropriate time to treat. GKRS offers a minimally invasive approach of particular interest in this specific group of patients.
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Affiliation(s)
- Henry Ruiz-Garcia
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States.,Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Daniel M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States.,Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Nasser Mohammed
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, United States
| | - Yi-Chieh Hung
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, United States
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, United States
| | - Tomas Chytka
- Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Manjul Tripathi
- Department of Neurological Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - David Arsanious
- Department of Neurological Surgery, West Virginia University, Morgantown, West Virginia, United States
| | - Christopher P Cifarelli
- Department of Neurological Surgery, West Virginia University, Morgantown, West Virginia, United States
| | - Marco Perez Caceres
- Department of Neurological Surgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
| | - David Mathieu
- Department of Neurological Surgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
| | - Herwin Speckter
- Department of Neurological Surgery, Dominican Gamma Knife Center and CEDIMAT Hospital, Santo Domingo, Dominican Republic
| | - Gautam U Mehta
- Department of Neurological Surgery, House Ear Institute, Los Angeles, California, United States
| | - Gregory P Lekovic
- Department of Neurological Surgery, House Ear Institute, Los Angeles, California, United States
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, United States
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9
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Samanci Y, Ardor GD, Peker S. Gamma Knife radiosurgery for tuberculum sellae meningiomas: a series of 78 consecutive patients. Neurosurg Rev 2022; 45:2315-2322. [PMID: 35138486 DOI: 10.1007/s10143-022-01753-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 01/01/2023]
Abstract
Outcomes of Gamma Knife radiosurgery (GKRS) for tuberculum sellae meningiomas (TSMs) have not been reported explicitly within any meningioma series. We present the first and largest TSM series with clinical, radiosurgical, and outcome features for 78 consecutive patients managed with GKRS. Patients who underwent GKRS for TSMs between 2005 and 2021 and had a minimum of 6 months of follow-up were included. Medical records, imaging studies, and follow-up examinations were evaluated retrospectively. A total of 78 patients with a median age of 50.5 years were included. SRS was conducted as an upfront treatment for 38 patients (48.7%). The median target volume was 1.7 cm3 (range, 0.1-14.6). During a median follow-up of 78.5 months, the cumulative PFS rates of the whole cohort at 1, 5, and 10 years by Kaplan-Meier analysis were 100%, 97.9%, and 94.5%, respectively. Of 47 patients with impaired vision, improvement and/or preservation of visual acuity, and visual field were achieved in 55.3% and 42.6%, respectively. No new-onset hormonal deficits were observed. Based on our data, SRS represents an effective and safe modality for unresected or recurrent/residual TSMs. SRS should be offered to patients who are not willing or not ideal candidates for surgery.
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Affiliation(s)
- Yavuz Samanci
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey.,Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey
| | - Gokce Deniz Ardor
- Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey
| | - Selcuk Peker
- Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey. .,Department of Neurosurgery, School of Medicine, Koç University, Davutpasa Caddesi No:4, 34010, Zeytinburnu/İstanbul, Turkey.
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10
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Ganz JC. Meningiomas. PROGRESS IN BRAIN RESEARCH 2022; 268:163-190. [PMID: 35074079 DOI: 10.1016/bs.pbr.2021.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Meningiomas arise in various locations. Convexity tumors are relatively simple to remove. Skull base tumors and tumors adjacent to the major cerebral veins and venous sinuses can be very difficult to extirpate. Attempts at radical resection can lead to serious morbidity. The combination of bulk reduction using microsurgery followed by GKNS gives greatly improved survival and very low morbidity. With smaller tumors, GKNS may be used as the primary treatment. Increasing numbers of asymptomatic meningiomas are demonstrated either as an unexpected finding or as a residual or recurrent tumor after surgery. In all of these situations, GKNS gives a better result than observation or reoperation.
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Affiliation(s)
- Jeremy C Ganz
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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11
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Mitchell D, Kwon HJ, Kubica PA, Huff WX, O’Regan R, Dey M. Brain metastases: An update on the multi-disciplinary approach of clinical management. Neurochirurgie 2022; 68:69-85. [PMID: 33864773 PMCID: PMC8514593 DOI: 10.1016/j.neuchi.2021.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/16/2021] [Accepted: 04/03/2021] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Brain metastasis (BM) is the most common malignant intracranial neoplasm in adults with over 100,000 new cases annually in the United States and outnumbering primary brain tumors 10:1. OBSERVATIONS The incidence of BM in adult cancer patients ranges from 10-40%, and is increasing with improved surveillance, effective systemic therapy, and an aging population. The overall prognosis of cancer patients is largely dependent on the presence or absence of brain metastasis, and therefore, a timely and accurate diagnosis is crucial for improving long-term outcomes, especially in the current era of significantly improved systemic therapy for many common cancers. BM should be suspected in any cancer patient who develops new neurological deficits or behavioral abnormalities. Gadolinium enhanced MRI is the preferred imaging technique and BM must be distinguished from other pathologies. Large, symptomatic lesion(s) in patients with good functional status are best treated with surgery and stereotactic radiosurgery (SRS). Due to neurocognitive side effects and improved overall survival of cancer patients, whole brain radiotherapy (WBRT) is reserved as salvage therapy for patients with multiple lesions or as palliation. Newer approaches including multi-lesion stereotactic surgery, targeted therapy, and immunotherapy are also being investigated to improve outcomes while preserving quality of life. CONCLUSION With the significant advancements in the systemic treatment for cancer patients, addressing BM effectively is critical for overall survival. In addition to patient's performance status, therapeutic approach should be based on the type of primary tumor and associated molecular profile as well as the size, number, and location of metastatic lesion(s).
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Affiliation(s)
- D Mitchell
- Department of Neurosurgery, Indiana University School of Medicine, Indiana University Purdue University Indianapolis, IN, USA
| | - HJ Kwon
- Department of Neurosurgery, Indiana University School of Medicine, Indiana University Purdue University Indianapolis, IN, USA
| | - PA Kubica
- Department of Neurosurgery, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, USA
| | - WX Huff
- Department of Neurosurgery, Indiana University School of Medicine, Indiana University Purdue University Indianapolis, IN, USA
| | - R O’Regan
- Department of Medicine/Hematology Oncology, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, USA
| | - M Dey
- Department of Neurosurgery, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, USA,Correspondence Should Be Addressed To: Mahua Dey, MD, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI 53792; Tel: 317-274-2601;
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12
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Bunevicius A, Ahn J, Fribance S, Peker S, Hergunsel B, Sheehan D, Sheehan K, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Chytka T, Liscak R, Alvarez RM, Moreno NM, Langlois AM, Mathieu D, Lee CC, Yang HC, Tripathi M, Warnick RE, Speckter H, Albert C, Picozzi P, Franzini A, Attuati L, Strickland BA, Zada G, Chang EL, Feliciano Valls CE, Carbini CH, Patel S, Sheehan J. Stereotactic Radiosurgery for Olfactory Groove Meningiomas: An International, Multicenter Study. Neurosurgery 2021; 89:784-791. [PMID: 34383951 DOI: 10.1093/neuros/nyab291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/06/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is increasingly considered for selected olfactory groove meningiomas (OGMs). OBJECTIVE To investigate the safety and efficacy of SRS for OGMs. METHODS From 20 institutions participating in the International Radiosurgery Research Foundation, we pooled patients who underwent SRS for histologically confirmed or radiologically suspected WHO grade I OGMs and were followed for 6 mo or more after the SRS. RESULTS In total, 278 (median age 57 yr) patients underwent SRS for histologically confirmed (29%) or radiologically suspected (71%) WHO grade I OGMs Median treatment volume was 4.60 cm3 (range: 0.12-27.3 cm3), median prescription dose was 12 Gy, and median dose to the olfactory nerve was 11.20 Gy. During median post-SRS imaging follow-up of 39 mo (range: 6-240 mo), 43% of patients had partial or marginal response, 54% of patients had stable disease, and 3% of patients experienced progression. During median post-SRS clinical follow-up of 51 mo (range: 6-240 mo), 36 (13%) patients experienced clinical and/or radiological adverse radiation events (AREs). Elevated risk of AREs was associated with larger OGM volume (P = .009) and pre-SRS peritumoral T2/fluid-attenuated inversion-recovery signal abnormalities (P < .001). After the SRS, olfaction remained stable, improved, or deteriorated in 90%, 8%, and 2% of patients, respectively. Complete post-SRS anosmia was predicted by partial/complete anosmia before the SRS (odds ratio [OR] = 83.125; 95% CI [24.589-281.01], P < .001) and prior resection of OGM (OR = 3.919; 95% CI [1.713-8.970], P = .001). CONCLUSION SRS is associated with durable local control of the majority of OGM patients with acceptable safety profile. SRS allows preservation or improvement of olfactory function in the majority of OGM patients.
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Affiliation(s)
- Adomas Bunevicius
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Jungeun Ahn
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sarah Fribance
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Selcuk Peker
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Batu Hergunsel
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Darrah Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kimball Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Tomas Chytka
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | | | | | - Anne-Marie Langlois
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ronald E Warnick
- Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio, USA
| | - Herwin Speckter
- Gamma Knife, Radiology Department Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
| | - Camilo Albert
- Gamma Knife, Radiology Department Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
| | - Piero Picozzi
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Andrea Franzini
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luca Attuati
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ben A Strickland
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Caleb E Feliciano Valls
- Department of Neurosurgery, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
| | - Carlos H Carbini
- Administración de Servicios Médicos de Puerto Rico, Centro Gamma Knife de Puerto Rico y El Caribe, San Juan, Puerto Rico
| | - Samir Patel
- Division of Radiation Oncology, University of Alberta, Edmonton, Canada
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
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13
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Ius T, Tel A, Minniti G, Somma T, Solari D, Longhi M, De Bonis P, Scerrati A, Caccese M, Barresi V, Fiorentino A, Gorgoglione L, Lombardi G, Robiony M. Advances in Multidisciplinary Management of Skull Base Meningiomas. Cancers (Basel) 2021; 13:2664. [PMID: 34071391 PMCID: PMC8198762 DOI: 10.3390/cancers13112664] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022] Open
Abstract
The surgical management of Skull Base Meningiomas (SBMs) has radically changed over the last two decades. Extensive surgery for patients with SBMs represents the mainstream treatment; however, it is often challenging due to narrow surgical corridors and proximity to critical neurovascular structures. Novel surgical technologies, including three-dimensional (3D) preoperative imaging, neuromonitoring, and surgical instruments, have gradually facilitated the surgical resectability of SBMs, reducing postoperative morbidity. Total removal is not always feasible considering a risky tumor location and invasion of surrounding structures and brain parenchyma. In recent years, the use of primary or adjuvant stereotactic radiosurgery (SRS) has progressively increased due to its safety and efficacy in the control of grade I and II meningiomas, especially for small to moderate size lesions. Patients with WHO grade SBMs receiving subtotal surgery can be monitored over time with surveillance imaging. Postoperative management remains highly controversial for grade II meningiomas, and depends on the presence of residual disease, with optional upfront adjuvant radiation therapy or close surveillance imaging in cases with total resection. Adjuvant radiation is strongly recommended in patients with grade III tumors. Although the currently available chemotherapy or targeted therapies available have a low efficacy, the molecular profiling of SBMs has shown genetic alterations that could be potentially targeted with novel tailored treatments. This multidisciplinary review provides an update on the advances in surgical technology, postoperative management and molecular profile of SBMs.
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Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Alessandro Tel
- Maxillofacial Surgery Department, Department of Medicine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (A.T.); (M.R.)
| | - Giuseppe Minniti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy;
- IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80125 Naples, Italy; (T.S.); (D.S.)
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80125 Naples, Italy; (T.S.); (D.S.)
| | - Michele Longhi
- Unit of Radiosurgery and Stereotactic Neurosurgery, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata (AOUI), 37128 Verona, Italy;
| | - Pasquale De Bonis
- Department of Neurosurgery, Sant’ Anna University Hospital, 44124 Ferrara, Italy; (P.D.B.); (A.S.)
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Alba Scerrati
- Department of Neurosurgery, Sant’ Anna University Hospital, 44124 Ferrara, Italy; (P.D.B.); (A.S.)
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (M.C.); (G.L.)
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
| | - Alba Fiorentino
- Radiation Oncology Department, Advance Radiation Therapy, General Regional Hospital F. Miulli, 70021 Acquaviva delle Fonti, Italy;
| | - Leonardo Gorgoglione
- Department of Neurosurgery, Hospital “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (M.C.); (G.L.)
| | - Massimo Robiony
- Maxillofacial Surgery Department, Department of Medicine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (A.T.); (M.R.)
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14
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Wei Z, Mallela AN, Faramand A, Niranjan A, Lunsford LD. Long-term survival in patients with long-segment complex meningiomas occluding the dural venous sinuses: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE21116. [PMID: 35855015 PMCID: PMC9245851 DOI: 10.3171/case21116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/03/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Invasive sagittal sinus meningiomas are difficult tumors to cure by resection alone. Stereotactic radiosurgery (SRS) can be used as an adjuvant management strategy to improve tumor control after incomplete resection. OBSERVATIONS The authors reported the long-term retrospective follow-up of two patients whose recurrent parasagittal meningiomas eventually occluded their superior sagittal sinus. Both patients underwent staged radiosurgery and fractionated radiation therapy to achieve tumor control that extended to 20 years after their initial surgery. After initial subtotal resection of meningiomas that had invaded major cerebral venous sinuses, adjuvant radiosurgery was performed to enhance local tumor control. Over time, adjacent tumor progression required repeat SRS and fractionated radiation therapy to boost long-term tumor response. Staged multimodality intervention led to extended survival in these patients with otherwise unresectable meningiomas. LESSONS Multimodality management with radiosurgery and fractionated radiation therapy was associated with long-term survival of two patients with otherwise surgically incurable and invasive meningiomas of the dural venous sinuses.
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15
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Marchetti M, Sahgal A, De Salles AAF, Levivier M, Ma L, Paddick I, Pollock BE, Regis J, Sheehan J, Suh JH, Yomo S, Fariselli L. Stereotactic Radiosurgery for Intracranial Noncavernous Sinus Benign Meningioma: International Stereotactic Radiosurgery Society Systematic Review, Meta-Analysis and Practice Guideline. Neurosurgery 2021; 87:879-890. [PMID: 32463867 PMCID: PMC7566438 DOI: 10.1093/neuros/nyaa169] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) for benign intracranial meningiomas is an established treatment. OBJECTIVE To summarize the literature and provide evidence-based practice guidelines on behalf of the International Stereotactic Radiosurgery Society (ISRS). METHODS Articles in English specific to SRS for benign intracranial meningioma, published from January 1964 to April 2018, were systematically reviewed. Three electronic databases, PubMed, EMBASE, and the Cochrane Central Register, were searched. RESULTS Out of the 2844 studies identified, 305 had a full text evaluation and 27 studies met the criteria to be included in this analysis. All but one were retrospective studies. The 10-yr local control (LC) rate ranged from 71% to 100%. The 10-yr progression-free-survival rate ranged from 55% to 97%. The prescription dose ranged typically between 12 and 15 Gy, delivered in a single fraction. Toxicity rate was generally low. CONCLUSION The current literature supporting SRS for benign intracranial meningioma lacks level I and II evidence. However, when summarizing the large number of level III studies, it is clear that SRS can be recommended as an effective evidence-based treatment option (recommendation level II) for grade 1 meningioma.
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Affiliation(s)
- Marcello Marchetti
- Department of Neurosurgery, Unit of Radiotherapy, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italia
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | | | - Marc Levivier
- Neurosurgery Service and Gamma Knife Center Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Lijun Ma
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Ian Paddick
- Medical Physics Ltd, Queen Square Radiosurgery Centre, London, United Kingdom
| | - Bruce E Pollock
- Department of Radiation Oncology and Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Jean Regis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit CHU Timone, Marseille, France
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - John H Suh
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shoji Yomo
- Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Japan
| | - Laura Fariselli
- Department of Neurosurgery, Unit of Radiotherapy, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italia
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16
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Kankane VK, Misra BK. Petroclival Meningioma: Management Strategy and Results in 21 st Century. Asian J Neurosurg 2021; 16:89-95. [PMID: 34211873 PMCID: PMC8202385 DOI: 10.4103/ajns.ajns_357_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/25/2020] [Accepted: 12/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background Petroclival meningioma (PCM) is considered among the most difficult tumors to be treated by microneurosurgery because of its location and its relation to critical structures. The authors report on the outcome in a series of patients with PCM treated in the new millennium with a tailored approach of gross total excision or subtotal removal and adjuvant Gamma Knife Radiosurgery (GKR) depending on the particular case. Methods Between 2001 and 2017, 72 consecutive PCMs were operated in a single center by the senior surgeon. Clinical presentation, operative approaches, intraoperative findings, complications, and imaging findings were retrospectively analyzed. Postoperative outcome, adjuvant Gamma knife, and follow-up findings were reviewed. Results The average age was 47.95 years, and female-to-male ratio was 52:20. Cavernous sinus extension was present in 21 patients. The mean duration of follow-up was 66.65 months. Gross-total resection, near-total resection (NTR), and subtotal resection (STR) resection was achieved in 30, 24, and 18 (42.8%, 34.28%, and 25%) patients, respectively, with recurrences of 10%, 33%, and 50%, respectively. Twenty-two patients (18 STR and 4 NTR) had received postoperative GKR. Only four patients had recurrences following GKR. New cranial nerve deficits were more common in patients in whom a total resection was performed. There was no mortality. Conclusions Gross total excision had the best recurrence free rate though with a higher morbidity. Upfront GKR is advisable in patients with residual tumor, if the preoperative temporal course had a rapid symptomatology, to reduce recurrence. Wait and watch for a small intracavernous residue and radiosurgery on growth is also a valid option as long as follow-up is not suspect. A flexible approach of individualizing the treatment protocol for a given patient goes a long way toward optimal outcome.
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Affiliation(s)
- Vivek Kumar Kankane
- Department of Neurosurgery, G.R. Medical College, JAH Groups of Hospital, Gwalior, Madhya Pradesh, India
| | - Basant Kumar Misra
- Department Neurosurgery and Gamma Knife Radiosurgery, P.D. Hinduja National Hospital and Medical Research Center, Mumbai, Maharashtra, India
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Song G, Cheng Y, Bai X, Ren J, Li M, Meng G, Tang J, Liang J, Guo H, Chen G, Bao Y, Xiao X. Technique Nuances for Functional Preservation of Lower Cranial Nerves during Surgical Management of Ventral Foramen Magnum Meningiomas Via a Dorsal Lateral Approach. World Neurosurg 2020; 146:e1242-e1254. [PMID: 33276173 DOI: 10.1016/j.wneu.2020.11.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study established novel technique nuances in surgery for ventral foramen magnum meningiomas (vFMMs) via a dorsal lateral approach. METHODS From July 2012 to July 2019, 37 patients with vFMMs underwent tumor resection surgery and were operated on with a dorsal lateral approach. Two safe zones were selected as the entrance of the surgical corridor. Safe zone I was located between the dural attachment of the first dental ligament (FDL) and the branches of C1; safe zone II lay between the dural attachment of the FDL and the jugular foramen. The tumor was debulked first through safe zone I and then through safe zone II. The tumor was removed through a trajectory from the caudal to cephalad to allow tumor debulking from below and downward delivery, away from the brainstem and lower cranial nerves. RESULTS Thirty-three patients underwent gross total resection, and 4 patients underwent subtotal resection. Four patients transiently required a nasogastric feeding tube. All patients recovered within 3 months postoperatively. Three patients (8.1%) developed permanent mild hoarseness and dysphagia as a result of postoperative damage of cranial nerves IX and X. One patient underwent tracheotomy. No patient experienced tumor recurrence during the follow-up period. CONCLUSIONS We established a minimal retraction principle, in which the selection of 2 safe zones as the entrance of the surgical corridor, tumor removal from the inferior to superior direction, and debulking followed by devascularization were the key elements to implement the minimal retraction principle in vFMM surgery.
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Affiliation(s)
- Gang Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ye Cheng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guolu Meng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Tang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongchuan Guo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuhai Bao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xinru Xiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Image-Guided Multisession Radiosurgery of Skull Base Meningiomas. Cancers (Basel) 2020; 12:cancers12123569. [PMID: 33260363 PMCID: PMC7761100 DOI: 10.3390/cancers12123569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Stereotactic radiosurgery has changed the landscape of treatment for skull base meningiomas. Lesions encasing or compressing radiosensitive structures are considered not suitable for single session stereotactic radiosurgery because of the high risk of side effects. Multisession stereotactic radiosurgery can reduce these risks, allowing for normal tissue repair between fractions, while delivering a high dose per fraction. The aim of this study is to validate the role of multi-session stereotactic radiosurgery in the treatment of skull base meningiomas, through a retrospective analysis of 156 patients affected by skull base meningioma, treated at the University of Messina between 2008 and 2018. Our study suggests that multisession stereotactic radiosurgery represents a safe and effective profile in the treatment of skull base meningioma, providing a satisfactory local control and a low toxicity rate, together with patient comfort from a frameless procedure. Abstract Background: The efficacy of single-session stereotactic radiosurgery (sSRS) for the treatment of intracranial meningioma is widely recognized. However, sSRS is not always feasible in cases of large tumors and those lying close to critically radiation-sensitive structures. When surgery is not recommended, multi-session stereotactic radiosurgery (mSRS) can be applied. Even so, the efficacy and best treatment schedule of mSRS are not yet established. The aim of this study is to validate the role of mSRS in the treatment of skull base meningiomas. Methods: A retrospective analysis of patients with skull base meningiomas treated with mSRS (two to five fractions) at the University of Messina, Italy, from 2008 to 2018, was conducted. Results: 156 patients met the inclusion criteria. The median follow-up period was 36.2 ± 29.3 months. Progression-free survival at 2-, 5-, and 10- years was 95%, 90%, and 80.8%, respectively. There were no new visual or motor deficits, nor cranial nerves impairments, excluding trigeminal neuralgia, which was reported by 5.7% of patients. One patient reported carotid occlusion and one developed brain edema. Conclusion: Multisession radiosurgery is an effective approach for skull base meningiomas. The long-term control is comparable to that obtained with conventionally-fractionated radiotherapy, while the toxicity rate is very limited.
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Akyoldaş G, Samancı Y, Yılmaz M, Şengöz M, Peker S. Long-term results of gamma knife radiosurgery for foramen magnum meningiomas. Neurosurg Rev 2020; 44:2667-2673. [PMID: 33244665 DOI: 10.1007/s10143-020-01446-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022]
Abstract
Outcomes of 37 patients of foramen magnum meningioma (FMM) were evaluated, and the related literature was reviewed to determine the efficacy of Gamma Knife radiosurgery (GKRS) for treating patients with FMM. We present the largest series reported from a single institution with the longest follow-up to date. The database of patients who underwent GKRS for FMM between 2007 and 2019 was evaluated retrospectively. A total of 37 patients with radiological and pathological features consistent with FMM were included in this series. Thirty-three patients were female, and 4 were male. The median age was 58 years (range, 23-74 years). The most common symptom at diagnosis was headache (64.9%). Twelve patients had a history of microsurgical resection. The median duration from the initial onset of symptoms to GKRS was 12 months (range 1-140 months). Among the 37 tumors, eight (21.6%) were located ventrally, 24 (64.9%) laterally, and five (13.5%) dorsally. The median target volume was 3.30 cm3 (range, 0.6-17.6 cm3). Thirty-five patients (95%) were treated with single fraction GKRS, and two patients (5%) were treated with hypofractionated GKRS. The median clinical follow-up was 80 months (range, 18-151 months), while the median radiological follow-up was 84 months (range, 18-144 months). At the last clinical follow-up after GKRS, 27 patients (73%) had improved symptoms, and none had worsened pre-GKRS symptoms. At the last radiological follow-up after GKRS, 23 tumors (62.2%) remained stable, 13 (35.1%) decreased in size, and 1 (2.7%) increased in size. Tumor control, including stable and regressed tumors, was achieved in 97.3% of patients. Our cohort demonstrates that GKRS is an effective and safe treatment for patients with either primary or recurrent/residual FMM.
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Affiliation(s)
- Göktuğ Akyoldaş
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey.
| | - Yavuz Samancı
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey
| | - Meltem Yılmaz
- Medical Biotechnology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Meriç Şengöz
- Department of Radiation Oncology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Selçuk Peker
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
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Yu Z, Huang B, Liang R. Radiation-induced cavernous malformation after stereotactic radiosurgery for cavernous sinus meningioma: a case report. BMC Neurol 2020; 20:422. [PMID: 33218314 PMCID: PMC7678286 DOI: 10.1186/s12883-020-01995-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/09/2020] [Indexed: 01/24/2023] Open
Abstract
Background Radiation-induced cavernous malformation (RICM) is a rare sequela of stereotactic radiosurgery (SRS) treatment of intracranial tumors. To date, no study reported on RICM after SRS for meningiomas originating from the skull base. The relationship between locus of initial meningioma and RICM has not been studied. Case presentation A 57-year-old woman presented with persistent headaches and blepharoptosis at initial episode. MRI disclosed a right parasellar lesion, diagnosed as a cavernous sinus meningioma (CSM). After receiving a single-fractionated SRS, headache relieved, but blepharoptosis did not significantly improve. Three years and three months later, she returned with headaches and dizziness. MRI showed an enlarged CSM. Moreover, a new mass-like lesion, suspected hemangioma, appeared in the nearby right temporal lobe. After surgical removal of the new lesion and the CSM, the patient’s neurological symptoms significantly improved. Pathology confirmed CSM and temporal RICM. Conclusions We report the first rare case of RICM occurring after SRS for CSM. The RICM may be in the same region as the initial tumor. Surgical intervention was preferred for symptomatic RICM and initial meningioma. We recommend long-term regular followup MRIs for patients with meningioma after SRS treatment.
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Affiliation(s)
- Zuan Yu
- Department of Neurosurgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Gulou District, Fuzhou City, Fujian Province, China
| | - Bin Huang
- Department of Neurosurgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Gulou District, Fuzhou City, Fujian Province, China
| | - Risheng Liang
- Department of Neurosurgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Gulou District, Fuzhou City, Fujian Province, China.
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Przybylowski CJ, Hendricks BK, Frisoli FA, Zhao X, Cavallo C, Borba Moreira L, Gandhi S, Sanai N, Almefty KK, Lawton MT, Little AS. Prognostic value of the Simpson grading scale in modern meningioma surgery: Barrow Neurological Institute experience. J Neurosurg 2020; 135:515-523. [PMID: 33096534 DOI: 10.3171/2020.6.jns20374] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recently, the prognostic value of the Simpson resection grading scale has been called into question for modern meningioma surgery. In this study, the authors analyzed the relationship between Simpson resection grade and meningioma recurrence in their institutional experience. METHODS This study is a retrospective review of all patients who underwent resection of a WHO grade I intracranial meningioma at the authors' institution from 2007 to 2017. Binary logistic regression analysis was used to assess for predictors of Simpson grade IV resection and postoperative neurological morbidity. Cox multivariate analysis was used to assess for predictors of tumor recurrence. Kaplan-Meier analysis and log-rank tests were used to assess and compare recurrence-free survival (RFS) of Simpson resection grades, respectively. RESULTS A total of 492 patients with evaluable data were included for analysis, including 394 women (80.1%) and 98 men (19.9%) with a mean (SD) age of 58.7 (12.8) years. The tumors were most commonly located at the skull base (n = 302; 61.4%) or the convexity/parasagittal region (n = 139; 28.3%). The median (IQR) tumor volume was 6.8 (14.3) cm3. Simpson grade I, II, III, or IV resection was achieved in 105 (21.3%), 155 (31.5%), 52 (10.6%), and 180 (36.6%) patients, respectively. Sixty-three of 180 patients (35.0%) with Simpson grade IV resection were treated with adjuvant radiosurgery. In the multivariate analysis, increasing largest tumor dimension (p < 0.01) and sinus invasion (p < 0.01) predicted Simpson grade IV resection, whereas skull base location predicted neurological morbidity (p = 0.02). Tumor recurrence occurred in 63 patients (12.8%) at a median (IQR) of 36 (40.3) months from surgery. Simpson grade I resection resulted in superior RFS compared with Simpson grade II resection (p = 0.02), Simpson grade III resection (p = 0.01), and Simpson grade IV resection with adjuvant radiosurgery (p = 0.01) or without adjuvant radiosurgery (p < 0.01). In the multivariate analysis, Simpson grade I resection was independently associated with no tumor recurrence (p = 0.04). Simpson grade II and III resections resulted in superior RFS compared with Simpson grade IV resection without adjuvant radiosurgery (p < 0.01) but similar RFS compared with Simpson grade IV resection with adjuvant radiosurgery (p = 0.82). Simpson grade IV resection with adjuvant radiosurgery resulted in superior RFS compared with Simpson grade IV resection without adjuvant radiosurgery (p < 0.01). CONCLUSIONS The Simpson resection grading scale continues to hold substantial prognostic value in the modern neurosurgical era. When feasible, Simpson grade I resection should remain the goal of intracranial meningioma surgery. Simpson grade IV resection with adjuvant radiosurgery resulted in similar RFS compared with Simpson grade II and III resections.
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Peciu-Florianu I, Régis J, Levivier M, Dedeciusova M, Reyns N, Tuleasca C. Trigeminal Neuralgia Secondary to Meningiomas and Vestibular Schwannoma Is Improved after Stereotactic Radiosurgery: A Systematic Review and Meta-Analysis. Stereotact Funct Neurosurg 2020; 99:6-16. [PMID: 32906130 DOI: 10.1159/000509842] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Trigeminal neuralgia (TN) secondary to tumors is encountered in up to 6% of patients with facial pain syndromes and is considered to be associated with tumors affecting the trigeminal nerve pathways. The most frequent are meningiomas and vestibular schwannomas (VS). Stereotactic radiosurgery (SRS) has emerged as a valuable treatment, with heterogeneity of clinical results. We sought to review the medical literature on TN treated with SRS for meningiomas and VS and investigate the rates of improvement of TN symptoms. METHODS We reviewed articles published between January 1990 and December 2019 in PubMed. Pain relief after SRS, the maintenance of pain relief, and TN recurrence and complications were evaluated with separate meta-analyses, taking into account the data on individual patients. RESULTS Pain relief after SRS was reported as Barrow Neurological Institute (BNI) pain intensity scores of BNI I in 50.5% (range 36-65.1%) of patients and BNI I-IIIb in 83.8% (range 77.8-89.8%). There was no significant difference in series discussing outcomes for tumor targeting versus tumor and nerve targeting. Recurrences were described in 34.7% (range 21.7-47.6; tumor targeting). Maintenance of BNI I was reported in 36.4% (range 20.1-52.7) and BNI I-IIIb in 41.2% (range 29.8-52.7; tumor targeting series). When both the nerve and the tumor were targeted, only 1 series reported 86.7% with BNI I-IIIb at last follow-up. Complications were encountered in 12.6% (range 6.3-18.8; tumor targeting series) of patients; however, they were much higher, as high as 26.7%, in the only study reporting them after targeting both the nerve and the tumor. The most common complication was facial numbness. CONCLUSION SRS for TNB secondary to benign tumors, such as meningiomas and VS, is associated with favorable clinical course, but less favorable than in idiopathic TN. There was, however, heterogeneity among reports and targeting approaches. Although targeting both the nerve and the tumor seemed to achieve better long-term results, the rate of complications was much higher and the number of patients treated was limited. Future clinical studies should focus on the standard reporting of clinical outcomes and randomization of targeting methods.
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Affiliation(s)
- Iulia Peciu-Florianu
- Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Lille, France
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, CHU Timone, Marseille, France
| | - Marc Levivier
- Neurosurgery Service and Gamma Knife Center, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland
| | - Michaela Dedeciusova
- First Faculty of Medicine, Charles University in Prague, Prague, Czechia.,Department of Neurosurgery and Neuro-Oncology, Military University Hospital Prague, Prague, Czechia
| | - Nicolas Reyns
- Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Lille, France
| | - Constantin Tuleasca
- Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Lille, France, .,Neurosurgery Service and Gamma Knife Center, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland, .,Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland, .,Signal Processing Laboratory (LTS-5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland,
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23
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Lippitz BE, Bartek J, Mathiesen T, Förander P. Ten-year follow-up after Gamma Knife radiosurgery of meningioma and review of the literature. Acta Neurochir (Wien) 2020; 162:2183-2196. [PMID: 32591948 PMCID: PMC7415024 DOI: 10.1007/s00701-020-04350-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 04/14/2020] [Indexed: 02/03/2023]
Abstract
Objectives With regard to the generally slow growth of meningioma, it is essential to analyse clinical treatment results in a long-term perspective. The purpose of the present analysis is to provide clinical data after Gamma Knife radiosurgery of meningioma in a 10-year perspective together with a review of the current literature. Methods The current study is a retrospective analysis of 86 consecutive Swedish patients with meningiomas treated using Gamma Knife radiosurgery at the Karolinska Hospital Stockholm between March 1991 and May 2001. A total of 130 tumours were treated in 115 treatment sessions. The median radiological follow-up was 10 years (1.8–16.5 years), and the median clinical follow-up was 9.4 years (2.1–17.4 years). Results After a median follow-up period of 10 years, local tumour control was achieved in 87.8% of meningiomas (108/123 tumours). The median latency between initial treatment and local (in-field) recurrence (n = 15) was 5.8 years (1.9–11.5). Recurrences adjacent but outside the initial radiation field occurred in 15.1% of patients (13/86) at a median of 7.5 years (1.3–15.7). New meningiomas were seen in 10.5% after a median of 5.4 years (0.9–10.8). In 72% of patients, no further treatment was required, 17.4% (15/86) underwent a second Gamma Knife treatment, 4.7% (4/86) required later open surgery and 5.8% (5/86) required both secondary treatments. Eighty-six percent of patients were neurologically unchanged or improved. A significantly lower rate of local (in-field) recurrences was seen in meningiomas treated with a prescription dose of > 13.4 Gy (7.1% vs. 24%, p = 0.02). Conclusions The current retrospective analysis provides a 10-year follow-up and comprises one of the longest available follow-up studies of radiosurgically treated meningiomas. The current series documents a persistent high local tumour control after Gamma Knife treatment, while providing an estimation of a necessary minimum dose for long-term tumour control in meningiomas. The study confirms the validity of previous short-term data in a long-term perspective.
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Affiliation(s)
- Bodo E Lippitz
- Interdisciplinary Centre for Radiosurgery (ICERA), Radiological Alliance Hamburg, Mörkenstr.47, 22767, Hamburg, Germany.
- Department of Clinical Neuroscience, Karolinska Institute, Centre for Molecular Medicine L8:04, Karolinska University Hospital, S-17176, Stockholm, Sweden.
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska Hospital, S-17176, Stockholm, Sweden
- Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tiit Mathiesen
- Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej3, 2200, Copenhagen, Denmark
- Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Petter Förander
- Department of Neurosurgery, Karolinska Hospital, S-17176, Stockholm, Sweden
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Joshi KC, Raghavan A, Muhsen B, Hsieh J, Borghei-Razavi H, Chao ST, Barnett GH, Suh JH, Neyman G, Kshettry VR, Recinos PF, Mohammadi AM, Angelov L. Fractionated Gamma Knife radiosurgery for skull base meningiomas: a single-institution experience. Neurosurg Focus 2020; 46:E8. [PMID: 31153152 DOI: 10.3171/2019.3.focus1963] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEGamma Knife radiosurgery (GKRS) has been successfully used for the treatment of intracranial meningiomas given its steep dose gradients and high-dose conformality. However, treatment of skull base meningiomas (SBMs) may pose significant risk to adjacent radiation-sensitive structures such as the cranial nerves. Fractionated GKRS (fGKRS) may decrease this risk, but until recently it has not been practical with traditional pin-based systems. This study reports the authors' experience in treating SBMs with fGKRS, using a relocatable, noninvasive immobilization system.METHODSThe authors performed a retrospective review of all patients who underwent fGKRS for SBMs between 2013 and 2018 delivered using the Extend relocatable frame system or the Icon system. Patient demographics, pre- and post-GKRS tumor characteristics, perilesional edema, prior treatment details, and clinical symptoms were evaluated. Volumetric analysis of pre-GKRS, post-GKRS, and subsequent follow-up visits was performed.RESULTSTwenty-five patients met inclusion criteria. Nineteen patients were treated with the Icon system, and 6 patients were treated with the Extend system. The mean pre-fGKRS tumor volume was 7.62 cm3 (range 4.57-13.07 cm3). The median margin dose was 25 Gy delivered in 4 (8%) or 5 (92%) fractions. The median follow-up time was 12.4 months (range 4.7-17.4 months). Two patients (9%) experienced new-onset cranial neuropathy at the first follow-up. The mean postoperative tumor volume reduction was 15.9% with 6 patients (27%) experiencing improvement of cranial neuropathy at the first follow-up. Median first follow-up scans were obtained at 3.4 months (range 2.8-4.3 months). Three patients (12%) developed asymptomatic, mild perilesional edema by the first follow-up, which remained stable subsequently.CONCLUSIONSfGKRS with relocatable, noninvasive immobilization systems is well tolerated in patients with SBMs and demonstrated satisfactory tumor control as well as limited radiation toxicity. Future prospective studies with long-term follow-up and comparison to single-session GKRS or fractionated stereotactic radiotherapy are necessary to validate these findings and determine the efficacy of this approach in the management of SBMs.
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Affiliation(s)
- Krishna C Joshi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | | | - Baha'eddin Muhsen
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Jason Hsieh
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Hamid Borghei-Razavi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Samuel T Chao
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gene H Barnett
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - John H Suh
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gennady Neyman
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Varun R Kshettry
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Pablo F Recinos
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Alireza M Mohammadi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Lilyana Angelov
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
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Sachdev S, Sita TL, Shlobin NA, Gopalakrishnan M, Sucholeiki R, Régis J, Bandt SK. Completion Corpus Callosotomy with Stereotactic Radiosurgery for Drug-Resistant, Intractable Epilepsy. World Neurosurg 2020; 143:440-444. [PMID: 32827745 DOI: 10.1016/j.wneu.2020.08.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) offers a noninvasive technique for division of the corpus callosum, which can confer improved seizure control to patients suffering from frequent atonic seizures due to rapid interhemispheric generalization. This noninvasive approach is well-suited for use in a palliative intervention for improved seizure control in this patient population. To our knowledge, this is the first report of radiosurgical completion corpus callosotomy in an adult in the United States. CASE DESCRIPTION A 20-year-old ambidextrous nonverbal man with a history of refractory generalized epilepsy status post open anterior corpus callosotomy at age 10 years, Lennox-Gastaut syndrome, and autism presented after 2 years of incremental, progressive deterioration in seizure control and behavior including 1 year. The family decided to pursue SRS corpus callosotomy. Under general anesthesia, a volume of interest encompassing a full midsagittal plane of the corpus callosum was defined to deliver 60 Gy to the 50% isodose line fully encompassing the target. Gamma Knife was used with 2 isocenters at 90° and 1 at 110° and isodose lines of 60, 20, and 12 Gy. Treatment was carried out without difficulty or complications while the patient remained under close monitoring. The patient was discharged the next day with a 2-week taper of dexamethasone. CONCLUSIONS Eight months postradiosurgical corpus callosotomy, the patient is free of atonic seizures and is ambulatory. In carefully selected cases and with protective radiosurgical planning, SRS for completion corpus callosotomy represents an effective option for refractory seizure control.
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Affiliation(s)
- Sean Sachdev
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Timothy L Sita
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mahesh Gopalakrishnan
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Roy Sucholeiki
- Department of Neurology, Northwestern Medicine Central Dupage Hospital, Winfield, Illinois, USA
| | - Jean Régis
- Functional and Stereotactic Neurosurgery Service and Gamma Knife Unit, Centre Hospitalier Universitaire La Timone Assistance Publique-Hopitaux de Marseille, Université de la Méditerranée, Marseille, France
| | - S Kathleen Bandt
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Brastianos PK, Galanis E, Butowski N, Chan JW, Dunn IF, Goldbrunner R, Herold-Mende C, Ippen FM, Mawrin C, McDermott MW, Sloan A, Snyder J, Tabatabai G, Tatagiba M, Tonn JC, Wen PY, Aldape K, Nassiri F, Zadeh G, Jenkinson MD, Raleigh DR. Advances in multidisciplinary therapy for meningiomas. Neuro Oncol 2020; 21:i18-i31. [PMID: 30649489 DOI: 10.1093/neuonc/noy136] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Surgery has long been established as the first-line treatment for the majority of symptomatic and enlarging meningiomas, and evidence for its success is derived from retrospective case series. Despite surgical resection, a subset of meningiomas display aggressive behavior with early recurrences that are difficult to treat. The decision to radically resect meningiomas and involved structures is balanced against the risk for neurological injury in patients. Radiation therapy has largely been used as a complementary and safe therapeutic strategy in meningiomas with evidence primarily stemming from retrospective, single-institution reports. Two of the first cooperative group studies (RTOG 0539 and EORTC 22042) evaluating the outcomes of adjuvant radiation therapy in higher-risk meningiomas have shown promising preliminary results. Historically, systemic therapy has resulted in disappointing results in meningiomas. However, several clinical trials are under way evaluating the efficacy of chemotherapies, such as trabectedin, and novel molecular agents targeting Smoothened, AKT1, and focal adhesion kinase in patients with recurrent meningiomas.
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Affiliation(s)
- Priscilla K Brastianos
- Divisions of Hematology/Oncology & Neuro-Oncology, Departments of Medicine & Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Evanthia Galanis
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas Butowski
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Jason W Chan
- Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - Ian F Dunn
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Roland Goldbrunner
- Department of General Neurosurgery, University Hospital Cologne, Cologne, Germany
| | | | - Franziska M Ippen
- Divisions of Hematology/Oncology & Neuro-Oncology, Departments of Medicine & Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christian Mawrin
- Institute of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany
| | - Michael W McDermott
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Andrew Sloan
- Department of Neurological Surgery, University Hospital-Case Medical Center, Cleveland, Ohio, USA
| | - James Snyder
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neuro-Oncology, Hertie Institute for Clinical Brain Research & Centre for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Joerg C Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kenneth Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Farshad Nassiri
- MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, University Health Network, University of Toronto, Ontario, Canada.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Michael D Jenkinson
- Department of Neurosurgery & Institute of Translational Medicine, The Walton Centre NHS Foundation Trust & University of Liverpool, Lower Lane, Liverpool, Merseyside, UK
| | - David R Raleigh
- Department of Neurological Surgery, University of California, San Francisco, California, USA.,Department of Radiation Oncology, University of California, San Francisco, California, USA
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Patterns of recurrence in patients receiving conformal radiation for intracranial meningioma: a single-institution experience. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAim:To evaluate the patterns of recurrence following postoperative conformal radiotherapy (RT) for intracranial meningioma.Materials and methods:Eighty-six patients who received conformal RT for intracranial meningiomas from 2014 to 2017 were retrospectively analysed. For documented recurrences, recurrence imaging was deformably co-registered to planning CT scan. In-field recurrence was defined as recurrence within the 90% isodose line, and out-of-field recurrences were those that occurred outside the 90% isodose line. We present the demographic details, surgical and RT details, outcomes and patterns of recurrence.Results:The median age was 46 years (range 17–72); 82·6% underwent surgery [46·5% had subtotal resection (STR), 43·7% gross tumour resection (GTR), 5·6% biopsy] and 17·4% had no surgery. Among these, 53·5% were WHO grade 2; 27·9% grade 1; and 1·2% grade 3 meningioma. Fifty per cent received stereotactic RT (SRT), 46·5% 3D conformal RT (3DCRT) and 3·5% intensity-modulated RT (IMRT). The mean clinical target volume (CTV) and planning target volume (PTV) margins were 4·5 mm (range 0–15) and 3·9 mm (range 1–5), respectively. The doses ranged from 54 to 59·4 Gy. The median follow-up after RT was 1·7 years (range 0·2–4·7). 17·4% were lost to follow-up, 5·4% had recurrence, and the median time to recurrence after completion of RT was 2 years (range 0·7–2·9). The 3-year recurrence-free rate was 81·5%. Three patients had in-field and two had in-field and out-of-field recurrence. Among the cases with recurrence, three received SRT, one 3DCRT and one IMRT. Four were grade 2 and one was grade 3 tumour, and the CTV margin ranged from 0 to 5 mm, and the PTV margin ranged from 3 to 5 mm.Conclusion:Local recurrence was seen in grade 2 and 3 meningiomas. SRT probably had more recurrence as they had lesser CTV margin. Increased CTV margin, escalated dose up to 59·4 Gy and 3DCRT/IMRT may be helpful in preventing local recurrences in grade 2 and grade 3 meningiomas.
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Iwai Y, Yamanaka K, Shimohonji W, Ishibashi K. Staged Gamma Knife Radiosurgery for Large Skull Base Meningiomas. Cureus 2019; 11:e6001. [PMID: 31807388 PMCID: PMC6876917 DOI: 10.7759/cureus.6001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: The authors have been treating skull base meningiomas using relatively low-dose gamma knife radiosurgery (GKS, ≤ 12 Gy) with acceptable tumor growth control and low morbidity. In the present study, volume-staged, low-dose GKS was performed for large skull base meningiomas with a maximum diameter > 4 cm. In this article, a treatment strategy for volume-staged GKS and results for large skull base meningiomas are described. Methods: Data from 27 patients with large skull base meningiomas histopathologically diagnosed as WHO grade I or diagnosed by imaging, who underwent volume-staged GKS between March 1995 and September 2018, were reviewed. Among these patients, 24 were followed-up for > six months. The tumor was located in the parasellar region in nine patients, cavernous sinus region in four, petroclival region in four, petrocavernous sinus region in four, cerebellopontine angle region in two, and in the tent in one. The mean tumor diameters ranged from 31 to 47.8 mm (median 39.4 mm), with tumor volumes between 14.7 and 49.5 cm3 (median 27.5 cm3). Results: The prescribed radiation dose was 8-12 Gy (median 10 Gy). The treatment interval between the first and second GKS was three to nine months (median 5.5 months). The median duration of follow-up after the first GKS was 84 months (range 6-204 months). Tumor volume decreased in nine (37.5%) patients, remained stable in nine (37.5%), and increased (local failure) in six (25%). The actuarial progression-free local control rate was 88% at three years, 78% at five years, 70% at 10 years, and 70% at 15 years. Neurological status improved in three (12.5%) patients, was unchanged in 16 (66.5%), and deteriorated in five (21%). Permanent radiation injury occurred in one (4%) patient. Conclusion: Volume-staged GKS demonstrated the usefulness for large skull meningiomas > 4 cm in diameter, over a long-term follow-up period.
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Patibandla MR, Lee CC, Tata A, Addagada GC, Sheehan JP. Stereotactic radiosurgery for WHO grade I posterior fossa meningiomas: long-term outcomes with volumetric evaluation. J Neurosurg 2019; 129:1249-1259. [PMID: 29303453 DOI: 10.3171/2017.6.jns17993] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEResearch over the past 2 decades has been characterizing the role of stereotactic radiosurgery (SRS) in the treatment of benign intracranial tumors, including meningiomas. However, few studies have examined the long-term outcomes of SRS treatment for posterior fossa meningiomas (PFMs). Furthermore, previous studies have typically used single diameter measurements when reporting outcomes, which can yield misleading results. The authors describe the use of SRS in the treatment of benign WHO grade I PFMs and correlate volumetric analysis with long-term outcomes.METHODSThis study is a retrospective analysis of a prospectively maintained IRB-approved database. Inclusion criteria were a diagnosis of WHO grade I PFM with subsequent treatment via single-session SRS and a minimum of 3 follow-up MRI studies available. Volumetric analysis was performed on the radiosurgical scan and each subsequently available follow-up scan by using slice-by-slice area calculations of the meningioma and numerical integration with the trapezoid rule.RESULTSThe final cohort consisted of 120 patients, 76.6% (92) of whom were female, with a median age of 61 years (12-88 years). Stereotactic radiosurgery was the primary treatment for 65% (78) of the patients, whereas 28.3% (34) had 1 resection before SRS treatment and 6.7% (8) had 2 or more resections before SRS. One patient had prior radiotherapy. Tumor characteristics included a median volume of 4.0 cm3 (0.4-40.9 cm3) at treatment with a median margin dose of 15 Gy (8-20 Gy). The median clinical and imaging follow-ups were 79.5 (15-224) and 72 (6-213) months, respectively. For patients treated with a margin dose ≥ 16 Gy, actuarial progression-free survival rates during the period 2-10 years post-SRS were 100%. In patients treated with a margin dose of 13-15 Gy, the actuarial progression-free survival rates at 2, 4, 6, 8, and 10 years were 97.5%, 97.5%, 93.4%, 93.4%, and 93.4%, respectively. Those who were treated with ≤ 12 Gy had actuarial progression-free survival rates of 95.8%, 82.9%, 73.2%, 56.9%, and 56.9% at 2, 4, 6, 8, and 10 years, respectively. The overall tumor control rate was 89.2% (107 patients). Post-SRS improvement in neurological symptoms occurred in 23.3% (28 patients), whereas symptoms were stable in 70.8% (85 patients) and worsened in 5.8% (7 patients). Volumetric analysis demonstrated that a change in tumor volume at 3 years after SRS reliably predicted a volumetric change and tumor control at 5 years (R2 = 0.756) with a p < 0.001 and at 10 years (R2 = 0.421) with a p = 0.001. The authors also noted that the 1- to 5-year tumor response is predictive of the 5- to 10-year tumor response (R2 = 0.636, p < 0.001).CONCLUSIONSStereotactic radiosurgery, as an either upfront or adjuvant treatment, is a durable therapeutic option for WHO grade I PFMs, with high tumor control and a low incidence of post-SRS neurological deficits compared with those obtained using alternate treatment modalities. Lesion volumetric response at the short-term follow-up of 3 years is predictive of the long-term response at 5 and 10 years.
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Affiliation(s)
- Mohana Rao Patibandla
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Cheng-Chia Lee
- 2Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan; and
| | - Athreya Tata
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | | | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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30
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Akyoldaş G, Hergünsel ÖB, Yılmaz M, Şengöz M, Peker S. Gamma Knife Radiosurgery for Anterior Clinoid Process Meningiomas: A Series of 61 Consecutive Patients. World Neurosurg 2019; 133:e529-e534. [PMID: 31562964 DOI: 10.1016/j.wneu.2019.09.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Gamma Knife radiosurgery (GKRS) outcomes for anterior clinoid process (ACP) meningiomas have not been specifically reported within any meningioma series. We present the initial and largest series in the literature that describes the presenting features, radiosurgery parameters, and radiologic and long-term clinical outcomes for 61 patients with ACP meningiomas treated with GKRS. METHODS Medical records were reviewed for 61 consecutive patients at a single center who underwent GKRS for ACP meningioma between 2008 and 2016. RESULTS Of 61 patients with ACP meningiomas, 49 (80%) were treated with GKRS as primary treatment, and 12 (20%) were treated with GKRS as an adjuvant therapy. Before GKRS, 29 patients presented with visual impairment and 50 patients presented with headache. Median patient age was 54.9 years. Median tumor volume was 3.2 cm3, and median margin dose was 12.0 Gy. The median radiologic follow-up time after GKRS was 75 months. During follow-up, tumor volume regressed in 37 cases (61%) and remained unchanged in 24 cases (39%). None of the patients experienced tumor volume progression. Tumor volume <3 cm3 was an independent predictor of tumor volume regression after GKRS (univariate analysis, P = 0.047; multivariate analysis, P = 0.049). Of 29 patients who presented with visual impairment, 16 (55%) improved after GKRS. None of the 61 patients developed new neurologic deficits after GKRS. CONCLUSIONS GKRS provides a high rate of tumor volume control for ACP meningiomas as well as a low complication rate. Excellent tumor volume control was associated with smaller tumor size only.
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Affiliation(s)
- Göktuğ Akyoldaş
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey.
| | - Ömer Batu Hergünsel
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Meltem Yılmaz
- Medical Biotechnology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Meriç Şengöz
- Department of Radiation Oncology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Selçuk Peker
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
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31
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Zhang Y, Chen JH, Chen TY, Lim SW, Wu TC, Kuo YT, Ko CC, Su MY. Radiomics approach for prediction of recurrence in skull base meningiomas. Neuroradiology 2019; 61:1355-1364. [PMID: 31324948 DOI: 10.1007/s00234-019-02259-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/04/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE A subset of skull base meningiomas (SBM) may show early progression/recurrence (P/R) as a result of incomplete resection. The purpose of this study is the implementation of MR radiomics to predict P/R in SBM. METHODS From October 2006 to December 2017, 60 patients diagnosed with pathologically confirmed SBM (WHO grade I, 56; grade II, 3; grade III, 1) were included in this study. Preoperative MRI including T2WI, diffusion-weighted imaging (DWI), and contrast-enhanced T1WI were analyzed. On each imaging modality, 13 histogram parameters and 20 textural gray level co-occurrence matrix (GLCM) features were extracted. Random forest algorithms were utilized to evaluate the importance of these parameters, and the most significant three parameters were selected to build a decision tree for prediction of P/R in SBM. Furthermore, ADC values obtained from manually placed ROI in tumor were also used to predict P/R in SBM for comparison. RESULTS Gross-total resection (Simpson Grades I-III) was performed in 33 (33/60, 55%) patients, and 27 patients received subtotal resection. Twenty-one patients had P/R (21/60, 35%) after a postoperative follow-up period of at least 12 months. The three most significant parameters included in the final radiomics model were T1 max probability, T1 cluster shade, and ADC correlation. In the radiomics model, the accuracy for prediction of P/R was 90%; by comparison, the accuracy was 83% using ADC values measured from manually placed tumor ROI. CONCLUSIONS The results show that the radiomics approach in preoperative MRI offer objective and valuable clinical information for treatment planning in SBM.
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Affiliation(s)
- Yang Zhang
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Jeon-Hor Chen
- Department of Radiological Sciences, University of California, Irvine, CA, USA.,Department of Radiology, E-DA Hospital, E-DA Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Tai-Yuan Chen
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan.,Department of Nursing, Min-Hwei College of Health Care, Management, Tainan, Taiwan
| | - Te-Chang Wu
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Department of of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan. .,Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, CA, USA
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Qiao L, Yu C, Zhang H, Zhang M, Qu Y, Ren M, Gu C, Wang H. Clinical outcomes and survival analysis for petroclival meningioma patients receiving surgical resection: an analysis of 176 cases. Cancer Manag Res 2019; 11:5949-5959. [PMID: 31308738 PMCID: PMC6612996 DOI: 10.2147/cmar.s200932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/05/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose: The relationship of clinical results and survival analysis of operative patients with petroclival meningioma (PCM) was studied. Patients and methods: Data from a total of 176 PCM patients receiving surgical resection were retrospectively collected. Follow-up was conducted through outpatient review by reexamination telephone calls and letters. Clinical outcomes, survival, and Karnofsky Performance Scale (KPS) data were analyzed. Results: Seventy-two percent of patients (127/176) received only surgery, 8.5% (15/176) received surgery and adjuvant radiation therapy (RT) (surgery + RT), and 19.3% (34/176) received surgery and adjuvant gamma knife surgery (GKS) (surgery + GKS). Gross total resection (GTR) was performed in 34.7% of patients (61/176), subtotal resection (STR) in 58.0% (102/176), and partial resection (PR) in 7.4% (13/176). Recent follow-up KPS was higher than preoperative (80 vs 70, P<0.05) and postoperative KPS (80 vs 70, P<0.05). Cumulative survival was the same for 3, 5, 7, and 9 years, ie, 95%, and mean survival time (MST) was (110.83±2.55) months (95% CI: 105.83–115.83). Recurrence/progression (R/P)-free survival was 88.9%, 86.9%, 71.1% and 71.1%, respectively for 3, 5, 7, and 9 years, and MST was (100.58±3.82) months (95% CI: 93.11–108.06). R/P (HR: 5.486, 95% CI: 1.655–18.180), surgery + RT (HR: 0.125, 95% CI: 0.016–0.990) and WHO grade III (HR: 2.766, 95% CI: 1.146–6.676) were independently associated with cumulative survival. Lack of adhesion to and encasement of neurovascular structures was independently associated with R/P-free survival (HR: 2.002, 95% CI: 1.023–3.919). Conclusion: Surgical treatment was safe and effective for PCM. R/P, surgery + RT, and WHO grade III were independently associated with cumulative survival. Lack of adhesion to and encasement of neurovascular structures was independently associated with R/P-free survival. These factors should be paid attention to in surgical treatment of PCM.
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Affiliation(s)
- Li Qiao
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neurosurgery, Gansu Provincial Hospital, Lanzhou, Gansu Province, People's Republic of China
| | - Chunjiang Yu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hongwei Zhang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Mingshan Zhang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yanming Qu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ming Ren
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chunyu Gu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Haoran Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
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Linear Accelerator-Based Radiosurgery of Grade I Intracranial Meningiomas. World Neurosurg X 2019; 3:100027. [PMID: 31225520 PMCID: PMC6584458 DOI: 10.1016/j.wnsx.2019.100027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/18/2019] [Indexed: 11/20/2022] Open
Abstract
Objective To determine the local control rate and complication rate in the treatment of grade I intracranial meningiomas. Methods A retrospective study was performed of patients with grade I meningioma who received radiosurgery with a dedicated linear accelerator from January 2002 to August 2012 with a minimum follow-up of 2 years. We performed descriptive statistics, logistic regression, and progression-free survival analysis through a Kaplan-Meier curve. Results Seventy-five patients with 78 grade I meningiomas received radiosurgery, 39 underwent surgery plus adjuvant radiosurgery, and 36 only radiosurgery. The follow-up median time was 68 months (range, 35–120 months). The tumor control rate was 93%, the 5-year progression-free survival was 92% (95% confidence interval, 77%–98%). Acute toxicity was 2.6%, and grade 1–2 late toxicity was 26.6%. Postradiosurgery edema was the main late morbidity. Age >55 years was the only significant factor for attaining a response >75%. The background of surgery before radiosurgery was the only significant prognostic factor for showing edema (odds ratio 5.78 [95% confidence interval, 2.14–15.64]). Conclusions The local control rate attained in our series is similar to that reported in other series worldwide; the acute toxicity rate was low and late toxicity was moderate.
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Fatima N, Meola A, Pollom EL, Soltys SG, Chang SD. Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis. Neurosurg Focus 2019; 46:E2. [DOI: 10.3171/2019.3.focus1970] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/20/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEStereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) have been used as a primary treatment or adjuvant to resection in the management of intracranial meningiomas (ICMs). The aim of this analysis is to compare the safety and long-term efficacy of SRS and SRT in patients with primary or recurrent ICMs.METHODSA systematic review of the literature comparing SRT and SRS in the same study was conducted using PubMed, the Cochrane Library, Google Scholar, and EMBASE from January 1980 to December 2018. Randomized controlled trials, case-control studies, and cohort studies (prospective and retrospective) analyzing SRS versus SRT for the treatment of ICMs in adult patients (age > 16 years) were included. Pooled and subgroup analyses were based on the fixed-effect model.RESULTSA total of 1736 patients from 12 retrospective studies were included. The treatment modality used was: 1) SRS (n = 306), including Gamma Knife surgery (n = 36), linear accelerator (n = 261), and CyberKnife (n = 9); or 2) SRT (n = 1430), including hypofractionated SRT (hFSRT, n = 268) and full-fractionated SRT (FSRT, n = 1162). The median age of patients at the time of treatment was 59 years. The median follow-up duration after treatment was 35.5 months. The median tumor volumes at the time of treatment with SRS, hFSRT, and FSRT were 2.84 cm3, 5.45 cm3, and 12.75 cm3, respectively. The radiographic tumor control at last follow-up was significantly worse in patients who underwent SRS than SRT (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.27–0.82, p = 0.007) with 7% less volume of tumor shrinkage (OR 0.93, 95% CI 0.61–1.40, p = 0.72). Compared to SRS, the radiographic tumor control was better achieved by FSRT (OR 0.46, 95% CI 0.26–0.80, p = 0.006) than by hFSRT (OR 0.81, 95% CI 0.21–3.17, p = 0.76). Moreover, SRS leads to a significantly higher risk of clinical neurological worsening during follow-up (OR 2.07, 95% CI 1.06–4.06, p = 0.03) and of immediate symptomatic edema (OR 4.58, 95% CI 1.67–12.56, p = 0.003) with respect to SRT. SRT could produce a better progression-free survival at 4–10 years compared to SRS, but this was not statistically significant (p = 0.29).CONCLUSIONSSRS and SRT are both safe options in the management of ICMs. However, SRT carries a better radiographic tumor control rate and a lower incidence of posttreatment symptomatic worsening and symptomatic edema, with respect to SRS. However, further prospective studies are still needed to validate these results.
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Affiliation(s)
- Nida Fatima
- 1Department of Neurosurgery, Stanford University School of Medicine, Palo Alto; and
| | - Antonio Meola
- 1Department of Neurosurgery, Stanford University School of Medicine, Palo Alto; and
| | - Erqi L. Pollom
- 2Department of Radiation Oncology, Stanford University, Stanford, California
| | - Scott G. Soltys
- 2Department of Radiation Oncology, Stanford University, Stanford, California
| | - Steven D. Chang
- 1Department of Neurosurgery, Stanford University School of Medicine, Palo Alto; and
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Risk group-adapted adjuvant radiotherapy for WHO grade I and II skull base meningioma. J Cancer Res Clin Oncol 2019; 145:1351-1360. [PMID: 30953136 DOI: 10.1007/s00432-019-02891-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/12/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Salvage treatment including surgery and radiotherapy (RT) for recurrent or progressive meningioma is not an easy task, especially for the skull base location. And yet, criteria for adjuvant radiotherapy after initial surgery are not clearly defined for WHO grade I/II meningioma. We determined prognostic factors for recurrence and evaluated the benefit of risk group-adapted adjuvant RT for WHO grade I/II meningioma in the skull base. METHODS We reviewed 272 patients who underwent surgery and were pathologically confirmed with WHO grade I or II skull base meningioma between January 2000 and July 2017. Subgroup analyses were performed for WHO grade I (259 patients) and WHO grade II (13 patients) meningiomas to evaluate the benefit of RT in each subgroup. RESULTS Patients with WHO grade II meningiomas tended to present more neurologic symptoms and to receive RT more frequently. In prognostic factor analysis, tumor size (p = 0.039), surgical extent (p < 0.001), and RT (p = 0.005) were associated with recurrence-free survival (RFS). In subgroup analysis of WHO grade I, RFS was significantly better in RT group after matching other variables. The risk stratification was performed using three risk factors (petroclival location, tumor size, Simpson grade) in WHO grade I patients, and significantly different RFS was observed according to the risk group in non-RT patients. CONCLUSIONS Tumor size, Simpson grade, and adjuvant RT were prognostic factors. The risk group-adapted approach can facilitate the selection of patients who may benefit from adjuvant RT for WHO grade I/II skull base meningiomas.
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Sadik ZHA, Lie ST, Leenstra S, Hanssens PEJ. Volumetric changes and clinical outcome for petroclival meningiomas after primary treatment with Gamma Knife radiosurgery. J Neurosurg 2018; 129:1623-1629. [DOI: 10.3171/2017.7.jns17380] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 07/24/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPetroclival meningiomas (PCMs) can cause devastating clinical symptoms due to mass effect on cranial nerves (CNs); thus, patients harboring these tumors need treatment. Many neurosurgeons advocate for microsurgery because removal of the tumor can provide relief or result in symptom disappearance. Gamma Knife radiosurgery (GKRS) is often an alternative for surgery because it can cause tumor shrinkage with improvement of symptoms. This study evaluates qualitative volumetric changes of PCM after primary GKRS and its impact on clinical symptoms.METHODSThe authors performed a retrospective study of patients with PCM who underwent primary GKRS between 2003 and 2015 at the Gamma Knife Center of the Elisabeth-Tweesteden Hospital in Tilburg, the Netherlands. This study yields 53 patients. In this study the authors concentrate on qualitative volumetric tumor changes, local tumor control rate, and the effect of the treatment on trigeminal neuralgia (TN).RESULTSLocal tumor control was 98% at 5 years and 93% at 7 years (Kaplan-Meier estimates). More than 90% of the tumors showed regression in volume during the first 5 years. The mean volumetric tumor decrease was 21.2%, 27.1%, and 31% at 1, 3, and 6 years of follow-up, respectively. Improvement in TN was achieved in 61%, 67%, and 70% of the cases at 1, 2, and 3 years of follow-up, respectively. This was associated with a mean volumetric tumor decrease of 25% at the 1-year follow-up to 32% at the 3-year follow-up.CONCLUSIONSGKRS for PCMs yields a high tumor control rate with a low incidence of neurological deficits. Many patients with TN due to PCM experienced improvement in TN after radiosurgery. GKRS achieves significant volumetric tumor decrease in the first years of follow-up and thereafter.
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Affiliation(s)
- Zjiwar H. A. Sadik
- 1Gamma Knife Center and
- 2Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg; and
- 3Department of Neurosurgery, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Suan Te Lie
- 1Gamma Knife Center and
- 2Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg; and
| | - Sieger Leenstra
- 1Gamma Knife Center and
- 2Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg; and
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Matias JG, Jusue-Torres I, Martin B, Bajaj A, Borys E, Melian E, Barton K, Anderson DE, Prabhu VC. Value of K i -67 Labeling Index in Predicting Recurrence of WHO Grade I Cranial Base Meningiomas. J Neurol Surg B Skull Base 2018; 80:287-294. [PMID: 31143573 DOI: 10.1055/s-0038-1669387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022] Open
Abstract
Objectives Assess impact of K i -67 labeling index (LI; K i -67 LI) on risk of recurrence or progression of WHO grade I meningiomas. Study Design Retrospective study of adult patients who underwent resection of cranial base meningioma between 2004 and 2016. Results 272 patients fulfilled criteria for inclusion in the study. Average age was 61.8 years; 196 (72%) were females. Simpson's grade 1 resection was noted in 77 patients (32%), grade 2 in 39 (16%), grade 3 in 36 (15%), and grade 4 in 88 (37%). The K i -67 LI was low (1-4%) in 214 (78.7%), intermediate (5-9%) in 44 (16.2%), and high (>10%) in 14 (5.2%). Median follow-up was 39 months (IQR: 16-71 months); 221 (87.1%) tumors remained stable or did not recur, 19 (7.4%) recurred, and 14 (5.5%) progressed. Compared with tumors with low K i -67 LI, those with intermediate K i -67 LI had 2.47 times (2.47 [1.09-5.59], p = 0.03), and those with high K i -67 LI had 3.38 times (3.38 [1.16-9.89], p = 0.03) higher risk of recurrence or progression. Tumors with K i -67 LI > 4% had a shorter time to recurrence or progression ( p = 0.01). Recurrence or progression-free survival rates at 3, 5, and 10 years for tumors with low K i -67 LI were 95%, 89%, and 75%, respectively; tumors with intermediate K i -67 LI, 87%, 69%, and 52%, respectively; tumors with high K i -67 LI, 78%, 49%, and 49%, respectively. Conclusions Following surgical resection of a WHO grade I cranial base meningioma, K i -67 LI > 4% may predict an increased risk of recurrence or progression of residual tumor.
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Affiliation(s)
| | - Ignacio Jusue-Torres
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States
| | - Brendan Martin
- Clinical Research Office, Loyola University Chicago, Maywood, Illinois, United States
| | - Ankush Bajaj
- Undergraduate Studies Department, Brown University, Providence, Rhode Island, United States
| | - Ewa Borys
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Edward Melian
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Kevin Barton
- Department of Internal Medicine (Oncology), Loyola University Medical Center, Maywood, Illinois, United States
| | - Douglas E Anderson
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States
| | - Vikram C Prabhu
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States
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McClelland S, Ciporen JN, Mitin T, Jaboin JJ. Long-term stroke risk of single-fraction photon-based stereotactic radiosurgery for meningioma. Clin Neurol Neurosurg 2018; 173:169-172. [PMID: 30145526 DOI: 10.1016/j.clineuro.2018.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/02/2018] [Accepted: 07/13/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES A recent randomized study of fractionated radiation therapy (RT) examining 44 subtotally resected/recurrent benign meningioma patients revealed that at median follow-up of 17.1 years, the risk of stroke following proton-photon RT was 20.5%; the average stroke developed 5.6 years following RT completion (Sanford et al., 2017). This stroke risk is up to 10 times higher than the 2-6% rate expected for the general population of ages 40-79 (Mozaffarian et al., 2015). The stroke rate following single-fraction stereotactic radiosurgery (SRS) has not been previously studied in meningioma patients. PATIENTS AND METHODS A PubMed database search for relevant articles examining SRS for meningioma with minimum mean/median follow-up of six years was undertaken. Stroke rate was assessed either from direct description in manuscripts, or from extrapolating post-SRS complications from reported clinical examinations (i.e. hemiparesis/weakness, pituitary dysfunction following treatment of cavernous sinus lesions). Results were then culled to determine an overall stroke rate. RESULTS Fourteen studies met inclusion criteria; 1431 patients received photon-based SRS for meningioma with a sufficient long-term follow-up. Median/mean follow-up ranged from 75 to 144 months. Operative resection prior to SRS occurred in 769/1377 patients (55.8%) for whom surgical history was reported. Twenty-four patients suffered a stroke following SRS, yielding a rate of 1.7%. CONCLUSIONS The long-term stroke rate following single-fraction photon-based SRS for benign meningioma was 1.7%, more than twelve times lower than for fractionated proton-photon RT and comparable to that expected for the general population. The majority of patients underwent resection prior to SRS. These findings indicate that for patients with benign meningioma desiring to avoid the high stroke risk of fractionated proton-photon RT, SRS has a comparable stroke risk profile to observation. Such findings are pertinent for radiation oncology, neuro-oncology, and neurosurgery management of these patients.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, United States.
| | - Jeremy N Ciporen
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR, United States
| | - Timur Mitin
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, United States
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Park HR, Lee JM, Park KW, Kim JH, Jeong SS, Kim JW, Chung HT, Kim DG, Paek SH. Fractionated Gamma Knife Radiosurgery as Initial Treatment for Large Skull Base Meningioma. Exp Neurobiol 2018; 27:245-255. [PMID: 30022876 PMCID: PMC6050410 DOI: 10.5607/en.2018.27.3.245] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/02/2018] [Accepted: 05/24/2018] [Indexed: 11/19/2022] Open
Abstract
We present our experience on the hypofractionated Gamma Knife radiosurgery (FGKS) for large skull base meningioma as an initial treatment. We retrospectively reviewed 23 patients with large skull base meningioma ≥10 cm3 who underwent FGKS as the initial treatment option. The mean volume of tumors prior to radiosurgery was 21.2±15.63 cm3 (range, 10.09~71.42). The median total margin dose and marginal dose per fraction were 18 Gy (range, 15~20) and 6 Gy (range, 5~6), respectively. Patients underwent three or four fractionations in consecutive days with the same Leksell® frame. The mean follow-up duration was 38 months (range, 17~78). There was no mortality. At the last follow-up, the tumor volume was stationary in 15 patients (65.2%) and had decreased in 8 patients (34.8%). Six patients who had cranial neuropathy at the time of FGKS showed improvement at the last clinical follow-up. Following FGKS, 4 patients (17%) had new cranial neuropathy. The trigeminal neuropathy was the most common and all were transient. The mean Karnofsky Performance Status score at pre-FGKS and the last clinical follow-up was 97.0±10.4 points (median, 100) and 98.6±6.9 (median, 100) points, respectively. FGKS has showed satisfactory tumor control with functional preservation for large skull base meningiomas. Further prospective studies of large cohorts with long term follow-up are required to clarify the efficacy in the tumor control and functional outcome as well as radiation toxicity.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Jae Meen Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan 49241, Korea
| | - Kwang-Woo Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung Hoon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Sang Soon Jeong
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyun-Tai Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea.,Cancer Research Institute, Seoul National University, Seoul 03080, Korea.,Ischemia Hypoxia Disease Institute, Seoul National University, Seoul 03080, Korea
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Galhom AE, Madawi AA, Ellabban MM. Surgical outcomes and predictors of complication in elderly patients with meningiomas. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:3. [PMID: 29780223 PMCID: PMC5954707 DOI: 10.1186/s41983-018-0005-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Surgical management of symptomatic meningioma in elderly is still a high-risk surgery due to increased incidence of complication rate. Many scoring systems have been proposed to expect the surgical risk and the outcome.The study tries to assess cranial meningioma surgery in elderly using the Ibañez grade for complication rate and the Geriatric Scoring System (GSS) for the surgical outcome (GSS). Methods A clinical and radiological data were studied retrospectively in 42 patients with a primary intracranial meningioma at or above the age of 65. Complication rate, surgical risk, and outcome were statistically analyzed. Results The mean Geriatric Scoring System (GSS) score on admission was 15.4 ± 2.6. Ibañez grade of severe complication or death (grades III-IV) were experienced in 26.2% of patients. It was more common in male and in emergency cases, but it was significant in relation to the comorbidities (P < 0.004). Most patients had World Health Organization (WHO) grades I lesions, accounted for 85.7% of patients. MRI evidence of post-surgical residual was 14.4%, and 83.3% of patients had recurrence-free survival (RFS). The GSS score >16 were more frequent in the patient with RFS than those of < 16, and it was statistically significant (P < 0.06). Patient with Karnofsky performance status (KPS) < 70, the mean GSS was 14.5 and KPS > 70, the mean GSS was 18.9, and it was statistically significant (P < 0.002). Conclusion The surgical technique for resection of elderly meningioma still had numbered cases of morbidity and mortality. The complication rate is related to preoperative co-morbidity and frequently associated with male and urgent surgery. Karnofsky score > 70, and RFS are favorable prognosis and related to GSS > 16 scores. The recurrence rate is usually attributed to high tumor grade and skull base tumor. Such scoring systems are valuable for elderly meningioma.
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Affiliation(s)
- Ayman E Galhom
- 1Department of Neurosurgery, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - A A Madawi
- 2Department of Neurosurgery, Faculty of Medicine, Suez Canal University Hospital, Ismailia, Egypt
| | - M M Ellabban
- 3Department of Pathology, Faculty of Medicine, Port Said University, Port Said, Egypt
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Abstract
Meningiomas are the most common adult primary intracranial tumor. Despite their higher incidence, there have not—until recently—been as many advances in understanding and managing meningiomas. Thus far, two broad classes of meningiomas have emerged on the basis of their mutational profile: those driven by neurofibromatosis 2 (NF2) inactivation and those with non-NF2 driver gene alterations, such as mammalian target of rapamycin and Hedgehog, Wingless/b-catenin, Notch, transforming growth factor-b receptor, mitogen-activated protein kinase, and phospholipase C pathway alterations. In addition to improvements in molecular diagnostics, advances in imaging are being studied to better predict tumor behavior, stratify risk, and potentially monitor for disease response. Management consists primarily of surgery and radiation therapy and there has been limited success from medical therapies, although novel targeted agents are now in clinical trials. Advances in imaging and understanding of the genetic makeup of meningiomas demonstrate the huge potential in revolutionizing the classification, diagnosis, management, and prognosis of meningiomas..
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Affiliation(s)
- Nawal Shaikh
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Karan Dixit
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Jeffrey Raizer
- Northwestern University Feinberg School of Medicine, Chicago, USA
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Ganau M, Foroni RI, Gerosa M, Zivelonghi E, Longhi M, Nicolato A. Radiosurgical Options in Neuro-oncology: A Review on Current Tenets and Future Opportunities. Part I: Therapeutic Strategies. TUMORI JOURNAL 2018. [DOI: 10.1177/1636.17912] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mario Ganau
- Department of Neurosciences, University Hospital, Azienda Ospedaliera Universitaria Integrata, Verona
- Department of Biomedical Engineering, University of Cagliari, Cagliari
| | - Roberto Israel Foroni
- Department of Pathology and Diagnosis, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Massimo Gerosa
- Department of Neurosciences, University Hospital, Azienda Ospedaliera Universitaria Integrata, Verona
| | - Emanuele Zivelonghi
- Department of Pathology and Diagnosis, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Michele Longhi
- Department of Neurosciences, University Hospital, Azienda Ospedaliera Universitaria Integrata, Verona
| | - Antonio Nicolato
- Department of Neurosciences, University Hospital, Azienda Ospedaliera Universitaria Integrata, Verona
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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. Stereotactic Radiosurgery for Benign (World Health Organization Grade I) Cavernous Sinus Meningiomas—International Stereotactic Radiosurgery Society (ISRS) Practice Guideline: A Systematic Review. Neurosurgery 2018; 83:1128-1142. [DOI: 10.1093/neuros/nyy009] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/05/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Antonio DeSalles
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California
| | - Laura Fariselli
- Radiotherapy unit, Radiosurgery dep Istituto neurologico Carlo Besta Foundation, Milan, Italy
| | - Motohiro Hayashi
- Department of Neurosurgery, Tokyo Women's Medical University, Toyko, Japan
| | - Marc Levivier
- Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lijun Ma
- Division Physics, Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Roberto Martínez Álvarez
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - Ian Paddick
- Division Physics, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jean Regis
- Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University, Stony Brook, New York
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
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Seo Y, Kim DG, Kim JW, Han JH, Chung HT, Paek SH. Long-Term Outcomes After Gamma Knife Radiosurgery for Benign Meningioma: A Single Institution's Experience With 424 Patients. Neurosurgery 2018. [DOI: 10.1093/neuros/nyx585] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Gamma knife radiosurgery (GKRS) is recognized as an important treatment modality for meningioma.
OBJECTIVE
To analyze the long-term outcomes in meningioma patients treated with GKRS to determine the risk factors related to treatment failure and peritumoral edema (PTE) development.
METHODS
Between 1998 and 2010, 770 consecutive patients were treated with GKRS for intracranial meningioma. After the exclusion of patients with follow-up periods of less than 5 yr and those with neurofibromatosis, multiple meningiomas, nonbenign meningioma, or radiotherapy, a total of 424 patients were enrolled in this study. The median follow-up duration was 92 mo. The median tumor volume was 4.35 cm3, and the median marginal dose was 14 Gy.
RESULTS
The overall local tumor control rate was 84%. The actuarial tumor control rates were 91.7% and 78.9% at 5 and 10 yr, respectively. The tumor control rate of a radiologically diagnosed tumor was higher than that of a grade I tumor (82% vs 70.1% at 10 yr, P = .001). In multivariate analysis, factors associated with tumor progression were female sex (hazard ratio: 0.5, P = .025) and a previous history of craniotomy (hazard ratio: 1.9, P = .009). Symptomatic PTE was identified in 36 (8.5%) patients, and the factor associated with poor PTE was the presence of PTE before GKRS (odds ratio: 4.6, P < .001). Permanent complication rate was 4%.
CONCLUSION
GKRS appears to be an effective treatment modality for meningioma with long-term follow-up. However, the identification of delayed tumor progression in our study suggests that extended follow-up data should be collected after GKRS.
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Affiliation(s)
- Youngbeom Seo
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun-Tai Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sun-Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Ko CC, Lim SW, Chen TY, Chen JH, Li CF, Shiue YL. Prediction of progression in skull base meningiomas: additional benefits of apparent diffusion coefficient value. J Neurooncol 2018; 138:63-71. [PMID: 29353434 DOI: 10.1007/s11060-018-2769-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/18/2018] [Indexed: 11/28/2022]
Abstract
A subset of benign (WHO grade I) skull base meningiomas show early progression/recurrence (P/R) in the first years after surgical resection. Besides, complete surgical resection may be difficult to achieve safely in skull base meningiomas due to complex neurovascular structures. The one main challenge in the treatment of skull base meningiomas is to determine factors that correlate with P/R. We retrospectively investigated the preoperative CT and MR imaging features for the prediction of P/R in skull base meningiomas, with emphasis on quantitative ADC values. Only patients had postoperative MRI follow-ups for more than 1 year (at least every 6 months) were included. From October 2006 to December 2015, total 73 patients diagnosed with benign (WHO grade I) skull base meningiomas were included (median follow-up time 41 months), and 17 (23.3%) patients had P/R (median time to P/R 28 months). Skull base meningiomas with spheno-orbital location, adjacent bone invasion, high DWI, and lower ADC value/ratio were significantly associated with P/R (P < 0.05). The cut-off points of ADC value and ADC ratio for prediction of P/R are 0.83 × 10- 3 mm2/s and 1.09 respectively, with excellent area under curve (AUC) values (0.86 and 0.91) (P < 0.05). In multivariate logistic regression, low ADC values (< 0.83 × 10- 3 mm2/s) and adjacent bone invasion are high-risk factors of P/R (P < 0.05), with odds ratios of 31.53 and 17.59 respectively. The preoperative CT and MRI features for prediction of P/R offered clinically vital information for the planning of treatment in skull base meningiomas.
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Affiliation(s)
- Ching-Chung Ko
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.,Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan
| | - Sher-Wei Lim
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan.,Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Tai-Yuan Chen
- Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Jeon-Hor Chen
- Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan.,Center for Functional Onco-Imaging of Radiological Sciences, School of Medicine, University of California, Irvine, CA, USA
| | - Chien-Feng Li
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.
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Isolan GR, Wayhs SY, Lepski GA, Dini LI, Lavinsky J. Petroclival Meningiomas: Factors Determining the Choice of Approach. J Neurol Surg B Skull Base 2017; 79:367-378. [PMID: 30009118 DOI: 10.1055/s-0037-1608654] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022] Open
Abstract
Objectives To review a surgical series of petroclival meningiomas and the factors considered in the choice of approach. Design Retrospective review. Setting The study was conducted in a university hospital in southern Brazil. Participants Twenty-two patients with petroclival meningioma originating from the upper two-thirds of the clivus medial to the fifth cranial nerve. Main Outcome Measures Gross-total resection, mortality, major morbidity, new cranial nerve deficits and tumor progression or recurrence. Results Retrosigmoid approach was used in tumors <3 cm and in those at or below the internal auditory meatus. Posterior petrosectomy was performed for tumors extending into the middle fossa. Gross-total resection was performed in 11 patients (50%). The mean follow-up time was 32 months (6-75 months). There were four cases of tumor progression or recurrence, which were treated with radiosurgery. Conclusions Resection of petroclival meningiomas remains challenging. In most cases, the retrosigmoid approach was sufficient, without affecting the degree of tumor resection. Petrosal approaches were reserved for patients with tumor extension into the middle fossa.
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Affiliation(s)
- Gustavo Rassier Isolan
- Graduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS); Neurotology and Acoustic Neuroma Center (CNNA); Clínica Lavinsky; Hospital Moinhos de Vento - Porto Alegre, Rio Grande do Sul, Brazil.,The Advanced Neurology and Neurosurgery Research Center (CEANNE), Porto Alegre, Rio Grande do Sul, Brazil
| | - Sâmia Yasin Wayhs
- Graduate Program in Medicine: Surgical Sciences, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Guilherme Alves Lepski
- Department of Neurology, Division of Neurosurgery, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil.,Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
| | - Leandro Infantini Dini
- The Advanced Neurology and Neurosurgery Research Center (CEANNE), Porto Alegre, Rio Grande do Sul, Brazil
| | - Joel Lavinsky
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,CNNA; Clínica Lavinsky, Porto Alegre, Rio Grande do Sul, Brazil
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Di Franco R, Borzillo V, Ravo V, Falivene S, Romano FJ, Muto M, Cammarota F, Totaro G, Ametrano G, Rossetti S, Cavaliere C, D' Aniello C, Iovane G, Porricelli MA, Berretta M, Botti G, Starace L, Salvia EL, Facchini G, Muto P. Radiosurgery and stereotactic radiotherapy with cyberknife system for meningioma treatment. Neuroradiol J 2017; 31:18-26. [PMID: 29206077 DOI: 10.1177/1971400917744885] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The aim of this work was to evaluate the impact of stereotactic radiosurgery/fractionated stereotactic radiotherapy with the Cyberknife system on local disease control, clinical outcome and toxicity in patients with meningioma, according to the site and histological grade of lesion. From January 2013 to April 2017, 52 patients with intracranial meningiomas were treated with the Cyberknife system. Twenty-four patients had undergone previous surgery: 38% gross total resection, 10% subtotal resection; 27 patients underwent no surgery; 22 patients had a recurrence of meningioma. Methods Radiosurgery was used for lesions smaller than 2 cm, stereotactic radiotherapy for lesions larger than 2 cm, or smaller but close to a critical site such as the optical chiasm, optic pathway or brainstem. Results Local control and clinical outcomes were analysed. Median follow-up was 20 months: six patients died, one after re-surgery died from post-surgical sepsis, three from heart disease. Progression-free survival had a mean value of 38.3 months and overall survival of 41.6 months. We evaluated at 12 months 28 patients (100% local control); at 24 months 19 patients (89% local control); at 36 months nine patients (89% local control). At baseline, 44/52 patients (85%) were symptomatic: 19 visual disorders, 17 motor disorders, six hearing disorders, 10 headache and six epilepsy. Visual symptoms remained unchanged in 52%, improved in 32%, resolved in 16%. Headache was improved in 40%, resolved in 10%, unchanged in 50%. Epilepsy was resolved in 17%, unchanged in 33%, worsened in 33%. Conclusions Stereotactic radiosurgery/fractionated stereotactic radiotherapy with Cyberknife provides a good local disease control, improving visual, hearing and motor symptoms.
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Affiliation(s)
- Rossella Di Franco
- 1 UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy.,2 Progetto ONCONET2.0, Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo, Italy
| | - Valentina Borzillo
- 1 UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy
| | - Vincenzo Ravo
- 1 UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy
| | - Sara Falivene
- 1 UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy
| | - Francesco Jacopo Romano
- 2 Progetto ONCONET2.0, Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo, Italy
| | - Matteo Muto
- 3 Department of Clinical Medicine and Surgery, Federico II University Medical School of Naples, Italy
| | - Fabrizio Cammarota
- 1 UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy
| | - Giuseppe Totaro
- 1 UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy
| | - Gianluca Ametrano
- 1 UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy.,2 Progetto ONCONET2.0, Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo, Italy
| | - Sabrina Rossetti
- 2 Progetto ONCONET2.0, Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo, Italy.,4 Division of Medical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy
| | - Carla Cavaliere
- 5 UOC of Medical Oncology, Ospedali Riuniti Area Nolana, Italy
| | - Carmine D' Aniello
- 6 Division of Medical Oncology, A.O.R.N. dei COLLI "Ospedali Monaldi-Cotugno-CTO", Italy
| | - Gelsomina Iovane
- 4 Division of Medical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy
| | - Maria Assunta Porricelli
- 4 Division of Medical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy
| | | | - Gerardo Botti
- 8 Pathology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy
| | - Luigi Starace
- 1 UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy
| | - Enrico La Salvia
- 1 UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy
| | - Gaetano Facchini
- 2 Progetto ONCONET2.0, Linea progettuale 14 per l'implementazione della prevenzione e diagnosi precoce del tumore alla prostata e testicolo, Italy.,4 Division of Medical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy
| | - Paolo Muto
- 1 UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Italy
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Patibandla MR, Lee CC, Sheehan J. Stereotactic Radiosurgery of Central Skull Base Meningiomas—Volumetric Evaluation and Long-Term Outcomes. World Neurosurg 2017; 108:176-184. [DOI: 10.1016/j.wneu.2017.08.166] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/25/2017] [Accepted: 08/26/2017] [Indexed: 10/18/2022]
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Abstract
BACKGROUND Gamma knife stereotactic radiosurgery (SRS) has become an important management strategy for patients with meningiomas. Although prior reports have studied early tumor control, neurological response, and associated morbidity, our purpose was to use clinical and imaging studies to determine whether long-term outcomes remain stable over time. MATERIALS AND METHODS We studied 290 consecutive patients (92 men and 198 women) who underwent gamma knife SRS for a meningioma between 1987 and 1997. The median tumor margin dose was 15 Gy and the median tumor volume was 5.5 mL. Target definition was performed using contrast enhanced computed tomography in 72 patients and magnetic resonance imaging in 218 patients. The median patient age at radiosurgery was 61 years. Twenty patients had a history of fractionated radiation therapy, 136 patients had undergone a subtotal resection, and 22 patients had recurrences after initial gross total resection. RESULTS The overall tumor control rate was 91%. Twenty-six patients (9%) had evidence of delayed local tumor growth and 44 (15%) had regional tumor progression, which occurred at a median of 38 months. The 10- and 20-year actuarial rates of freedom from tumor progression of the targeted tumor were 87.7%±2.5% and 87.2%±4.2%. Of 234 patients who had symptoms before SRS (n=62, 26%) improved, 126 (54%) had no change in symptoms and 46 (20%) gradually worsened. Thirty-two of 34 (94%) asymptomatic patients remained asymptomatic. We found no difference in long-term tumor control rates between patients who had undergone craniotomy before radiosurgery (89%) and patients who underwent primary radiosurgery (93.1%). Adverse radiation effects were detected in 3.1% of patients. Factors associated with worse progression-free survival included prior radiation therapy (P<0.0001) and higher grade meningioma (P<0.0001). At a median of 8.7 years after SRS, 137 patients were dead at a median age of 77 years. CONCLUSIONS We found that gamma knife SRS provided durable tumor control with low morbidity in meningioma patients.
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Pinzi V, Biagioli E, Roberto A, Galli F, Rizzi M, Chiappa F, Brenna G, Fariselli L, Floriani I. Radiosurgery for intracranial meningiomas: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2017; 113:122-134. [DOI: 10.1016/j.critrevonc.2017.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 01/30/2017] [Accepted: 03/08/2017] [Indexed: 10/20/2022] Open
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