Stereotactic Radiosurgery for Benign Cavernous Sinus Meningiomas: A Multicentre Study and Review of the Literature

GND
1150168021
Affiliation
Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, 59073 Hamm, Germany
Santacroce, Antonio;
Affiliation
Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
Tuleasca, Constantin;
Affiliation
Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, 15000 Prague, Czech Republic
Liščák, Roman;
Affiliation
Dipartimento di Neuroscienze, Neurochirurgia, Università degli Studi di Milano, 20122 Milano, Italy; Villa Maria Cecilia Hospital, 48033 Cotignola, Italy
Motti, Enrico;
Affiliation
Gamma Knife Centre, Bupa Cromwell Hospital, London SW5 0TU, UK
Lindquist, Christer;
Affiliation
National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
Radatz, Matthias;
Affiliation
Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria
Gatterbauer, Brigitte;
ORCID
0000-0001-5804-4549
Affiliation
Interdisciplinary Centre for Radiosurgery (ICERA), Radiological Alliance, 22767 Hamburg, Germany
Lippitz, Bodo E.;
Affiliation
Department of Radiosurgery, Rúber International Hospital, 28034 Madrid, Spain
Martínez Álvarez, Roberto;
ORCID
0000-0003-2400-704X
Affiliation
Department of Radiosurgery, Rúber International Hospital, 28034 Madrid, Spain
Martínez Moreno, Nuria;
GND
133492672
ORCID
0000-0002-1252-2944
Affiliation
Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, 07747 Jena, Germany
Kamp, Marcel A.;
ORCID
0000-0001-9876-5826
Affiliation
Department of Neurosurgery, Haukeland University Hospital, 5021 Bergen, Norway
Sandvei Skeie, Bente;
Affiliation
Department of Neurosurgery, Haukeland University Hospital, 5021 Bergen, Norway
Schipmann, Stephanie;
Affiliation
Unit of Radiosurgery and Stereotactic Neurosurgery, Department of Neurosciences, Azienda Ospedaliera Universitaria, 37126 Verona, Italy
Longhi, Michele;
Affiliation
Department of Neurosurgery, Medical University Graz, 8036 Graz, Austria
Unger, Frank;
Affiliation
Gamma Knife Unit, Wellington Hospital (Platinum Medical Centre), London NW8 7JA, UK
Sabin, Ian;
ORCID
0000-0002-8229-1926
Affiliation
Gamma Knife Center Zurich, Klinik Im Park Hirslanden, 8002 Zurich, Switzerland
Mindermann, Thomas;
Affiliation
Gamma Knife Zentrum Hannover, 30167 Hannover, Germany
Bundschuh, Otto;
Affiliation
Gamma Knife Zentrum Krefeld, 47805 Krefeld, Germany
Horstmann, Gerhard A.;
Affiliation
Gamma Knife Zentrum Krefeld, 47805 Krefeld, Germany
van Eck, A.T.C. J.;
Affiliation
Institute of Medical Biometry, Epidemiology and Informatics, University Medical Center of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
Walier, Maja;
Affiliation
Institute of Medical Biometry, Epidemiology and Informatics, University Medical Center of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
Berres, Manfred;
Affiliation
Department of Medicine, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
Nakamura, Makoto;
ORCID
0000-0002-8249-2998
Affiliation
Department of Neurosurgery, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
Steiger, Hans Jakob;
Affiliation
Department of Neurosurgery, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
Hänggi, Daniel;
Affiliation
Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, 59073 Hamm, Germany
Fortmann, Thomas;
ORCID
0000-0002-9592-3881
Affiliation
Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, 59073 Hamm, Germany
Alsofy, Samer Zawy;
ORCID
0000-0002-4842-3753
Affiliation
Service de Neurochirurgie Fonctionnelle et Stereotaxique, Hôpital D’adulte de la Timone, 13354 Marseille, France
Régis, Jean;
GND
131867881
Affiliation
Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, 59073 Hamm, Germany
Ewelt, Christian

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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