Gamma Knife Radiosurgery for Cerebellopontine Angle Meningiomas: A Multicenter Study.
Ding, Dale MD *; Starke, Robert M. MD, MSc *; Kano, Hideyuki MD, PhD ++; Nakaji, Peter MD [S]; Barnett, Gene H. MD, MBA [P]; Mathieu, David MD ||; Chiang, Veronica MD #; Omay, Sacit B. MD #; Hess, Judith BA #; McBride, Heyoung L. MD [S]; Honea, Norissa PhD [S]; Lee, John Y.K. MD **; Rahmathulla, Gazanfar MD [P]; Evanoff, Wendi A. BA [P]; Alonso-Basanta, Michelle MD, PhD **; Lunsford, L. Dade MD ++; Sheehan, Jason P. MD, PhD *
75(4):398-408, October 2014.
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BACKGROUND: Resection of cerebellopontine angle (CPA) meningiomas may result in significant neurological morbidity. Radiosurgery offers a minimally invasive alternative to surgery.
OBJECTIVE: To evaluate, in a multicenter cohort study, the outcomes of patients harboring CPA meningiomas who underwent Gamma Knife radiosurgery (GKRS).
METHODS: From 7 institutions participating in the North American Gamma Knife Consortium, 177 patients with benign CPA meningiomas treated with GKRS and at least 6 months radiologic follow-up were included for analysis. The mean age was 59 years and 84% were female. Dizziness or imbalance (48%) and cranial nerve (CN) VIII dysfunction (45%) were the most common presenting symptoms. The median tumor volume and prescription dose were 3.6 cc and 13 Gy, respectively. The mean radiologic and clinical follow-up durations were 47 and 46 months, respectively. Multivariate regression analyses were performed to identify the predictors of tumor progression and neurological deterioration.
RESULTS: The actuarial rates of progression-free survival at 5 and 10 years were 93% and 77%, respectively. Male sex (P = .014), prior fractionated radiation therapy (P = .010), and ataxia at presentation (P = .002) were independent predictors of tumor progression. Symptomatic adverse radiation effects and permanent neurological deterioration were observed in 1.1% and 9% of patients, respectively. Facial spasms at presentation (P = .007) and lower maximal dose (P = .011) were independently associated with neurological deterioration.
CONCLUSION: GKRS is an effective therapy for CPA meningiomas. Depending on the patient and tumor characteristics, radiosurgery can be an adjuvant treatment to initial surgical resection or a standalone procedure that obviates the need for resection in most patients.
ABBREVIATIONS: ARE, adverse radiation effect
CN, cranial nerve
CPA, cerebellopontine angle
EBRT, external beam radiation therapy
GKRS, Gamma Knife radiosurgery
IAC, internal auditory canal
NAGKC, North American Gamma knife Consortium
PFS, progression-free survival
SRS, stereotactic radiosurgery
WHO, World Health Organization
Copyright (C) by the Congress of Neurological Surgeons