Parasellar and sellar meningiomas are challenging tumors owing in part to their proximity to important neurovascular and endocrine structures. Complete resection can be associated with significant morbidity, and incomplete resections are common. In this study, the authors evaluated the outcomes of parasellar and sellar meningiomas managed with Gamma Knife radiosurgery (GKRS) both as an adjunct to microsurgical removal or conventional radiation therapy and as a primary treatment modality.
开云体育世界杯赔率
A multicenter study of patients with benign sellar and parasellar meningiomas was conducted through the North American Gamma Knife Consortium. For the period spanning 1988 to 2011 at 10 centers, the authors identified all patients with sellar and/or parasellar meningiomas treated with GKRS. Patients were also required to have a minimum of 6 months of imaging and clinical follow-up after GKRS. Factors predictive of new neurological deficits following GKRS were assessed via univariate and multivariate analyses. Kaplan-Meier analysis and Cox multivariate regression analysis were used to assess factors predictive of tumor progression.
Results
作者发现763 sellar患者d/or parasellar meningiomas treated with GKRS. Patients were assessed clinically and with neuroimaging at routine intervals following GKRS. There were 567 females (74.3%) and 196 males (25.7%) with a median age of 56 years (range 8–90 years). Three hundred fifty-five patients (50.7%) had undergone at least one resection before GKRS, and 3.8% had undergone prior radiation therapy. The median follow-up after GKRS was 66.7 months (range 6–216 months). At the last follow-up, tumor volumes remained stable or decreased in 90.2% of patients. Actuarial progression-free survival rates at 3, 5, 8, and 10 years were 98%, 95%, 88%, and 82%, respectively. More than one prior surgery, prior radiation therapy, or a tumor margin dose < 13 Gy significantly increased the likelihood of tumor progression after GKRS.
At the last clinical follow-up, 86.2% of patients demonstrated no change or improvement in their neurological condition, whereas 13.8% of patients experienced symptom progression. New or worsening cranial nerve deficits were seen in 9.6% of patients, with cranial nerve (CN) V being the most adversely affected nerve. Functional improvements in CNs, especially in CNs V and VI, were observed in 34% of patients with preexisting deficits. New or worsened endocrinopathies were demonstrated in 1.6% of patients; hypothyroidism was the most frequent deficiency. Unfavorable outcome with tumor growth and accompanying neurological decline was statistically more likely in patients with larger tumor volumes (p = 0.022) and more than 1 prior surgery (p = 0.021).
Conclusions
伽玛刀放射治疗提供了一个高速率的tumor control for patients with parasellar or sellar meningiomas, and tumor control is accompanied by neurological preservation or improvement in most patients.
Address correspondence to: Jason P. Sheehan, M.D., Ph.D., Department of Neurological Surgery, University of Virginia, Box 800212, Charlottesville, VA 22908. email:jsheehan@virginia.edu.
Please include this information when citing this paper: published online March 28, 2014; DOI: 10.3171/2014.2.JNS13139.
BassiouniH,,AsgariS,&StolkeD:Tuberculum sellae meningiomas: functional outcome in a consecutive series treated microsurgically.Surg Neurol66:37–45,2006
Bindal
R
,
Goodman
JM
,
Kawasaki
A
,
Purvin
V
,
Kuzma
B
:
The natural history of untreated skull base meningiomas
.Surg Neurol
59
:
87
–
92
,
2003
10.1016/S0090-3019(02)00995-3)| false
BradaM,,BurchellL,,AshleyS,&TraishD:The incidence of cerebrovascular accidents in patients with pituitary adenoma.Int J Radiat Oncol Biol Phys45:693–698,1999
Brada
M
,
Burchell
L
,
Ashley
S
,
Traish
D
:
The incidence of cerebrovascular accidents in patients with pituitary adenoma
.Int J Radiat Oncol Biol Phys
45
:
693
–
698
,
1999
10.1016/S0360-3016(99)00159-5)| false
CavalloLM,,CappabiancaP,,GalzioR,,IaconettaG,,de DivitiisE,&TschabitscherM:Endoscopic transnasal approach to the cavernous sinus versus transcranial route: anatomic study.开云体育app官方网站下载入口56:2 Suppl379–389,2005
Cavallo
LM
,
Cappabianca
P
,
Galzio
R
,
Iaconetta
G
,
de Divitiis
E
,
Tschabitscher
M
:
Endoscopic transnasal approach to the cavernous sinus versus transcranial route: anatomic study
.开云体育app官方网站下载入口
56
:
2 Suppl
379
–
389
,
2005)| false
DeMonte
F
,
Smith
HK
,
al-Mefty
O
:
Outcome of aggressive removal of cavernous sinus meningiomas
.J Neurosurg
81
:
245
–
251
,
1994
10.3171/jns.1994.81.2.0245)| false
DiBiaseSJ,,KwokY,,YovinoS,,ArenaC,,NaqviS,&TempleR,et al.:Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas.Int J Radiat Oncol Biol Phys60:1515–1519,2004
DufourH,,MuraccioleX,,MétellusP,,RégisJ,,ChinotO,&GrisoliF:Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with or without previous surgery: is there an alternative to aggressive tumor removal?.开云体育app官方网站下载入口48:285–296,2001
Dufour
H
,
Muracciole
X
,
Métellus
P
,
Régis
J
,
Chinot
O
,
Grisoli
F
:
Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with or without previous surgery: is there an alternative to aggressive tumor removal?
.开云体育app官方网站下载入口
48
:
285
–
296
,
2001)| false
EustacchioS,,TrummerM,,FuchsI,,SchröttnerO,,SutterB,&PendlG:Preservation of cranial nerve function following Gamma Knife radiosurgery for benign skull base meningiomas: experience in 121 patients with follow-up of 5 to 9.8 years.Acta Neurochir Suppl84:71–76,2002
Eustacchio
S
,
Trummer
M
,
Fuchs
I
,
Schröttner
O
,
Sutter
B
,
Pendl
G
:
Preservation of cranial nerve function following Gamma Knife radiosurgery for benign skull base meningiomas: experience in 121 patients with follow-up of 5 to 9.8 years
.Acta Neurochir Suppl
84
:
71
–
76
,
2002)| false
FeiglGC,,SamiiM,&HorstmannGA:Volumetric follow-up of meningiomas: a quantitative method to evaluate treatment outcome of gamma knife radiosurgery.开云体育app官方网站下载入口61:281–287,2007
Ganz
JC
:
Gamma knife radiosurgery and its possible relationship to malignancy: a review
.J Neurosurg
97
:
5 Suppl
644
–
652
,
2002
10.3171/jns.2002.97.supplement_5.0644)| false
Ganz
JC
,
Reda
WA
,
Abdelkarim
K
:
Gamma Knife surgery of large meningiomas: early response to treatment
.Acta Neurochir (Wien)
151
:
1
–
8
,
2009
10.1007/s00701-008-0166-4)| false
GoldsmithBJ,,WaraWM,,WilsonCB,&LarsonDA:Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990.J Neurosurg80:195–201,1994.(Erratum inJ Neurosurg80:777, 1994)
HasegawaT,,KidaY,,YoshimotoM,,KoikeJ,,IizukaH,&IshiiD:Long-term outcomes of Gamma Knife surgery for cavernous sinus meningioma.J Neurosurg107:745–751,2007
Hasegawa
T
,
Kida
Y
,
Yoshimoto
M
,
Koike
J
,
Iizuka
H
,
Ishii
D
:
Long-term outcomes of Gamma Knife surgery for cavernous sinus meningioma
.J Neurosurg
107
:
745
–
751
,
2007
10.3171/JNS-07/10/0745)| false
IchinoseT,,GotoT,,IshibashiK,,TakamiT,&OhataK:The role of radical microsurgical resection in multimodal treatment for skull base meningioma. Clinical article.J Neurosurg113:1072–1078,2010.(Erratum inJ Neurosurg113:1123, 2010)
Ichinose
T
,
Goto
T
,
Ishibashi
K
,
Takami
T
,
Ohata
K
:
The role of radical microsurgical resection in multimodal treatment for skull base meningioma. Clinical article
.J Neurosurg
113
:
1072
–
1078
,
2010
.
(Erratum in
J Neurosurg113:1123, 2010)
10.3171/2010.2.JNS091118)| false
IwaiY,,YamanakaK,&IkedaH:Gamma Knife radiosurgery for skull base meningioma: long-term results of low-dose treatment. Clinical article.J Neurosurg109:804–810,2008
JääskeläinenJ:Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis.Surg Neurol26:461–469,1986
Kollová
A
,
Liscák
R
,
Novotný
J
Jr
,
Vladyka
V
,
Simonová
G
,
Janousková
L
:
Gamma Knife surgery for benign meningioma
.J Neurosurg
107
:
325
–
336
,
2007
10.3171/JNS-07/08/0325)| false
KondziolkaD,,MathieuD,,LunsfordLD,,MartinJJ,,MadhokR,&NiranjanA,et al.:Radiosurgery as definitive management of intracranial meningiomas.开云体育app官方网站下载入口62:53–60,2008
KreilW,,LugginJ,,FuchsI,,WeiglV,,EustacchioS,&PapaefthymiouG:Long term experience of gamma knife radiosurgery for benign skull base meningiomas.J Neurol Neurosurg Psychiatry76:1425–1430,2005
Kreil
W
,
Luggin
J
,
Fuchs
I
,
Weigl
V
,
Eustacchio
S
,
Papaefthymiou
G
:
Long term experience of gamma knife radiosurgery for benign skull base meningiomas
.J Neurol Neurosurg Psychiatry
76
:
1425
–
1430
,
2005
10.1136/jnnp.2004.049213)| false
LinskeyME,,DavisSA,&RatanatharathornV:Relative roles of microsurgery and stereotactic radiosurgery for the treatment of patients with cranial meningiomas: a single-surgeon 4-year integrated experience with both modalities.J Neurosurg102:Suppl59–70,2005
Linskey
ME
,
Davis
SA
,
Ratanatharathorn
V
:
Relative roles of microsurgery and stereotactic radiosurgery for the treatment of patients with cranial meningiomas: a single-surgeon 4-year integrated experience with both modalities
.J Neurosurg
102
:
Suppl
59
–
70
,
2005
10.3171/sup.2005.102.s_supplement.0059)| false
Lo
SS
,
Cho
KH
,
Hall
WA
,
Kossow
RJ
,
Hernandez
WL
,
McCollow
KK
,
:
Single dose versus fractionated stereotactic radiotherapy for meningiomas
.Can J Neurol Sci
29
:
240
–
248
,
2002
10.1017/S0317167100002018)| false
Loeffler
JS
,
Niemierko
A
,
Chapman
PH
:
Second tumors after radiosurgery: tip of the iceberg or a bump in the road?
.开云体育app官方网站下载入口
52
:
1436
–
1442
,
2003
10.1227/01.NEU.0000064809.59806.E8)| false
MaireJP,,CaudryM,,GuérinJ,,CélérierD,,San GalliF,&CausseN,et al.:Fractionated radiation therapy in the treatment of intracranial meningiomas: local control, functional efficacy, and tolerance in 91 patients.Int J Radiat Oncol Biol Phys33:315–321,1995
Maire
JP
,
Caudry
M
,
Guérin
J
,
Célérier
D
,
San Galli
F
,
Causse
N
,
:
Fractionated radiation therapy in the treatment of intracranial meningiomas: local control, functional efficacy, and tolerance in 91 patients
.Int J Radiat Oncol Biol Phys
33
:
315
–
321
,
1995
10.1016/0360-3016(94)00661-4)| false
MendenhallWM,,MorrisCG,,AmdurRJ,,FooteKD,&FriedmanWA:Radiotherapy alone or after subtotal resection for benign skull base meningiomas.Cancer98:1473–1482,2003
MetellusP,,RegisJ,,MuraccioleX,,FuentesS,,DufourH,&NanniI,et al.:Evaluation of fractionated radiotherapy and gamma knife radiosurgery in cavernous sinus meningiomas: treatment strategy.开云体育app官方网站下载入口57:873–886,2005
Metellus
P
,
Regis
J
,
Muracciole
X
,
Fuentes
S
,
Dufour
H
,
Nanni
I
,
:
Evaluation of fractionated radiotherapy and gamma knife radiosurgery in cavernous sinus meningiomas: treatment strategy
.开云体育app官方网站下载入口
57
:
873
–
886
,
2005
10.1227/01.NEU.0000179924.76551.cd)| false
NatarajanSK,,SekharLN,,SchesselD,&MoritaA:Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up.开云体育app官方网站下载入口60:965–981,2007
NewmanS:A prospective study of cavernous sinus surgery for meningiomas and resultant common ophthalmic complications (an American Ophthalmological Society thesis).Trans Am Ophthalmol Soc105:392–447,2007
Newman
S
:
A prospective study of cavernous sinus surgery for meningiomas and resultant common ophthalmic complications (an American Ophthalmological Society thesis)
.Trans Am Ophthalmol Soc
105
:
392
–
447
,
2007)| false
NicolatoA,,ForoniR,,AlessandriniF,,MalutaS,,BricoloA,&GerosaM:G的角色amma Knife radiosurgery in the management of cavernous sinus meningiomas.Int J Radiat Oncol Biol Phys53:992–1000,2002
Nicolato
A
,
Foroni
R
,
Alessandrini
F
,
Maluta
S
,
Bricolo
A
,
Gerosa
M
:
G的角色amma Knife radiosurgery in the management of cavernous sinus meningiomas
.Int J Radiat Oncol Biol Phys
53
:
992
–
1000
,
2002
10.1016/S0360-3016(02)02802-X)| false
NuttingC,,BradaM,,BrazilL,,SibtainA,,SaranF,&WestburyC,et al.:Radiotherapy in the treatment of benign meningioma of the skull base.J Neurosurg90:823–827,1999
Nutting
C
,
Brada
M
,
Brazil
L
,
Sibtain
A
,
Saran
F
,
Westbury
C
,
:
Radiotherapy in the treatment of benign meningioma of the skull base
.J Neurosurg
90
:
823
–
827
,
1999
10.3171/jns.1999.90.5.0823)| false
O'Sullivan
MG
,
van Loveren
HR
,
Tew
JM
Jr
:
The surgical resectability of meningiomas of the cavernous sinus
.开云体育app官方网站下载入口
40
:
238
–
247
,
1997
10.1097/00006123-199702000-00003)| false
OtaniN,,MuroiC,,YanoH,,KhanN,,PangaluA,&YonekawaY:Surgical management of tuberculum sellae meningioma: role of selective extradural anterior clinoidectomy.Br J Neurosurg20:129–138,2006
Otani
N
,
Muroi
C
,
Yano
H
,
Khan
N
,
Pangalu
A
,
Yonekawa
Y
:
Surgical management of tuberculum sellae meningioma: role of selective extradural anterior clinoidectomy
.Br J Neurosurg
20
:
129
–
138
,
2006
10.1080/02688690600776747)| false
PearceMS,,SalottiJA,,LittleMP,,McHughK,,LeeC,&KimKP,et al.:Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study.Lancet380:499–505,2012
Pearce
MS
,
Salotti
JA
,
Little
MP
,
McHugh
K
,
Lee
C
,
Kim
KP
,
:
Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study
.Lancet
380
:
499
–
505
,
2012
10.1016/S0140-6736(12)60815-0)| false
SalvatiM,,FratiA,,RussoN,,CaroliE,,PolliFM,&MinnitiG,et al.:Radiation-induced gliomas: report of 10 cases and review of the literature.Surg Neurol60:60–67,2003
Salvati
M
,
Frati
A
,
Russo
N
,
Caroli
E
,
Polli
FM
,
Minniti
G
,
:
Radiation-induced gliomas: report of 10 cases and review of the literature
.Surg Neurol
60
:
60
–
67
,
2003
10.1016/S0090-3019(03)00137-X)| false
SannaM,,BacciuA,,PasanisiE,,TaibahA,&PiazzaP:Posterior petrous face meningiomas: an algorithm for surgical management.Otol Neurotol28:942–950,2007
Sanna
M
,
Bacciu
A
,
Pasanisi
E
,
Taibah
A
,
Piazza
P
:
Posterior petrous face meningiomas: an algorithm for surgical management
.Otol Neurotol
28
:
942
–
950
,
2007)| false
SekharLN,,SwamyNK,,JaiswalV,,RubinsteinE,,HirschWEJr,&WrightDC:Surgical excision of meningiomas involving the clivus: preoperative and intraoperative features as predictors of postoperative functional deterioration.J Neurosurg81:860–868,1994
Sekhar
LN
,
Swamy
NK
,
Jaiswal
V
,
Rubinstein
E
,
Hirsch
WE
Jr
,
Wright
DC
:
Surgical excision of meningiomas involving the clivus: preoperative and intraoperative features as predictors of postoperative functional deterioration
.J Neurosurg
81
:
860
–
868
,
1994
10.3171/jns.1994.81.6.0860)| false
ShamisaA,,BanceM,,NagS,,TatorC,,WongS,&NorénG,et al.:Glioblastoma multiforme occurring in a patient treated with gamma knife surgery. Case report and review of the literature.J Neurosurg94:816–821,2001
Shamisa
A
,
Bance
M
,
Nag
S
,
Tator
C
,
Wong
S
,
Norén
G
,
:
Glioblastoma multiforme occurring in a patient treated with gamma knife surgery. Case report and review of the literature
.J Neurosurg
94
:
816
–
821
,
2001
10.3171/jns.2001.94.5.0816)| false
StaffordSL,,PerryA,,SumanVJ,,MeyerFB,,ScheithauerBW,&LohseCM,et al.:Primarily resected meningiomas: outcome and prognostic factors in 581 Mayo Clinic patients, 1978 through 1988.Mayo Clin Proc73:936–942,1998
StarkeRM,,WilliamsBJ,,HilesC,,NguyenJH,,ElsharkawyMY,&SheehanJP:Gamma Knife surgery for skull base meningiomas. Clinical article.J Neurosurg116:588–597,2012
SughrueME,,KaneAJ,,ShangariG,,RutkowskiMJ,,McDermottMW,&BergerMS,et al.:The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas. Clinical article.J Neurosurg113:1029–1035,2010
Sughrue
ME
,
Kane
AJ
,
Shangari
G
,
Rutkowski
MJ
,
McDermott
MW
,
Berger
MS
,
:
The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas. Clinical article
.J Neurosurg
113
:
1029
–
1035
,
2010
10.3171/2010.3.JNS091971)| false
SughrueME,,RutkowskiMJ,,ArandaD,,BaraniIJ,,McDermottMW,&ParsaAT:Factors affecting outcome following treatment of patients with cavernous sinus meningiomas. Clinical article.J Neurosurg113:1087–1092,2010
SughrueME,,RutkowskiMJ,,ArandaD,,BaraniIJ,,McDermottMW,&ParsaAT:Treatment decision making based on the published natural history and growth rate of small meningiomas. A review and meta-analysis.J Neurosurg113:1036–1042,2010
Sughrue
ME
,
Rutkowski
MJ
,
Aranda
D
,
Barani
IJ
,
McDermott
MW
,
Parsa
AT
:
Treatment decision making based on the published natural history and growth rate of small meningiomas. A review and meta-analysis
.J Neurosurg
113
:
1036
–
1042
,
2010
10.3171/2010.3.JNS091966)| false
TorresRC,,FrighettoL,,De SallesAA,,GossB,,MedinP,&SolbergT,et al.:Radiosurgery and stereotactic radiotherapy for intracranial meningiomas.Neurosurg Focus14:5E5,2003
Torres
RC
,
Frighetto
L
,
De Salles
AA
,
Goss
B
,
Medin
P
,
Solberg
T
,
:
Radiosurgery and stereotactic radiotherapy for intracranial meningiomas
.Neurosurg Focus
14
:
5
E5
,
2003)| false
WeberDC,,SchneiderR,,GoiteinG,,KochT,,AresC,&GeismarJH,et al.:Spot scanning-based proton therapy for intracranial meningioma: long-term results from the Paul Scherrer Institute.Int J Radiat Oncol Biol Phys83:865–871,2012
Weber
DC
,
Schneider
R
,
Goitein
G
,
Koch
T
,
Ares
C
,
Geismar
JH
,
:
Spot scanning-based proton therapy for intracranial meningioma: long-term results from the Paul Scherrer Institute
.Int J Radiat Oncol Biol Phys
83
:
865
–
871
,
2012
10.1016/j.ijrobp.2011.08.027)| false
ZachenhoferI,,WolfsbergerS,,AichholzerM,,BertalanffyA,,RoesslerK,&KitzK,et al.:Gamma-knife radiosurgery for cranial base meningiomas: experience of tumor control, clinical course, and morbidity in a follow-up of more than 8 years.开云体育app官方网站下载入口58:28–36,2006
Zachenhofer
I
,
Wolfsberger
S
,
Aichholzer
M
,
Bertalanffy
A
,
Roessler
K
,
Kitz
K
,
:
Gamma-knife radiosurgery for cranial base meningiomas: experience of tumor control, clinical course, and morbidity in a follow-up of more than 8 years
.开云体育app官方网站下载入口
58
:
28
–
36
,
2006
10.1227/01.NEU.0000190654.82265.A3)| false
