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Neurosurgery. 2014 Oct;75(4):398-408; quiz 408. doi: 10.1227/NEU.0000000000000480.

Gamma knife radiosurgery for cerebellopontine angle meningiomas: a multicenter study.

Author information

1
*Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia; ‡Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; §Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona; ¶Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio; ‖Department of Surgery, Division of Neurosurgery, University of Sherbrooke, Sherbrooke, Quebec, Canada; #Department of Neurosurgery, Yale University, New Haven, Connecticut; and **Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

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.

PMID:
24991710
DOI:
10.1227/NEU.0000000000000480
[Indexed for MEDLINE]

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