OBJECTIVE: To evaluate the role of stereotactic radiosurgery in the management of petroclival meningiomas, we retrospectively reviewed our experience with 62 patients managed at the University of Pittsburgh during an 8-year period. METHODS: All patients had cranial base meningiomas involving the region between the petrous apex and the upper two-thirds of the clivus. Some tumors extended into the cavernous sinus. Each of 39 patients (63%) had previously undergone one or more attempts at surgical resection. Seven patients (11%) had received fractionated external beam radiation therapy. Using the gamma knife, conformal multiple isocenter radiosurgery was performed with tumor margin doses of 11 to 20 Gy. RESULTS: During the median follow-up period of 37 months, neurological statuses improved in 13 patients (21%), remained stable in 41 patients (66%), and eventually worsened in 8 patients (13%). Tumor volumes decreased in 14 patients (23%), remained stable in 42 patients (68%), and increased in 5 patients (8%). Despite the proximity of these tumors to critical neural and vascular structures, complications resulting from radiosurgery were rare. Five patients (8%) developed new cranial nerve deficits within 24 months of radiosurgery, although none had evidence of tumor progression. These deficits resolved completely in two patients within 6 months of onset. CONCLUSION: Although an even longer follow-up period is desirable, we conclude that stereotactic radiosurgery provides a safe and effective management strategy for petroclival meningiomas, both as a primary procedure and as an adjunct to incomplete resection.
OBJECTIVE: To evaluate the role of stereotactic radiosurgery in the management of petroclival meningiomas, we retrospectively reviewed our experience with 62 patients managed at the University of Pittsburgh during an 8-year period. METHODS: All patients had cranial base meningiomas involving the region between the petrous apex and the upper two-thirds of the clivus. Some tumors extended into the cavernous sinus. Each of 39 patients (63%) had previously undergone one or more attempts at surgical resection. Seven patients (11%) had received fractionated external beam radiation therapy. Using the gamma knife, conformal multiple isocenter radiosurgery was performed with tumor margin doses of 11 to 20 Gy. RESULTS: During the median follow-up period of 37 months, neurological statuses improved in 13 patients (21%), remained stable in 41 patients (66%), and eventually worsened in 8 patients (13%). Tumor volumes decreased in 14 patients (23%), remained stable in 42 patients (68%), and increased in 5 patients (8%). Despite the proximity of these tumors to critical neural and vascular structures, complications resulting from radiosurgery were rare. Five patients (8%) developed new cranial nerve deficits within 24 months of radiosurgery, although none had evidence of tumor progression. These deficits resolved completely in two patients within 6 months of onset. CONCLUSION: Although an even longer follow-up period is desirable, we conclude that stereotactic radiosurgery provides a safe and effective management strategy for petroclival meningiomas, both as a primary procedure and as an adjunct to incomplete resection.
Authors: Elena Vera; J Bryan Iorgulescu; Daniel M S Raper; Karthik Madhavan; Brian E Lally; Jacques Morcos; Samy Elhammady; Jonathan Sherman; Ricardo J Komotar Journal: J Neurol Surg B Skull Base Date: 2014-03-12
Authors: Mustafa El-Khatib; Faycal El Majdoub; Stefan Hunsche; Mauritius Hoevels; Martin Kocher; Volker Sturm; Mohammad Maarouf Journal: Strahlenther Onkol Date: 2015-08-08 Impact factor: 3.621
Authors: Carol L Armstrong; Kunsang Gyato; Abdel W Awadalla; Robert Lustig; Zelig A Tochner Journal: Neuropsychol Rev Date: 2004-03 Impact factor: 7.444