Does prior microsurgery improve or worsen the outcomes of stereotactic radiosurgery for cavernous sinus meningiomas?

Hideyuki Kano, Kyung-Jae Park, Douglas Kondziolka, Aditya Iyer, Xiaomin Liu, Daniel Tonetti, John C. Flickinger, L. Dade Lunsford

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Stereotactic radiosurgery (SRS) is an important option for patients with cavernous sinus meningiomas. Objective: To evaluate cranial nerve outcomes in patients who underwent SRS for cavernous sinus meningiomas with or without prior microsurgery. Methods: During a 23-year interval, 272 patients underwent Gamma Knife SRS for cavernous sinus meningiomas (70 men, 202 women; median age, 54 years). In this series, 99 patients underwent prior microsurgical resection. The median tumor volume was 7.9 cm and median marginal dose was 13 Gy. The median follow-up period was 62 months (range, 6-209 months). Results: The progression-free survival after SRS was 96% at 3 years, 94% at 5 years, and 86% at 10 years. After SRS, 13 of 91 patients (14%) who underwent prior microsurgery had improvement of preexisting cranial nerve symptoms or signs. In comparison, 54 of 145 patients (37%) without prior microsurgery had improvement of preexisting cranial nerve symptoms or signs. The improvement rate of cranial nerve deficits after SRS in patients without prior microsurgery was 20% at 1 year, 34% at 2 years, 36% at 3 years, and 39% at 5 years. Patients who had not undergone prior microsurgery had significantly higher improvement rates of preexisting cranial nerve symptoms and signs (P = .001). After SRS, 29 patients (11%) developed new or worsened cranial nerve function. Conclusion: SRS provided long-term effective tumor control and a low risk of new cranial nerve deficits. Improvement in preexisting cranial neuropathies was detected in significantly more patients who had not undergone prior microsurgical procedures.

Original languageEnglish
Pages (from-to)401-410
Number of pages10
JournalNeurosurgery
Volume73
Issue number3
DOIs
Publication statusPublished - 2013 Sep 1

Keywords

  • Cavernous sinus
  • Cranial nerve deficits
  • Gamma Knife
  • Meningioma
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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