Journal Mobile Options
Table of Contents
Vol. 76, No. 3-4, 2001
Issue release date: September 2002

Radiosurgery and Stereotactic Radiation Therapy of Skull Base Meningiomas: Proposal of a Grading System

De Salles A.A.F. · Frighetto L. · Grande C.V. · Solberg T.D. · Cabatan-Awang C. · Selch M.T. · Wallace R. · Ford J.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Objective: The development of a grading system to guide treatment selection, and predict treatment difficulty and outcome of skull base meningiomas infiltrating the cavernous sinus which are managed by stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT), based on an 8-year experience with stereotactic radiation of skull base meningiomas. Methods: T1 gadoliniun-enhanced magnetic resonance imaging (MRI) of 40 patients with skull base meningiomas, with or without prior surgery, who underwent radiosurgery or stereotactic radiation therapy from 1991 to 1998 at the UCLA Medical Center were reviewed, and the result of treatment was related to the tumor grade. Grade was based on tumor infiltration of the cavernous sinus and extension into adjacent structures. Treatment was performed with a linac-based system. The dose prescribed to the periphery of the tumor for SRS patients (n = 34) ranged from 12 to 22 Gy, and the maximum dose delivered to the tumor ranged from 24 to 46 Gy. SRT (n = 6). Treatment was planned using a single isocenter, usually prescribed to the 90% isodose volume, bringing the fractionation scheme to the maximal tolerance of the optic apparatus. The periphery dose ranged from 24 to 46 Gy with a maximum dose of 45 to 51 Gy. Clinical and MRI follow-up was performed every six months for the first 3 years and every year thereafter. Results: Grade I meningiomas were restricted to the cavernous sinus (n = 12). Grade II cavernous sinus meningiomas extended to the clivus and/or the petrous bone, without compression of the brainstem (n = 9). Grade III meningiomas had superior and/or anterior extension with compression of the optic nerve or tract (n = 9). Grade IV tumors compressed the brain stem (n = 8), and Grade V were bilateral lesions (n = 2). Tumor control rates were 90% for Grade I, 86% for Grade II, 86% for Grade III, 42% for Grade IV and no control for tumors Grade V. Complications were not related to tumor grade. Conclusion: This grading system correlated with outcome and difficulty in planning radiosurgery. Failure of treatment was more likely to occur in patients with higher Grade tumors.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Engelhard HH: Current status of radiation therapy and radiosurgery in the treatment of intracranial meningiomas. Neurosurg Focus 1997;2:6.
  2. Morita A, Coffey RJ, Foote RL, Schiff D, Gorman D: Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: Experience in 88 patients. J Neurosurg 1999;90:42–49.
  3. O’Sullivan M, Loveren HR, Tew J: The surgical resectability of meningiomas of the cavernous sinus. Neurosurgery 1997;40:238–246.
  4. Samii M, Carvalho G, Tatagiba M, Matthies C: Surgical management of meningiomas originating in Meckel’s cave. Neurosurgery 1997;41:767–774.
  5. Sen C, Hague K: Meningiomas involving the cavernous sinus: Histological factors affecting the degree of resection. J Neurosurg 1998;87:535–543.
  6. Sindou M, Alaywan M: Most intracranial meningioma are not cleavable tumors: Anatomic-surgical evidence and angiographic predictibility. Neurosurgery 1998;42:476–480.
  7. De Salles AAF, Bajada CL, Goetsch S, Holly FE, Solberg T, Becker DP: Radiosurgery of cavernous sinus tumors. Acta Neurochir Suppl 1993;58:101–103.
  8. Duma CM, Lunsford LD, Kondziolka D, Harsh GR, Flickinger JC: Stereotactic radiosurgery of cavernous sinus meningiomas as an addition or alternative to microsurgery. Neurosurgery 1993;32:699–704.
  9. Tishler RB, Loeffler JS, Lunsford D, et al: Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 1993;27:215–221.
  10. Black PMcL: Benign Brain Tumors. Neurologic Clinics 1995;13:927–951.
  11. Chopard RP, Lucas GA, Venosa A: Estudo micro-mesoscopico da parede lateral do seio cavernoso humano. Arq Neuropsiquiatr 1996;54:645–651.
  12. Kawase T, Van Loveren H, Keller J T, Tew J: Meningeal architecture of the cavernous sinus: Clinical and surgical implications. Neurosurgery 1996;39:527–536.
  13. Rachlin JR, Rosenblum ML: Etiology and biology of meningiomas; in Al-mefty S (ed): Meningiomas .New York, Raven Press, 1991;3:27–35.
  14. Zimmerman RD: MRI of intracranial meningiomas; in Al-mefti S (ed): Meningiomas. New York, Raven Press 1991;18:209–223.
  15. Sekhar LN, Patel S, Cusimano M, Wrigth DC, Sen CN, Bank WO: Surgical treatment of meningiomas involving the cavernous sinus: Evolving ideas based on a ten years experience. Acta Neurochir Suppl 1996;65:58–62.
  16. Subach BR, Lunsford LD, Kondziolka D, Maitz AH, Flickinger JC: Management of petroclival meningiomas by stereotactic radiosurgery. Neurosurgery 1998;42:437–443.
  17. Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiat 1957;20:22–39.
  18. Valentino V, Schinaia G, Raimond AJ: The results of radiosurgical management of 72 middle fossa meningiomas. Acta Neurochir 1993;122:60–70.

    External Resources

  19. Cioffi FA, Bernini FP, Punzo A, et al: Cavernous sinus meningiomas. Neurochirurgia 1987;30:40–47.

    External Resources

  20. Cusimano MD, Sekhar LN, Parikh HK, et al: The results of surgery for benign tumors of the cavernous sinus. Neurosurgery 1995;37:1–10.
  21. De Jesus P, Sekhar LN, Parikh HK, et al: Long-term follow-up of patients with meningiomas involving the cavernous sinus: Recurence, progression, and quality of life. Neurosurgery 1996;39:915–920.
  22. De Monte F, Smith HK, Al-Mefty O: Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 1994;81:245–251.
  23. Kleinpeter G, Bock F: Invasion of the cavernous sinus by medial sphenoid meningioma – ‘Radical’ surgery and recurrence. Acta Neurochir 1990;103:87–91.

    External Resources

  24. Sekhar LN, Buchanan RI, Wright DC, Broemeling LD: Benign tumors of the cavernous sinus. The case of aggressive resection. Clin Neurosurg 1999;45:263–278.
  25. Sepehrnia A, Samii M, Tatagiba M: Management of intracavernous tumors: An 11-year experience. Acta Neurochir Suppl 1991;53:122–126.
  26. Suzuki M, Mizoi K, Yoshimoto T: Should meningiomas involving the cavernous sinus be totally resected? Surg Neurol 1995;44:3–13.
  27. Wilson CB: Cavernous sinus meningiomas (letter). Surg Neurol 1996;46:191–193.

    External Resources

  28. Hakin R, Alexander E Loeffler JS, Shrieve DC, Wen P, et al: Results of linear accelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 1998;42:446–453.
  29. Knosp E, Perneczky A, Koos WT, et al: Meningiomas of the space of the cavernous sinus. Neurosurgery 1996;38:434–444.
  30. De Michele D, DiChiro G: Grading meningiomas by positron emission tomography; in Al-Mefty S (ed): Meningioma. New York, Raven Press, 1991, pp 243–253.
  31. Zamorano L, Saenz A, Matter A, Buciuc R, et al: Radiosurgical treatment of meningiomas. Stereotact Funct Neurosurg 1997;69:156–161.

    External Resources

  32. Hirsch WL, Sekhar LN, Lanzino G, et al: Meningiomas involving the cavernous sinus: Value of imaging for predicting surgical complications. AJR 1993;160:1083–1088.
  33. Lee S, Taylor J, McBride WH, Withers HR: The radiobiology of stereotactic radiosurgery and radiotherapy; in De Salles AAF, Goetsch SJ (eds): Stereotoactic Surgery and Radiosurgery. Madison, Medical Physics Publishing 1993, pp 169–184.
  34. Friedlander RM, Ojeman RG, Thornton AF: Benign tumors of the cavernous sinus. Management of meningiomas of the cavernous sinus: Conservative surgery and adjuvant therapy. Clin Neurosurg 1999;45:279–282.
  35. Wilson CB: Meningiomas: Genetics, malignancy, and the role of radiation in induction and treatment. J Neurosurg 1994;81:666–675.
  36. Taylor BW Jr, Marcus RB Jr, Friedman WA, Ballinger WE Jr, Million RR: The meningioma controversy: Postoperative radiation therapy. Int J Radiat Oncol Biol Phys 1988;15:299–304.
  37. Goldsmith BJ, Wara WM, Wilson CB, Larson DA: Postoperative irradiation for subtotally resected meningiomas. J Neurosurg 1994;80:195–201.
  38. Barbaro NM, Gutin PH, Wilson CB, Sheline GE, Boldrey EB, Wara WM: Radiation therapy in the treatment of partially resected meningiomas. Neurosurgery 1987;20:525–528.
  39. Glaholm J, Bloom HJG, Crow JH: The role of radiotherapy in the management of intracranial meningiomas: The Royal Mardsen Hospital experience with 186 patients. Int J Radiat Oncol Biol Phys 1990;18:755–761.
  40. Al-Mefty O, Kersch JE, Routh A, Smith RR: The long term side effects of radiation therapy for benign brain tumors in adults. J Neurosurg 1990;73:502–512.
  41. Crossen JR, Garwood D, Glatstein E, Neuwelt EA: Neurobehavioral sequelae of cranial irradiation in adults: A review of radiation-induced encephalopathy. J Clin Oncol 1994;12:627–642.
  42. Mehta M, Kinsella TJ: Cavernous sinus cranial neuropathies: Is there a dose-response relationship following radiosurgery? Int J Radiat Oncol Biol Phys 1993;27:477–480.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50