Exp Neurobiol.
2018 Jun;27(3):245-255. 10.5607/en.2018.27.3.245.
Fractionated Gamma Knife Radiosurgery as Initial Treatment for Large Skull Base Meningioma
- Affiliations
-
- 1Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea.
- 2Department of Neurosurgery, Pusan National University Hospital, Busan 49241, Korea.
- 3Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea. paeksh@snu.ac.kr
- 4Cancer Research Institute, Seoul National University, Seoul 03080, Korea.
- 5Ischemia Hypoxia Disease Institute, Seoul National University, Seoul 03080, Korea.
- KMID: 2416252
- DOI: http://doi.org/10.5607/en.2018.27.3.245
Abstract
- We present our experience on the hypofractionated Gamma Knife radiosurgery (FGKS) for large skull base meningioma as an initial treatment. We retrospectively reviewed 23 patients with large skull base meningioma ≥10 cm³ who underwent FGKS as the initial treatment option. The mean volume of tumors prior to radiosurgery was 21.2±15.63 cm³ (range, 10.09~71.42). The median total margin dose and marginal dose per fraction were 18 Gy (range, 15~20) and 6 Gy (range, 5~6), respectively. Patients underwent three or four fractionations in consecutive days with the same Leksell® frame. The mean follow-up duration was 38 months (range, 17~78). There was no mortality. At the last follow-up, the tumor volume was stationary in 15 patients (65.2%) and had decreased in 8 patients (34.8%). Six patients who had cranial neuropathy at the time of FGKS showed improvement at the last clinical follow-up. Following FGKS, 4 patients (17%) had new cranial neuropathy. The trigeminal neuropathy was the most common and all were transient. The mean Karnofsky Performance Status score at pre-FGKS and the last clinical follow-up was 97.0±10.4 points (median, 100) and 98.6±6.9 (median, 100) points, respectively. FGKS has showed satisfactory tumor control with functional preservation for large skull base meningiomas. Further prospective studies of large cohorts with long term follow-up are required to clarify the efficacy in the tumor control and functional outcome as well as radiation toxicity.
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