Long-term results of gamma knife radiosurgery for foramen magnum meningiomas
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ORIGINAL ARTICLE
Long-term results of gamma knife radiosurgery for foramen magnum meningiomas Göktuğ Akyoldaş 1
&
Yavuz Samancı 2
&
Meltem Yılmaz 3 & Meriç Şengöz 4 & Selçuk Peker 1
Received: 8 October 2020 / Revised: 11 November 2020 / Accepted: 18 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Outcomes of 37 patients of foramen magnum meningioma (FMM) were evaluated, and the related literature was reviewed to determine the efficacy of Gamma Knife radiosurgery (GKRS) for treating patients with FMM. We present the largest series reported from a single institution with the longest follow-up to date. The database of patients who underwent GKRS for FMM between 2007 and 2019 was evaluated retrospectively. A total of 37 patients with radiological and pathological features consistent with FMM were included in this series. Thirty-three patients were female, and 4 were male. The median age was 58 years (range, 23–74 years). The most common symptom at diagnosis was headache (64.9%). Twelve patients had a history of microsurgical resection. The median duration from the initial onset of symptoms to GKRS was 12 months (range 1–140 months). Among the 37 tumors, eight (21.6%) were located ventrally, 24 (64.9%) laterally, and five (13.5%) dorsally. The median target volume was 3.30 cm3 (range, 0.6–17.6 cm3). Thirty-five patients (95%) were treated with single fraction GKRS, and two patients (5%) were treated with hypofractionated GKRS. The median clinical follow-up was 80 months (range, 18–151 months), while the median radiological follow-up was 84 months (range, 18–144 months). At the last clinical follow-up after GKRS, 27 patients (73%) had improved symptoms, and none had worsened pre-GKRS symptoms. At the last radiological follow-up after GKRS, 23 tumors (62.2%) remained stable, 13 (35.1%) decreased in size, and 1 (2.7%) increased in size. Tumor control, including stable and regressed tumors, was achieved in 97.3% of patients. Our cohort demonstrates that GKRS is an effective and safe treatment for patients with either primary or recurrent/residual FMM. Keywords Foramen magnum . Gamma Knife radiosurgery . Meningioma . Radiation . Stereotactic radiosurgery
Introduction Meningiomas are the most common primary intracranial tumors [1, 2]. Foramen magnum meningiomas (FMMs) account for only 2–3% of all meningiomas but 75% of all benign extramedullary tumors at the foramen magnum [3–7]. Seventy percent of the meningiomas, even small ones, were * Göktuğ Akyoldaş [email protected] 1
Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
2
Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey
3
Medical Biotechnology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
4
Department of Radiation Oncology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
shown to grow radiologically and become symptomatic [8]. Despite the rarity of FMMs, microsurgical resection is extremely challenging for neurosurgeons
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