Outcomes from treatment of asymptomatic skull base meningioma with stereotactic radiosurgery
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ORIGINAL ARTICLE - TUMOR - MENINGIOMA
Outcomes from treatment of asymptomatic skull base meningioma with stereotactic radiosurgery Stylianos Pikis 1 & Adomas Bunevicius 1 & Jason Sheehan 1 Received: 22 September 2020 / Accepted: 12 November 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Optimal management of asymptomatic skull base meningiomas is controversial. We evaluated the safety and efficiency of Gamma Knife radiosurgery (GKRS) for the management of asymptomatic skull base meningiomas. Methods This retrospective study involved patients managed with GKRS for asymptomatic, skull base meningiomas from 1997 to 2019. Patient clinico-radiologic data, tumor characteristics, and procedural details were analyzed. Favorable outcome was defined as lack of procedure-related mortality or permanent neurologic morbidity and radiologic evidence of tumor control. Tumor progression and regression were defined as an increase or decrease of > 20% in volume from baseline to the last neuroimaging study respectively. Tumor volumes within ± 20% of baseline volume were considered stable. Results Thirty-seven patients (30 women), median age 68 years old (range 42–83 months) were managed with a single-session GKRS for 40 asymptomatic, skull base meningiomas. At a median clinical follow-up of 58.5 months (range 14–150 months), no mortality associated with the procedure or the treated tumor was noted. Permanent neurologic morbidity was 2.75%. There was a statistically significant decrease in mean tumor volume (p < 0.001) from 4.04 cc (SD 3.09 cc) prior to radiosurgery to 2.73 cc (SD 2.24 cc) at last follow-up. Higher margin dose was associated with tumor regression at last follow-up (HR = 1.351; 95%CI [1.094–1.669]; p = 0.05). Conclusion As compared to natural history studies, GKRS affords long-standing tumor control and neurologic preservation in the vast majority of patients treated for asymptomatic, skull base meningiomas. Further study is necessary to identify the optimal management of asymptomatic skull base meningiomas. Keywords Asymptomatic . Skull base . Meningioma . Radiosurgery . Gamma Knife
Introduction Meningiomas arise from the meningeal arachnoid cap cells and constitute the most common, usually benign, primary, intracranial tumor [9, 20, 21]. Asymptomatic meningiomas account for 30% of newly diagnosed meningiomas [9] and approximately one third of these are located in the skull base [7]. Optimal management of asymptomatic skull base meningiomas is controversial and despite the lack of Level 1 This article is part of the Topical Collection on Tumor - Meningioma * Jason Sheehan [email protected] Stylianos Pikis [email protected] 1
Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA 22908, USA
evidence, initial management recommendations consist of observation with frequent neuroimaging for an unspecified period of time [5]. However, natural history studies have demonstrated that 2.6–40% of patients with an untreated skull base meningioma will det
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