Skip to main content
Log in

Linear Accelerator-Based Radiosurgery in the Management of Skull Base Meningiomas

  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

From May 1994 to December 1999, 43 patients with meningiomas in the base of the skull underwent linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) at Chung Gung Memorial Hospital. SRS was performed as a primary treatment in 14 patients, and after resection in 29 patients. The mean tumor volume was 5.68 cc, and the mean target surface dose was 16 Gy, delivered with an average of three isocenters. The median follow-up was 74.5 months. The 7-year local control rate and 7-year overall survival rate were 89.7% and 80.2%, respectively. The 7-year local control was 100% and 84.4% in SRS alone group and surgical excision with SRS group (p = 0.21), respectively. A stationary tumor following SRS was seen in 23 (53.5%) patients, partial shrinkage was seen in 16 (37.2%) patients, and complete disappearance in one patient was seen (2.3%). Furthermore, disease progression was noted in three (7%) patients, one of whom died of disease. The median time to tumor response was 15.4 months (range 5.8–52.8 months). Cases remained stable or had improved neurological statuses without any deterioration in 37.9% and 78.7% of the groups treated with surgery and SRS and SRS alone, retrospectively. In summary, LINAC-based SRS is an effective and safe modality of treating unresectable or partially resected meningiomas in the base of the skull. For tumors with diameters of 3 cm or less, particularly in patients without or with minimal clinical neurological symptom, SRS alone can provide a good local control without causing cranial neuropathy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Choi NW, Schuman LM, Gullen WH: Epidemiology of primary central nervous system neoplasms. II. Case-control study. Am J Epidemiol 91: 467-485, 1970

    Google Scholar 

  2. Rohringer M, Sutherland GR, Louw DF, Sima AA: Incidence and clinicopathological features of meningiomas. J Neurosurg 71: 665-672, 1989

    Google Scholar 

  3. Beks JW, de Windt HL: The recurrence of supratentorial meningiomas after surgery. Acta Neurochir (Wien) 95: 3-5, 1988

    Google Scholar 

  4. De Jesus O, Sekhar LN, Parikh HK, Wright DC, Wagner DP: Long-term follow-up of patients with meningiomas involving the cavernous sinus: recurrence, progression, and quality of life. Neurosurgery 39: 915-920, 1996

    Google Scholar 

  5. Black PM, Villavicencio AT, Rhouddou C, Loeffler JS: Aggressive surgery and focal radiation in the management of meningiomas of the skull base: preservation of function with maintenance of local control. Acta Neurochir (Wein) 143: 555-562, 2001

    Google Scholar 

  6. Couldwell WT, Fukushima T, Giannotta SL, Weiss MH: Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 84: 20-28, 1996

    Google Scholar 

  7. Sekhar LN, Jannetta PJ, Burkhart LE J, Anosky JE: Meningiomas involving the clivus: a six-year experience with 41 patients. Neurosurgery 27: 764-781, 1990

    Google Scholar 

  8. Mesic JB, Hanks GE, Doggett RL: The value of radiation therapy as an adjuvant to surgery in intracranial meningiomas. Am J Clin Oncol 9: 337-340, 1986

    Google Scholar 

  9. Flickinger JC, Kondziolka D, Niranjan A, Lunsford LD: Results of acoustic neuroma radiosurgery: an analysis of 5 years' experience using current methods. J Neurosurg 94: 1-6, 2001

    Google Scholar 

  10. Younis GA, Sawaya R, DeMonte F, Hess KR, Albrecht S, Bruner JM: Aggressive meningeal tumors: review of a series. J Neurosurg 82: 17-27, 1995

    Google Scholar 

  11. Chang SD, Adler JR Jr: Treatment of cranial base meningiomas with linear accelerator radiosurgery. Neurosurgery 41: 1019-1127, 1997

    Google Scholar 

  12. Kondziolka D, Levy EI, Niranjan A, Flickinger JC, Lunsford LD: Long-term outcomes after meningioma radiosurgery: physician and patient perspectives. J Neurosurg 91: 44-50, 1999

    Google Scholar 

  13. Petty AM, Kun LE, Meyer GA: Radiation therapy for incompletely resected meningiomas. J Neurosurg 62: 502-507, 1985

    Google Scholar 

  14. Adegbite AB, Khan MI, Paine KW, Tan LK: The recurrence of intracranial meningiomas after surgical treatment. J Neurosurg 58: 51-56, 1983

    Google Scholar 

  15. Black PM: Meningiomas. Neurosurgery 32: 643-657, 1993

    Google Scholar 

  16. Al-Mefty O, Fox JL, Smith RR: Petrosal approach for petroclival meningiomas. Neurosurgery 22: 510-517, 1988

    Google Scholar 

  17. Cosgrove VP, Jahn U, Pfaender M, Bauer S, Budach V, Wurm RE: Commissioning of a micro multi-leaf collimator and planning system for stereotactic radiosurgery. Radiother Oncol 50: 325-336, 1999

    Google Scholar 

  18. Kondziolka D, Lunsford LD, Coffey RJ, Flickinger JC: Stereotactic radiosurgery of meningiomas. J Neurosurg 74: 552-559, 1991

    Google Scholar 

  19. Shin M, Kurita H, Sasaki T, Kawamoto S, Tago M, Kawahara N, Morita A, Ueki K, Kirino T: Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas. Neurosurgery 95: 435-439, 2001

    Google Scholar 

  20. Subach BR, Lunsford LD, Kondziolka D, Maitz AH, Flickinger JC: Management of petroclival meningiomas by stereotactic radiosurgery. Neurosurgery 42: 437-445, 1998

    Google Scholar 

  21. Nicolato A FP, Foroni R, Pasqualin A, Piovan E, Severi F, Masotto B, Gerosa M: Gamma Knife radiosurgery in skull base meningiomas. Preliminary experience with 50 cases. Stereotact Funct Neurosurg 66(Suppl 1): 112-120, 1996

    Google Scholar 

  22. Pendl GSO, Eustacchio S, Feichtinger K, Ganz J: Stereotactic radiosurgery of skull base meningiomas. Minim Invasive Neurogurg 40: 87-90, 1997

    Google Scholar 

  23. Pollock BESS, Link MJ: Gamma knife radiosurgery for skull base meningiomas. Neurosurg Clin N Am 11: 659-666, 2000

    Google Scholar 

  24. Roche PHRJ, Dufour H, Fournier HD, Delsanti C, Pellet W, Grisoli F, Peragut JC: Gamma knife radiosurgery in the management of cavernous sinus meningiomas. J Neurosurg 93(Suppl 3): 68-73, 2000

    Google Scholar 

  25. Hakim RAEr, Loeffler JS, Shrieve DC, Wen P, Fallon MP, Stieg PE, Black PM: Results of linear accelerator-based radiosurgery for intracranial meningiomas. Neurosurgery 42: 446-454, 1998

    Google Scholar 

  26. Shafron DHFW, Buatti JM, Bova FJ, Mendenhall WM: Linac radiosurgery for benign meningiomas. Int J Radiat Oncol Biol Phys 43: 321-327, 1999

    Google Scholar 

  27. Palva T, Troupp H, Jauhiainen T: Hearing preservation neurinoma surgery. Acta Otolaryngol 99: 1-7, 1985

    Google Scholar 

  28. Glasscock ME, McKennan KX, Levine SC: Acoustic neuroma surgery: the results of hearing conservation surgery. Laryngoscope 97: 785-789, 1987

    Google Scholar 

  29. Nadol JB Jr, Levine R, Ojemann RG, Martuza RL, Montgomery WW, de Sandoval PK: Preservation of hearing in surgical removal of acoustic neuromas of the internal auditory canal and cerebellar pontine angle. Laryngoscope 97: 1287-1294, 1987

    Google Scholar 

  30. Alvarez F, Roda JM, Perez Romero M, Morales C, Sarmiento MA, Blazquez MG: Malignant and atypical meningiomas: a reappraisal of clinical, histological, and computed tomographic features. Neurosurgery 20: 688-694, 1987

    Google Scholar 

  31. Jaaskelainen J, Haltia M, Servo A: Atypical and anaplastic meningiomas: radiology, surgery, radiotherapy, and outcome. Surg Neurol 25: 233-242, 1986

    Google Scholar 

  32. Tishler RB, Loeffler JS, Lunsford LD, Duma C, Alexander E 3rd, Kooy HM, Flickinger JC: Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27: 215-221, 1993

    Google Scholar 

  33. Leber KABJ, Pendl G: Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 88: 43-50, 1998

    Google Scholar 

  34. 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 90: 42-49, 1999

    Google Scholar 

  35. Benedict SHCR, Wu Q, Zwicker RD, Broaddus WC, Mohan R: Intensity-modulated stereotactic radiosurgery using dynamic micro-multileaf collimation. Int J Radiat Oncol Biol Phys 50: 751-758, 2001

    Google Scholar 

  36. Nakamura JL, Verhey LJ, Smith V, Petti PL, Lamborn KR, Larson DA, Wara WM, McDermott MW, Sneed PK: Dose conformity of gamma knife radiosurgery and risk factors for complications. Int J Radiat Oncol Biol Phys 51: 1313-1319, 2001

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chuang, CC., Chang, CN., Tsang, NM. et al. Linear Accelerator-Based Radiosurgery in the Management of Skull Base Meningiomas. J Neurooncol 66, 241–249 (2004). https://doi.org/10.1023/B:NEON.0000013500.11150.36

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:NEON.0000013500.11150.36

Navigation