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doi: 10.1227/NEU.0000000000000480

Gamma Knife Radiosurgery for Cerebellopontine Angle Meningiomas: A Multicenter Study.

Ding, Dale M.D.; Starke, Robert M. M.D., M.Sc.; Kano, Hideyuki M.D., Ph.D.; Nakaji, Peter M.D.; Barnett, Gene H. M.D., M.B.A.; Mathieu, David M.D.; Chiang, Veronica M.D.; Omay, Sacit B. M.D.; Hess, Judith B.A.; McBride, Heyoung L. M.D.; Honea, Norissa Ph.D.; Lee, John Y.K. M.D.; Rahmathulla, Gazanfar M.D.; Evanoff, Wendi A. B.A.; Alonso-Basanta, Michelle M.D., Ph.D.; Lunsford, L. Dade M.D.; Sheehan, Jason P. M.D., Ph.D.

Published Ahead-of-Print
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Background: Resection of cerebellopontine angle (CPA) meningiomas may result in significant neurological morbidity. Radiosurgery offers a minimally invasive alternative to surgery.

Objective: To evaluate, in a multicenter cohort study, the outcomes of patients harboring CPA meningiomas who underwent Gamma Knife radiosurgery (GKRS).

Methods: From seven institutions participating in the North American Gamma Knife Consortium, 177 patients with benign CPA meningiomas treated with GKRS and at least six months radiologic follow-up were included for analysis. The mean age was 59 years and 84% were female. Dizziness or imbalance (48%) and cranial nerve (CN) VIII dysfunction (45%) were the most common presenting symptoms. The median tumor volume and prescription dose were 3.6 cc and 13 Gy, respectively. The mean radiologic and clinical follow-up durations were 47 and 46 months, respectively. Multivariate regression analyses were performed to identify predictors of tumor progression and neurological deterioration.

Results: The actuarial rates of progression-free survival at 5 and 10 years were 93% and 77%, respectively. Male gender (p=0.014), prior fractionated radiation therapy (p=0.010), and ataxia at presentation (p=0.002) were independent predictors of tumor progression. Symptomatic adverse radiation effects and permanent neurological deterioration were observed in 1.1% and 9% of patients, respectively. Facial spasms at presentation (p=0.007) and lower maximal dose (p=0.011) were independently associated with neurological deterioration.

Conclusion: GKRS is an effective therapy for CPA meningiomas. Depending on the patient and tumor characteristics, radiosurgery can be an adjuvant treatment to initial surgical resection or a standalone procedure that obviates the need for resection in most patients.

Copyright (C) by the Congress of Neurological Surgeons


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