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 7 institutions participating in the North American Gamma Knife Consortium, 177 patients with benign CPA meningiomas treated with GKRS and at least 6 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 the 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 sex (P = .014), prior fractionated radiation therapy (P = .010), and ataxia at presentation (P = .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 = .007) and lower maximal dose (P = .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.
ABBREVIATIONS: ARE, adverse radiation effect
CN, cranial nerve
CPA, cerebellopontine angle
EBRT, external beam radiation therapy
GKRS, Gamma Knife radiosurgery
IAC, internal auditory canal
NAGKC, North American Gamma knife Consortium
PFS, progression-free survival
SRS, stereotactic radiosurgery
WHO, World Health Organization
*Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia;
‡Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania;
§Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona;
¶Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio;
‖Department of Surgery, Division of Neurosurgery, University of Sherbrooke, Sherbrooke, Quebec, Canada;
#Department of Neurosurgery, Yale University, New Haven, Connecticut; and
**Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
Correspondence: Jason P. Sheehan, MD, PhD, Department of Neurological Surgery, University of Virginia, P.O. Box 800212, Charlottesville, VA 22908. E-mail: firstname.lastname@example.org
Received January 22, 2014
Accepted June 02, 2014