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Gamma Knife Radiosurgery for Cerebellopontine Angle Meningiomas: A Multicenter Study

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

doi: 10.1227/NEU.0000000000000480
Research-Human-Clinical Studies: Editor's Choice
Editor's Choice

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: jps2f@hscmail.mcc.virginia.edu

Received January 22, 2014

Accepted June 02, 2014

Copyright © by the Congress of Neurological Surgeons