Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
J Neurosurg. 2013 Sep;119(3):675-82. doi: 10.3171/2013.5.JNS13206. Epub 2013 Jun 28.
Stereotactic radiosurgery (SRS) is an important treatment option for patients with cavernous sinus meningiomas (CSM). To analyze factors associated with local tumor control and complications after single-fraction SRS, the authors reviewed cases involving patients treated with Gamma Knife SRS between 1990 and 2008.
Excluded were patients with WHO Grade II or III tumors, radiation-induced tumors, multiple meningiomas, neurofibromatosis Type 2, and prior or concurrent radiotherapy. Five patients were lost to follow-up and 3 patients refused research authorization. The remaining 115 patients (29 men, 86 women) had either histologically confirmed WHO Grade I (n = 46, 40%) or presumed (n = 69, 60%) CSM. The median treatment volume was 9.3 cm(3) (range 1.3-42.2 cm(3)). The median margin dose was 16 Gy (range 12-20 Gy). The median follow-up after SRS was 89 months (range 12-251 months). Thirty-nine patients (34%) had 10 or more years of follow-up after SRS.
Six patients (5%) had tumor progression (in field, n = 3; marginal, n = 3) at a median of 74 months (range 42-145 months) after SRS. The local tumor control rate was 99% at 5 years and 93% at 10 years after SRS. No analyzed factor was associated with local control after SRS. Fourteen patients (12%) had permanent complications at a median onset of 23 months (range 2-146 months) including trigeminal dysfunction (n = 9), diplopia (n = 2), ischemic stroke (n = 2), and hypopituitarism (n = 1). The 2-year, 5-year, and 10-year rates of complications were 7%, 10%, and 15%, respectively. Multivariate analysis found larger treatment volume (HR 1.1, 95% CI 1.02-1.2, p = 0.01) to be associated with complications after SRS. The complication rate for patients with a treatment volume of 9.3 cm(3) or less was 3% (2 of 58 cases) compared with 21% (12 of 57 cases) for patients with a treatment volume greater than 9.4 cm(3).
Single-fraction SRS at the radiation doses used in this series provided durable tumor control for patients with benign CSM. Larger tumor volume remains the primary factor associated with complications after single-fraction SRS of benign CSM despite advancements in SRS technique.
立体定向放射外科（SRS）是治疗海绵窦脑膜瘤（CSM）患者的重要治疗选择。为了分析单次分割 SRS 后与局部肿瘤控制和并发症相关的因素，作者回顾了 1990 年至 2008 年间接受伽玛刀 SRS 治疗的患者。
排除了 WHO 分级 II 或 III 级肿瘤、放射性肿瘤、多发性脑膜瘤、神经纤维瘤病 2 型和既往或同期放疗的患者。5 例患者失访，3 例患者拒绝研究授权。其余 115 例患者（29 例男性，86 例女性）中，46 例（40%）经组织学证实为 WHO 分级 I，69 例（60%）为推测性（60%）CSM。中位治疗体积为 9.3cm³（范围 1.3-42.2cm³）。中位边缘剂量为 16Gy（范围 12-20Gy）。SRS 后中位随访时间为 89 个月（范围 12-251 个月）。39 例（34%）患者在 SRS 后 10 年以上有随访。
6 例患者（5%）在 SRS 后中位 74 个月（范围 42-145 个月）时出现肿瘤进展（场内，n=3；边缘，n=3）。SRS 后 5 年和 10 年的局部肿瘤控制率分别为 99%和 93%。没有分析的因素与 SRS 后的局部控制有关。14 例患者（12%）在中位发病 23 个月（范围 2-146 个月）时出现永久性并发症，包括三叉神经功能障碍（n=9）、复视（n=2）、缺血性中风（n=2）和垂体功能减退（n=1）。2 年、5 年和 10 年的并发症发生率分别为 7%、10%和 15%。多变量分析发现较大的治疗体积（HR 1.1，95%CI 1.02-1.2，p=0.01）与 SRS 后的并发症有关。治疗体积为 9.3cm³或以下的患者并发症发生率为 3%（58 例中的 2 例），而治疗体积大于 9.4cm³的患者并发症发生率为 21%（57 例中的 12 例）。
在本系列中使用的放射剂量单次分割 SRS 为良性 CSM 患者提供了持久的肿瘤控制。尽管 SRS 技术取得了进步，但较大的肿瘤体积仍然是良性 CSM 单次分割 SRS 后并发症的主要相关因素。
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