Department of Neurological Surgery, and.
J Neurosurg. 2013 Oct;119(4):871-7. doi: 10.3171/2013.6.JNS13110. Epub 2013 Aug 9.
Parasagittal and parafalcine (PSPF) meningiomas represent the second most common location for intracranial meningiomas. Involvement of the superior sagittal sinus or deep draining veins may prevent gross-total resection of these tumors without significant morbidity. The authors review their results for treatment of PSPF meningiomas with radiosurgery.
The authors retrospectively reviewed the institutional review board-approved University of Virginia Gamma Knife database and identified 65 patients with 90 WHO Grade I parasagittal (59%) and parafalcine (41%) meningiomas who had a mean MRI follow-up of 56.6 months. The patients' mean age was 57 years, the median preradiosurgery Karnofsky Performance Status score was 80, and the median initial tumor and treatment volumes were 3 and 3.7 cm(3), respectively. The median prescription dose was 15 Gy, isodose line was 40%, and the number of isocenters was 5. Kaplan-Meier analysis was used to determine progression-free survival (PFS). Univariate and multivariate Cox regression analyses were used to identify factors associated with PFS.
The median overall PFS was 75.6 months. The actuarial tumor control rate was 85% at 3 years and 70% at 5 years. Parasagittal location, no prior resection, and younger age were found to be independent predictors of tumor PFS. For the 49 patients with clinical follow-up (mean 70.8 months), the median postradiosurgery Karnofsky Performance Status score was 90. Symptomatic postradiosurgery peritumoral edema was observed in 4 patients (8.2%); this group comprised 3 patients (6.1%) with temporary and 1 patient (2%) with permanent clinical sequelae. Two patients (4.1%) died of tumor progression.
Radiosurgery offers a minimally invasive treatment option for PSPF meningiomas, with a good tumor control rate and an acceptable complication rate comparable to most surgical series.
矢状旁和岩斜脑膜瘤是颅内脑膜瘤的第二常见部位。由于上矢状窦或深部引流静脉的受累，这些肿瘤可能无法在不引起显著发病率的情况下进行全切除。作者回顾了他们采用放射外科治疗矢状旁和岩斜脑膜瘤的结果。
作者回顾性地审查了弗吉尼亚大学伽玛刀数据库中经机构审查委员会批准的病例，共纳入 65 例 90 个 WHO 分级 I 级矢状旁（59%）和岩斜（41%）脑膜瘤患者，平均 MRI 随访时间为 56.6 个月。患者的平均年龄为 57 岁，放射外科前 Karnofsky 表现状态评分中位数为 80，初始肿瘤和治疗体积中位数分别为 3 和 3.7cm³。中位处方剂量为 15Gy，等剂量线为 40%，等中心点数量为 5 个。采用 Kaplan-Meier 分析确定无进展生存率（PFS）。采用单变量和多变量 Cox 回归分析确定与 PFS 相关的因素。
中位总 PFS 为 75.6 个月。3 年时的肿瘤无进展生存率为 85%，5 年时为 70%。矢状旁位置、无先前切除术和年龄较小是肿瘤 PFS 的独立预测因素。在有临床随访的 49 例患者中（平均随访 70.8 个月），放射外科后 Karnofsky 表现状态评分中位数为 90。4 例（8.2%）患者出现放射外科后肿瘤周围水肿，其中 3 例（6.1%）为暂时性，1 例（2%）为永久性临床后遗症。2 例（4.1%）患者因肿瘤进展而死亡。
放射外科为矢状旁和岩斜脑膜瘤提供了一种微创治疗选择，具有良好的肿瘤控制率和可接受的并发症发生率，与大多数手术系列相当。
