Hadelsberg Uri, Nissim Uzi, Cohen Zvi R, Spiegelmann Roberto
Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
Stereotact Funct Neurosurg. 2015;93(1):10-6. doi: 10.1159/000368440. Epub 2014 Dec 9.
At present, there is no general agreement for the best approach to parasagittal meningiomas. Invasion of the superior sagittal sinus is frequent and responsible for relatively high recurrence rates following conventional microsurgery. Radiosurgery has the potential to treat less accessible portions of these tumors, and its application in this pathology is increasing either as a primary or a complementary therapeutic tool.
To evaluate our results with LINAC radiosurgery for the treatment of parasagittal meningiomas.
The patient cohort consisted of 74 patients treated for parasagittal meningioma by LINAC radiosurgery at our institution's Radiosurgery Unit during a 15-year period. Women accounted for 61% of patients. Thirteen patients (18%) underwent radiosurgery as the primary treatment for their meningioma.
The overall actuarial control rate was 90.6% at a mean follow-up of 49 months. In 17 patients (22.9%), there was no volumetric change. Fifty patients (67.5%) showed tumor shrinkage ranging from 15 to 80% of the original mass. In 7 patients, tumor recurrence was observed at an average time of 42.2 months after radiosurgery. All the patients with previously untreated tumors were controlled. Symptomatic transient peritumoral edema developed in 5 patients (6.7%) at a mean of 6.4 months after radiosurgery. Three patients complained of protracted headaches after treatment.
LINAC radiosurgery was highly effective for the treatment of parasagittal meningiomas in this series. For small to medium-sized meningiomas with clear invasion of the sinusal lumen, radiosurgery is a reasonable option as a first-line treatment. Either alone or combined with conventional surgery, radiosurgery may improve the control rate for parasagittal meningiomas.
目前，对于矢状窦旁脑膜瘤的最佳治疗方法尚无普遍共识。上矢状窦受侵很常见，这是导致传统显微手术后复发率相对较高的原因。放射外科有潜力治疗这些肿瘤中较难触及的部分，其在这种病理情况下作为主要或辅助治疗工具的应用正在增加。
评估我们使用直线加速器放射外科治疗矢状窦旁脑膜瘤的结果。
患者队列包括在15年期间于我们机构的放射外科接受直线加速器放射外科治疗矢状窦旁脑膜瘤的74例患者。女性占患者的61%。13例患者（18%）接受放射外科作为其脑膜瘤的主要治疗方法。
平均随访49个月时，总体精算控制率为90.6%。17例患者（22.9%）肿瘤体积无变化。50例患者（67.5%）肿瘤缩小，范围为原始肿块的15%至80%。7例患者在放射外科治疗后平均42.2个月出现肿瘤复发。所有先前未治疗肿瘤的患者均得到控制。5例患者（6.7%）在放射外科治疗后平均6.4个月出现有症状的短暂瘤周水肿。3例患者治疗后抱怨长期头痛。
在本系列中，直线加速器放射外科治疗矢状窦旁脑膜瘤非常有效。对于明确侵犯窦腔的中小型脑膜瘤，放射外科作为一线治疗是一个合理的选择。单独或与传统手术联合，放射外科可提高矢状窦旁脑膜瘤的控制率。
