Azar Maziar, Kazemi Farid, Jahanbakhshi Amin, Chanideh Iran, Jalessi Maryam, Amini Elahe, Geraily Ghazale, Farhadi Mohammad
Skull Base Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Stereotact Funct Neurosurg. 2017;95(4):259-267. doi: 10.1159/000478024. Epub 2017 Aug 11.
The outcomes of Gamma Knife radiosurgery (GKRS) for cavernous sinus meningioma (CSM) are presented, and factors possibly affecting outcome are investigated.
The medical records and imaging and procedural reports of 166 patients with CSM were retrospectively reviewed. Demographic data, procedural data, symptomatic improvement, radiological regression, and progression-free survival (PFS) rates were evaluated.
There were 124 women and 42 men; including 44 postoperative and 122 primary GKRS cases. Mean follow-up was 32.4 months. Mean marginal dose was 13 Gy. Symptomatic improvement was seen in 40.4%, while neurologic deterioration occurred in 9.6%; 50% remained symptomatically stable. Radiological regression was noted in 57.2%; the tumor remained stable in 35.5%, and 7.2% of the patients experienced tumor progression. The actuarial 5- and 10-year PFS rates were 90.1% (±3.3) and 75.8% (±8.8), respectively. History of previous surgery or radiotherapy were associated with lower symptomatic improvement. Higher tumor coverage and isodose lines were accompanied with better radiological prognosis. However, a history of conventional radiotherapy, presence of facial sensory deficits at presentation, a higher tumor volume, and tumor extension to the suprasellar compartment affected the radiologic outcome negatively.
This study revealed a high efficacy and safety for GKRS in both postoperative and primary GKRS patients. Achievability of a good profile of tumor coverage and isodose lines at radiosurgical planning predict a better outcome.
介绍伽玛刀放射外科治疗（GKRS）海绵窦脑膜瘤（CSM）的结果，并研究可能影响治疗结果的因素。
回顾性分析166例CSM患者的病历、影像及手术报告。评估人口统计学数据、手术数据、症状改善情况、影像学退缩情况及无进展生存率（PFS）。
女性124例，男性42例；包括44例术后患者和122例原发性GKRS病例。平均随访32.4个月。平均边缘剂量为13 Gy。40.4%的患者症状改善，9.6%的患者出现神经功能恶化；50%的患者症状保持稳定。57.2%的患者出现影像学退缩；35.5%的患者肿瘤保持稳定，7.2%的患者出现肿瘤进展。5年和10年的精算PFS率分别为90.1%（±3.3）和75.8%（±8.8）。既往手术或放疗史与较低的症状改善率相关。较高的肿瘤覆盖率和等剂量线与较好的影像学预后相关。然而，传统放疗史、就诊时存在面部感觉障碍、较高的肿瘤体积以及肿瘤向上鞍区扩展对影像学结果有负面影响。
本研究显示GKRS在术后和原发性GKRS患者中均具有较高的疗效和安全性。放射外科手术规划时实现良好的肿瘤覆盖率和等剂量线预测效果更佳。
