Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
Department of Neurological Surgery, Rambam Health Care Campus, Haifa, Israel.
Neurosurgery. 2019 Nov 1;85(5):E889-E899. doi: 10.1093/neuros/nyz126.
Some patients are diagnosed with asymptomatic meningioma(s) after undergoing a screening CT and MRI for minor ailments or postresection.
To help clinicians in decision making for treatment of asymptomatic meningiomas.
A single center retrospective cohort study of 117 patients with 122 tumors treated with Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden). Patients were followed with longitudinal imaging and clinical evaluations. Tumor volumetry and developments of new signs or symptoms after GKRS were the end points in the study.
Median patient age at GKRS was 60 yr (range 21-86 yr) with a median clinical follow-up of 53 mo (range 20-252 mo). The median pre-GKRS tumor volume was 3.6 ± 3.8 cc (±standard deviation). Tumors were treated with a median margin dose of 14 ± 2 Gy. At last follow-up, median tumor volume was 2.5 ± 3.6 cc. Radiological progression-free survival (PFS) rates were 97% and 94.4% at 5 yr and 10 yr, respectively. Clinical PFS rates were 86% and 70% at 5 yr and 10 yr, respectively. Development of neurological complications was seen in 21 (18%) patients, and 11 (52%) of them had undergone surgical resection prior to GKRS.
GKRS is a reasonable treatment strategy for asymptomatic meningiomas and compares favorably to natural history studies in terms of tumor control and neurological preservation. It results in relatively low morbidity in previously untreated meningiomas and serves as an appealing alternative treatment modality for recurrent meningiomas in asymptomatic patients.
一些患者在因小病或术后接受 CT 和 MRI 筛查后被诊断为无症状脑膜瘤。
为临床医生治疗无症状脑膜瘤的决策提供帮助。
对 117 例 122 个肿瘤患者进行单中心回顾性队列研究，这些患者均接受了伽玛刀放射外科治疗（GKRS；Elekta AB，斯德哥尔摩，瑞典）。对患者进行了纵向影像学和临床评估。肿瘤体积测量和 GKRS 后新发症状或体征的发展是本研究的终点。
GKRS 时患者的中位年龄为 60 岁（范围 21-86 岁），中位临床随访时间为 53 个月（范围 20-252 个月）。GKRS 前肿瘤体积中位数为 3.6±3.8cc（±标准差）。肿瘤接受了中位边缘剂量 14±2Gy 的治疗。末次随访时，肿瘤体积中位数为 2.5±3.6cc。放射学无进展生存率（PFS）在 5 年和 10 年时分别为 97%和 94.4%。临床 PFS 在 5 年和 10 年时分别为 86%和 70%。21 例（18%）患者出现神经并发症，其中 11 例（52%）患者在 GKRS 前已接受手术切除。
GKRS 是治疗无症状脑膜瘤的合理治疗策略，在肿瘤控制和神经保留方面与自然史研究相比具有优势。它导致未经治疗的脑膜瘤的发病率相对较低，是无症状患者复发性脑膜瘤的一种有吸引力的替代治疗方式。
