Rueß Daniel, Fritsche Fenja, Grau Stefan, Treuer Harald, Hoevels Mauritius, Kocher Martin, Baues Christian, Ruge Maximilian I
Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University Hospital Cologne, Cologne, Germany.
Department of General Neurosurgery, Center of Neurosurgery, University Hospital Cologne, Cologne, Germany.
J Neurol Surg B Skull Base. 2020 Apr;81(2):158-164. doi: 10.1055/s-0039-1683430. Epub 2019 Mar 12.
Microsurgical resection of cavernous sinus meningiomas (CSM) is associated with a high rate of incomplete resection, recurrence, and the risk for permanent, severe cranial nerve deficits. Stereotactic radiosurgery (SRS) has evolved as alternative treatment for primary and recurrent CSM. Here, we report about the long-term clinical and radiological follow-up (FU) of a unique cohort of patients with CSM treated with LINAC or Cyberknife based SRS. In this single-center retrospective analysis, we include all patients with CSM who underwent single fraction SRS between 1993 and 2016. Clinical and radiological tumor control were evaluated by the Kaplan-Meier method. Additionally, patient data were analyzed in terms of symptom control and incidence of side effects rated by the common terminology criteria for adverse events (CTCAE; v4.03). 116 patients (female/male = 91/25; median age, 54 years; range, 33-82 years) were included. Mean tumor volume was 5.7 ± 3.3 cm (range, 0.6-16.2 cm ), the median marginal dose was 12.6 Gy applied to isodose levels of 75%. Median clinical FU was 55 months (range, 3-226 months). Tumor control was 98% after 2 and 5 years and 90% after 10 years. Twelve patients (10.3%) had permanent or transient radiation related toxicity (CTCAE I-III). An improvement of symptoms was observed in 26.7% of the symptomatic patients ( = 20 of 75). SRS for CSM provides excellent long-term tumor and symptom control without considerable permanent side effects. Thus, SRS should be considered when counseling patients suffering from CSM.
海绵窦脑膜瘤（CSM）的显微手术切除与不完全切除率高、复发率高以及永久性严重脑神经功能缺损风险相关。立体定向放射外科（SRS）已发展成为原发性和复发性CSM的替代治疗方法。在此，我们报告一组接受基于直线加速器（LINAC）或射波刀的SRS治疗的CSM患者的长期临床和影像学随访（FU）情况。
在这项单中心回顾性分析中，我们纳入了1993年至2016年间接受单次分割SRS治疗的所有CSM患者。采用Kaplan-Meier法评估临床和影像学肿瘤控制情况。此外，根据不良事件通用术语标准（CTCAE；v4.03）对患者数据进行症状控制和副作用发生率分析。
共纳入116例患者（女性/男性=91/25；中位年龄54岁；范围33 - 82岁）。平均肿瘤体积为5.7±3.3 cm³（范围0.6 - 16.2 cm³），中位边缘剂量为12.6 Gy，等剂量线为75%。中位临床随访时间为55个月（范围3 - 226个月）。2年和5年后的肿瘤控制率为98%，10年后为90%。12例患者（10.3%）出现永久性或暂时性放疗相关毒性（CTCAE I - III级）。75例有症状患者中有26.7%（20例）症状得到改善。
CSM的SRS提供了出色的长期肿瘤和症状控制，且无明显永久性副作用。因此，在为CSM患者提供咨询时应考虑SRS。
