1Gamma Knife Center Cairo.
2Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo.
J Neurosurg. 2023 Feb 17;139(3):780-789. doi: 10.3171/2023.1.JNS221951. Print 2023 Sep 1.
Meningiomas close to the optic pathway are commonly candidates for microsurgical decompression, more so if they are large perioptic meningiomas. However, microsurgery itself imposes risk to vision, and the larger the tumor, the more the risk and the lower the possibility of postoperative visual recovery. Fractionated stereotactic radiotherapy is usually reserved for such cases. The purpose of this study was to assess the long-term efficacy and safety of single-session stereotactic radiosurgery (SRS) for large (≥ 10 cm3) perioptic intracranial benign meningiomas.
This retrospective study included 175 patients with large perioptic benign meningiomas (≥ 10 cm3) who were treated by single-session SRS. Perioptic meningiomas were defined as meningiomas touching, compressing, or within 3 mm of the optic pathway. The median tumor volume was 15 cm3 (range 10-57.3 cm3, IQR 8.4 cm3). The median prescription dose was 12 Gy (range 9-14 Gy, IQR 1 Gy).
The median follow-up period was 72 months (range 13-217 months, IQR 65 months). The tumor control rate was 92%. The progression-free survival rates at 5 and 10 years were 97% and 80%, respectively. Favorable (better/stable) visual outcome was reported in 169 patients (97%) and unfavorable (worse) outcome in 6 patients (3%). Temporary adverse radiation effects were observed in 21 patients (12%), but only 7 patients (4%) were symptomatic. Sixty-three patients had a blind/nonuseful eye according to the pretreatment visual field examination. Visual improvement was observed in the blind/nonuseful eye in 17 patients (27%), while vision remained unchanged in 46 patients (73%). Ocular nerve palsy improved in 36 patients (61%). Tumor shrinkage was not a prerequisite for cranial nerve improvement.
SRS provides an effective and safe treatment option for large perioptic meningiomas.
靠近视路的脑膜瘤通常是显微减压手术的候选者，如果它们是大型眶内脑膜瘤，则更是如此。然而，显微手术本身对视功能有风险，肿瘤越大，风险越高，术后视力恢复的可能性越低。分次立体定向放射治疗通常保留用于此类病例。本研究的目的是评估单次立体定向放射外科（SRS）治疗大型（≥ 10 cm3）眶内颅内良性脑膜瘤的长期疗效和安全性。
本回顾性研究纳入了 175 例大型眶内良性脑膜瘤（≥ 10 cm3）患者，采用单次 SRS 治疗。眶内脑膜瘤定义为触及、压迫或距离视路 3mm 以内的脑膜瘤。肿瘤体积中位数为 15cm3（范围 10-57.3cm3，IQR 8.4cm3）。处方剂量中位数为 12Gy（范围 9-14Gy，IQR 1Gy）。
中位随访时间为 72 个月（范围 13-217 个月，IQR 65 个月）。肿瘤控制率为 92%。5 年和 10 年无进展生存率分别为 97%和 80%。169 例患者（97%）报告视力良好/稳定，6 例患者（3%）视力不佳。21 例患者（12%）出现暂时性放射性不良反应，但仅有 7 例患者（4%）出现症状。63 例患者根据术前视野检查为盲/无用眼。17 例患者（27%）的盲/无用眼视力改善，46 例患者（73%）视力保持不变。36 例患者（61%）的动眼神经麻痹改善。肿瘤缩小不是颅神经改善的先决条件。
SRS 为大型眶内脑膜瘤提供了一种有效且安全的治疗选择。
