Subach B R, Lunsford L D, Kondziolka D, Maitz A H, Flickinger J C
Department of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pennsylvania, USA.
Neurosurgery. 1998 Mar;42(3):437-43; discussion 443-5. doi: 10.1097/00006123-199803000-00001.
To evaluate the role of stereotactic radiosurgery in the management of petroclival meningiomas, we retrospectively reviewed our experience with 62 patients managed at the University of Pittsburgh during an 8-year period.
All patients had cranial base meningiomas involving the region between the petrous apex and the upper two-thirds of the clivus. Some tumors extended into the cavernous sinus. Each of 39 patients (63%) had previously undergone one or more attempts at surgical resection. Seven patients (11%) had received fractionated external beam radiation therapy. Using the gamma knife, conformal multiple isocenter radiosurgery was performed with tumor margin doses of 11 to 20 Gy.
During the median follow-up period of 37 months, neurological statuses improved in 13 patients (21%), remained stable in 41 patients (66%), and eventually worsened in 8 patients (13%). Tumor volumes decreased in 14 patients (23%), remained stable in 42 patients (68%), and increased in 5 patients (8%). Despite the proximity of these tumors to critical neural and vascular structures, complications resulting from radiosurgery were rare. Five patients (8%) developed new cranial nerve deficits within 24 months of radiosurgery, although none had evidence of tumor progression. These deficits resolved completely in two patients within 6 months of onset.
Although an even longer follow-up period is desirable, we conclude that stereotactic radiosurgery provides a safe and effective management strategy for petroclival meningiomas, both as a primary procedure and as an adjunct to incomplete resection.
