Postoperative Gamma Knife surgery for benign meningiomas of the cranial base.
ABSTRACT The standard treatment for meningiomas is complete resection, but the proximity of skull base meningiomas to important neurovascular structures makes complete excision of the lesion difficult or impossible. The authors analyzed the mid- and long-term results obtained in patients treated with postresection Gamma Knife surgery (GKS) for residual or recurrent benign meningiomas of the cranial base.
Thirty-six patients with residual or recurrent benign meningiomas of the skull base following one or more surgical procedures underwent GKS. There were 31 women and five men, ranging in age from 22 to 73 years. The median tumor volume was 4.1 ml (range 0.8-20 ml) and the median radiation dose to the tumor margin was 16 Gy (range 15-16 Gy).
Patients were followed for a median of 81 months (range 30-141 months) after GKS. At the end of the follow-up period, overall neurological improvement was observed in 16 patients (44.4%), whereas the condition in 20 patients (55.6%) was unchanged. One patient suffered transient cerebral edema 6 months after GKS. Based on imaging documentation, a partial response was seen in five patients (13.9%), the disease remained stable in 30 patients (83.3%), and in one patient (2.8%) there was an increase in tumor size. The actuarial progression-free survival rate was 100% at 5 years and 94.7% at 10 years.
Gamma Knife surgery was shown to be an excellent adjunct to resection because of its durable rate of tumor control and low toxicity. It should be initially considered along with surgery for the treatment of complex skull base meningiomas.
Article: The dural tail sign.Radiology 11/2004; 233(1):56-7. · 6.34 Impact Factor
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ABSTRACT: Anticancer cytotoxic agents go through a process by which their antitumor activity-on the basis of the amount of tumor shrinkage they could generate-has been investigated. In the late 1970s, the International Union Against Cancer and the World Health Organization introduced specific criteria for the codification of tumor response evaluation. In 1994, several organizations involved in clinical research combined forces to tackle the review of these criteria on the basis of the experience and knowledge acquired since then. After several years of intensive discussions, a new set of guidelines is ready that will supersede the former criteria. In parallel to this initiative, one of the participating groups developed a model by which response rates could be derived from unidimensional measurement of tumor lesions instead of the usual bidimensional approach. This new concept has been largely validated by the Response Evaluation Criteria in Solid Tumors Group and integrated into the present guidelines. This special article also provides some philosophic background to clarify the various purposes of response evaluation. It proposes a model by which a combined assessment of all existing lesions, characterized by target lesions (to be measured) and nontarget lesions, is used to extrapolate an overall response to treatment. Methods of assessing tumor lesions are better codified, briefly within the guidelines and in more detail in Appendix I. All other aspects of response evaluation have been discussed, reviewed, and amended whenever appropriate.JNCI Journal of the National Cancer Institute 03/2000; 92(3):205-16. · 14.34 Impact Factor
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ABSTRACT: The optimal management for patients with cavernous sinus meningiomas remains controversial. We attempt to contribute to the ongoing debate of appropriate surgical indications. In this retrospective review, 39 patients, including 27 women and 12 men ranging in age from 24 to 73 years (median, 48 yr), underwent surgical treatment for this condition. Completeness of tumor resection, cranial nerve morbidity, general morbidity, and long-term outcome were studied. The cavernous internal carotid artery was partially encased in 15 patients, totally encased in 11 patients, and narrowed by tumor in 13 patients. Of eight patients who underwent complete tumor resection, seven had partial encasement of the internal carotid artery. Of 31 patients who underwent subtotal resection, 11 underwent postoperative radiotherapy. There were no deaths in the series. Morbidity was 17.9% for cranial nerves controlling extraocular motor function. Trigeminal nerve function did not improve after surgical treatment. The median follow-up period was 2 years (range, 6 mo-5.3 yr). Symptomatic and radiographic recurrence occurred in two patients who underwent complete tumor resection and in two patients who underwent subtotal resection. Based on our findings and a review of the literature, we conclude the following: 1) the resectability of meningiomas of the cavernous sinus depends on the degree of internal carotid artery involvement; 2) total excision of cavernous sinus meningiomas is possible but rarely achieved in holocavernous meningiomas; 3) cranial nerve morbidity is significant; and 4) subtotal excision with or without postoperative radiotherapy is an effective short-term oncological strategy.Neurosurgery 03/1997; 40(2):238-44; discussion 245-7. · 2.53 Impact Factor