Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients.
OBJECTIVE
In this study the authors sought to determine the neurological risks and potential clinical benefits of gamma knife radiosurgery for skull base meningiomas.


METHODS
A consecutive series of 88 patients harboring skull base meningiomas were treated between 1990 and 1996 by using the Leksell gamma knife in a prospective clinical study that included a strict dose-volume protocol. Forty-nine patients had previously undergone surgery, and six had received external-beam radiotherapy. The median treatment volume was 10 cm3, and the median dose to the tumor margin was 16 Gy. The radiosurgical dosage to the optic nerve, the cavernous sinus, and Meckel's cave was calculated and correlated with clinical outcome. The median patient follow-up time was 35 months (range 12-83 months). Two tumors (2.3%) progressed after radiosurgery; the progression-free 5-year survival rate was 95%. At last follow-up review, 60 (68%) tumors were smaller and 26 (29.5%) remained unchanged. Clinical improvement (in vision, trigeminal pain, or other cranial nerve symptoms) occurred in 15 patients. Functioning optic nerves received a median dose of 10 Gy (range 1-16 Gy), and no treatment-induced visual loss occurred. Among nine patients with new trigeminal neuropathy, six received doses of more than 19 Gy to Meckel's cave.


CONCLUSIONS
Gamma knife radiosurgery appeared to be an effective method to control the growth of most skull base meningiomas in this intermediate-term study. The risk of trigeminal neuropathy seemed to be associated with doses of more than 19 Gy, and the optic apparatus appeared to tolerate doses greater than 10 Gy. Considering the risks to cranial nerves associated with open surgery for comparable tumors, the authors believe that gamma knife radiosurgery is a useful method for the management of properly selected recurrent, residual, or newly diagnosed skull base meningiomas.
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
A
A
Morita
R J
RJ
Coffey
R L
RL
Foote
D
D
Schiff
D
D
Gorman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002426:Cavernous Sinus / Q000601:surgery; D003389:Cranial Nerve Diseases / Q000209:etiology; D020209:Cranial Nerve Injuries; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D009900:Optic Nerve / Q000601:surgery; D010579:Petrous Bone / Q000601:surgery; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects* / Q000295:instrumentation; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012307:Risk Factors; D019291:Skull Base / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000601:surgery