title: Protecting venous structures during radiosurgery for parasagittal meningiomas.
abstract: Symptomatic edema is a potential complication of meningioma radiosurgery. Parasagittal meningiomas are at a particular risk for symptomatic edema, suggesting a role for a venous occlusive complication. The authors sought to develop a strategy to optimize CyberKnife stereotactic radiosurgical treatment parameters to reduce the irradiation of the peritumoral venous system. Multislice CT venography with 3D reconstructions was performed and coregistered with thin-section, contrast-enhanced, volumetric MR images. The tumor and critical volumes were contoured on the MR images. Venous anatomical details obtained from the CT venographic study were then exported onto the MR imaging and fused MR imaging-CT study. Target and critical structure volumes and dosimetric parameters obtained with this method were analyzed. The authors found that reducing the irradiation of veins that course along the surface of the meningioma, which may be at risk for radiation-induced occlusion, is feasible in parasagittal meningioma radiosurgery without compromising other treatment parameters including conformality, homogeneity, and target coverage. Long-term follow-up is needed to assess the clinical validity of this treatment strategy.
authors.affiliation: Departments of Neurosurgery, University of Messina, Italy. alfredo.conti@unime.it
authors.forename: Alfredo
authors.initials: A
authors.lastname: Conti
authors.forename: Antonio
authors.initials: A
authors.lastname: Pontoriero
authors.forename: Ignazio
authors.initials: I
authors.lastname: Salamone
authors.forename: Carmelo
authors.initials: C
authors.lastname: Siragusa
authors.forename: Federica
authors.initials: F
authors.lastname: Midili
authors.forename: Domenico
authors.initials: D
authors.lastname: La Torre
authors.forename: Amedeo
authors.initials: A
authors.lastname: Calisto
authors.forename: Francesca
authors.initials: F
authors.lastname: Granata
authors.forename: Pantaleo
authors.initials: P
authors.lastname: Romanelli
authors.forename: Costantino
authors.initials: C
authors.lastname: De Renzis
authors.forename: Francesco
authors.initials: F
authors.lastname: Tomasello
mesh_terms: D000328:Adult; D001929:Brain Edema / Q000517:prevention & control; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000098:blood supply / Q000601:surgery*; D008579:Meningioma / Q000098:blood supply / Q000601:surgery*; D010690:Phlebography; D016634:Radiosurgery / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted; D012307:Risk Factors; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014680:Veins / Q000528:radiation effects