Gamma knife radiosurgery for benign tumors with symptoms from brainstem compression.
OBJECTIVE
This study evaluated the role of radiosurgery in the management of symptomatic patients with brainstem compression from benign basal tumors.


METHODS
Over a 17-year, period 246 patients (202 vestibular schwannomas and 44 meningiomas) with brainstem compression from benign skull-base tumors were managed with Gamma Knife radiosurgery. Median tumor volumes were 3.9 cm(3) (range, 0.8-39.0 mL) and 6.6 mL (range, 1.6-25.1 mL) for vestibular schwannomas and meningiomas, respectively. For both tumors, a median marginal dose of 13 Gy was prescribed. Median follow-up of patients was 65 months for vestibular schwannomas and 60 months for meningiomas. Patients were categorized into four groups on the basis of the tumor-brainstem relationship on neuroimaging.


RESULTS
Preservation of function was stratified according to grade of brainstem compression. We analyzed the effect of radiosurgery on symptoms of brainstem compression. The tumor control rate was 100 % for meningioma and 97% for vestibular schwannomas (although 5% required an additional procedure such as a ventriculoperitoneal shunt). In patients with vestibular schwannoma, serviceable hearing was preserved in 72.0%. Balance improved in 31.9%, remained unchanged in 56.5%, and deteriorated in 11.6% of patients who had imbalance at presentation. Balance improved significantly in patients who had less tumor compression (p = 0.0357) after radiosurgery. Symptoms improved in 43.2% of patients with meningioma.


CONCLUSIONS
Radiosurgery is a minimally invasive option for patients with benign basal tumors that indent or distort the brainstem. A high tumor growth control rate and satisfactory rate of neurological preservation and symptom control can be obtained with radiosurgery.
Nakaya
Kotaro
K
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Niranjan
Ajay
A
Kondziolka
Douglas
D
Kano
Hideyuki
H
Khan
Aftab A
AA
Nettel
Barbara
B
Koebbe
Christopher
C
Pirris
Stephen
S
Flickinger
John C
JC
Lunsford
L Dade
LD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001933:Brain Stem; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*; D018709:Statistics, Nonparametric; D055815:Young Adult