title: Gamma knife radiosurgery for benign cavernous sinus tumors: treatment concept and outcomes in 120 cases.
abstract: Availability of modern computer-aided robotized devices, such as the Automatic Positioning System (APSTM; Elekta Instruments AB, Stockholm, Sweden) and PerfexionTM (Elekta Instruments AB), allowed us to develop the original concept of robotic gamma knife microradiosurgery, which is based on the very precise irradiation of the lesion with regard to conformity and selectivity; intentional avoidance of the excessive irradiation of functionally-important anatomical structures, particularly cranial nerves, located both within and in the vicinity of the target; and delivery of sufficient irradiation energy to the tumor with the intention to attain lesion shrinkage, while keeping the marginal dose sufficiently low for prevention of possible complications. The results of such treatment strategy were evaluated retrospectively in 120 patients with benign cavernous sinus neoplasms (pituitary adenomas, meningiomas, schwannomas, and hemangiomas), who were followed up from 24 to 78 months (mean 47 months) after radiosurgery. Tumor growth control and shrinkage rates were 98% and 68%, respectively. More than 50% volume reduction was noted in 25% of lesions. The most prominent volumetric tumor response was observed in hemangiomas, followed by schwannomas, pituitary adenomas, and meningiomas. Treatment-related complications were marked in 7% of cases, and were mainly related to transient isolated cranial neuropathy appearing within several months after radiosurgery. Major morbidity was limited to one patient (0.8%). Application of microradiosurgical treatment principles provides effective and safe management of benign cavernous sinus tumors and is associated with high probability of lesion shrinkage and minimal risk of complications.
authors.affiliation: Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan. GKRmoto@gmail.com
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Mikhail
authors.initials: M
authors.lastname: Chernov
authors.forename: Noriko
authors.initials: N
authors.lastname: Tamura
authors.forename: Manabu
authors.initials: M
authors.lastname: Tamura
authors.forename: Ayako
authors.initials: A
authors.lastname: Horiba
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Konishi
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Okada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Muragaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iseki
authors.forename: Kintomo
authors.initials: K
authors.lastname: Takakura
mesh_terms: D020434:Abducens Nerve Diseases / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D003390:Cranial Nerve Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D006392:Hemangioma, Cavernous / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D009442:Neurilemmoma / Q000175:diagnosis / Q000601:surgery*; D038361:Neuronavigation / Q000379:methods*; D015840:Oculomotor Nerve Diseases / Q000175:diagnosis / Q000601:surgery; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000473:pathology / Q000601:surgery