title: Does prior microsurgery improve or worsen the outcomes of stereotactic radiosurgery for cavernous sinus meningiomas?
abstract: BACKGROUND
  Stereotactic radiosurgery (SRS) is an important option for patients with cavernous sinus meningiomas.
  
  
  OBJECTIVE
  To evaluate cranial nerve outcomes in patients who underwent SRS for cavernous sinus meningiomas with or without prior microsurgery.
  
  
  METHODS
  During a 23-year interval, 272 patients underwent Gamma Knife SRS for cavernous sinus meningiomas (70 men, 202 women; median age, 54 years). In this series, 99 patients underwent prior microsurgical resection. The median tumor volume was 7.9 cm and median marginal dose was 13 Gy. The median follow-up period was 62 months (range, 6-209 months).
  
  
  RESULTS
  The progression-free survival after SRS was 96% at 3 years, 94% at 5 years, and 86% at 10 years. After SRS, 13 of 91 patients (14%) who underwent prior microsurgery had improvement of preexisting cranial nerve symptoms or signs. In comparison, 54 of 145 patients (37%) without prior microsurgery had improvement of preexisting cranial nerve symptoms or signs. The improvement rate of cranial nerve deficits after SRS in patients without prior microsurgery was 20% at 1 year, 34% at 2 years, 36% at 3 years, and 39% at 5 years. Patients who had not undergone prior microsurgery had significantly higher improvement rates of preexisting cranial nerve symptoms and signs (P = .001). After SRS, 29 patients (11%) developed new or worsened cranial nerve function.
  
  
  CONCLUSIONS
  SRS provided long-term effective tumor control and a low risk of new cranial nerve deficits. Improvement in preexisting cranial neuropathies was detected in significantly more patients who had not undergone prior microsurgical procedures.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. kanoh@upmc.edu
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kano
authors.forename: Kyun-Jae
authors.initials: KJ
authors.lastname: Park
authors.forename: Douglas
authors.initials: D
authors.lastname: Kondziolka
authors.forename: Aditya
authors.initials: A
authors.lastname: Iyer
authors.forename: Xiaomin
authors.initials: X
authors.lastname: Liu
authors.forename: Daniel
authors.initials: D
authors.lastname: Tonetti
authors.forename: John C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: L Dade
authors.initials: LD
authors.lastname: Lunsford
mesh_terms: D000328:Adult; D000368:Aged; D002426:Cavernous Sinus / Q000601:surgery*; D003389:Cranial Nerve Diseases / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality / Q000601:surgery*; D008579:Meningioma / Q000401:mortality / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult