title: Stereotactic radiosurgery of petroclival meningiomas: a multicenter study.
abstract: Petroclival meningiomas are difficult to treat due to their intimate location with critical structures, and complete microsurgical resection is often associated with significant morbidity. In this study, we evaluate the outcomes of petroclival meningiomas treated with Gamma Knife radiosurgery (GKRS) as an adjunct to microsurgery or a primary treatment modality. A multicenter study of 254 patients with a benign petroclival meningioma was conducted through the North American Gamma Knife Consortium. One hundred and forty patients were treated with upfront radiosurgery, and 114 following surgery. Multivariate analysis was used to determine predictors of favorable defined as no tumor progression following radiosurgery and the absence of any new or worsening neurological function. At mean follow up of 71 months (range 6-252), tumor volumes increased in 9 % of tumors, remained stable in 52 %, and decreased in 39 %. Kaplan-Meier actuarial progression free survival rates at 3, 5, 8, 10, and 12 years were 97, 93, 87, 84, and 80 % respectively. At last clinical follow-up, 93.6 % of patients demonstrated no change or improvement in their neurological condition whereas 6.4 % of patients experienced progression of symptoms. Favorable outcome was achieved in 87 % of patients and multivariate predictors of favorable outcome included smaller tumor volume (OR = 0.92; 95 % CI 0.87-0.97, p = 0.003), female gender (OR 0.37; 95 % CI 0.15-0.89, p = 0.027), no prior radiotherapy (OR 0.03; 95 % CI 0.01-0.36, p = 0.006), and decreasing maximal dose (OR 0.92; 95 % CI 0.96-0.98, p = 0.010). GKRS of petroclival meningiomas achieves neurological preservation in most patients and with a high rate of tumor control.
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Starke
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kano
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
authors.forename: Gene H
authors.initials: GH
authors.lastname: Barnett
authors.forename: David
authors.initials: D
authors.lastname: Mathieu
authors.forename: Veronica
authors.initials: V
authors.lastname: Chiang
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.forename: Judith
authors.initials: J
authors.lastname: Hess
authors.forename: Heyoung L
authors.initials: HL
authors.lastname: McBride
authors.forename: Norissa
authors.initials: N
authors.lastname: Honea
authors.forename: John Y K
authors.initials: JY
authors.lastname: Lee
authors.forename: Gazanfar
authors.initials: G
authors.lastname: Rahmathulla
authors.forename: Wendi A
authors.initials: WA
authors.lastname: Evanoff
authors.forename: Michelle
authors.initials: M
authors.lastname: Alonso-Basanta
authors.forename: L Dade
authors.initials: LD
authors.lastname: Lunsford
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sheehan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D016634:Radiosurgery; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult