Post-radiosurgical edema associated with parasagittal and parafalcine meningiomas: a multicenter study.
Stereotactic radiosurgery (SRS) offers a high degree of tumor control for benign meningiomas. However, radiosurgery can occasionally incite edema or exacerbate pre-existing peri-tumoral edema. The current study investigates the incidence, timing, and extent of edema around parasagittal or parafalcine meningiomas following SRS. A retrospective multicenter review was undertaken through participating centers in the International Gamma Knife Research Foundation (previously the North American Gamma Knife Consortium or NAGKC). All included patients had a parafalcine or parasagittal meningioma and a minimum of 6 months follow up. The median follow up was 19.6 months (6-158 months). Extent of new or worsening edema was quantitatively analyzed using volumetric analysis; edema indices were longitudinally computed following radiosurgery. Analysis was performed to identify prognostic factors for new or worsening edema. A cohort of 212 patients comprised of 51.9 % (n = 110) females, 40.1 % upfront SRS and 59.9 % underwent adjuvant SRS for post-surgical residual tumor. The median tumor volume at SRS was 5.2 ml. Venous sinus compression or invasion was demonstrated in 25 % (n = 53). The median marginal dose was 14 Gy (8-20 Gy). Tumor volume control was determined in 77.4 % (n = 164 out of 212 patients). Tumor edema progressed and then regressed in 33 % (n = 70), was stable or regressed in 52.8 % (n = 112), and progressively worsened in 5.2 % (n = 11). Tumor location, tumor volume, venous sinus invasion, margin, and maximal dose were found to be significantly related to post-SRS edema in multivariate analysis. SRS affords a high degree of tumor control for patients with parasagittal or parafalcine meningiomas. Nevertheless, SRS can lead to worsening peritumoral edema in a subset of patients such as those with larger tumors (>10 cc) and venous sinus invasion/compression. Long-term follow up is required to detect and appropriately manage post-SRS edema.
Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA. jps2f@virginia.edu.
Jason P
JP
Sheehan
Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA.
Or
O
Cohen-Inbar
University of Pennsylvania, Philadelphia, USA.
Rawee
R
Ruangkanchanasetr
Yale University, New Haven, USA.
S
S
Bulent Omay
Yale University, New Haven, USA.
Judith
J
Hess
Yale University, New Haven, USA.
Veronica
V
Chiang
Université de Sherbrooke and Centre de recherche du CHUS, Sherbrooke, Canada.
Christian
C
Iorio-Morin
University of Pennsylvania, Philadelphia, USA.
Michelle
M
Alonso-Basanta
Université de Sherbrooke and Centre de recherche du CHUS, Sherbrooke, Canada.
David
D
Mathieu
Beaumont Health System, Royal Oak, USA.
Inga S
IS
Grills
University of Pennsylvania, Philadelphia, USA.
John Y K
JY
Lee
Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA.
Cheng-Chia
CC
Lee
University of Pittsburgh, Pittsburgh, USA.
L
L
Dade Lunsford
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001929:Brain Edema / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects*; D055815:Young Adult
Edema; Gamma Knife; Meningioma; Radiosurgery