Gamma knife radiosurgery in skull base meningiomas - Preliminary experience with 50 cases

Gamma Knife radiosurgery was performed on 50 patients (10 males and 40 females) with skull base meningiomas (SBMs) between February 1993 and September 1995. The patients ranged in age from 25 to 78 years (mean age 56 years). The location of the tumors was anterior fossa (n = 4), sphenoorbital (n = 2), sellar region (n = 5), cavernous sinus (n = 26), petroclival (n = 12), and occipital foramen (n = 1). The tumor volume ranged from 0.6 to 20 cm(3) (mean 8.6 cm(3)). The mean values for dose planning were edge isodose (EI) 46.7%, edge dose (ED) 18.0 Gy, maximum dose 39.8 Gy, average dose (AD) 25.3 Gy, and average number of isocentres 5.7. The patients were analyzed for five parameters: tumor volume (<7.5 vs. greater than or equal to 7.5 cm(3)); EI (<50 vs. greater than or equal to 50%); ED (<18 vs. greater than or equal to 18 Gy); AD (<25 vs. greater than or equal to 25 Gy), and primary versus residual or recurrent tumors. The overall frequency of tumor growth control (TGC) was 98%, with 1- and 2-year TGC rates of 97% and 100%, respectively. The most favorable neurological results were obtained with a tumor volume <7.5 cm(3) (p<0.05), EI greater than or equal to 50% (NS), ED greater than or equal to 18 Gy (NS) and with primary SBMs (p<0.01). A favorable TGC was demonstrated at follow-up imaging examinations when the tumor volume was greater than or equal to 7.5 cm(3) (100% TGC rate), EI <50% (100%), ED greater than or equal to 18 Gy (100%), AD >25 Gy (100%), in both primary SBMs (100%) and residual or recurrent SBMs (96.5%). To date, only 3 (6%) of the 50 patients have presented signs of neurological worsening related to the Gamma Knife radiosurgery. While no early complications were noted, neuroradiological follow-up did show delayed transient imaging complications (3 edema and 1 radionecrosis; 8% of all patients). In conclusion, our preliminary results seem to confirm that Gamma Knife radiosurgery is an effective and safe adjuvant or a feasible alternative primary treatment in controlling or preventing SBM progression.