Repeat gamma knife radiosurgery for cavernous sinus hemangiomas: A report of 3 cases

Background: Gamma knife radiosurgery(GKS) is well established in the management of cavernous sinus hemangiomas(CaSHs) alternative to microsurgery. Tumor regrowth is occasionally encountered and the role of repeat GKS in these situations is still unclear. Objective: The goal of this study was to investigate whether repeat GKS is an effective and safe treatment for recurrent CaSHs after initial GKS. Methods: Between January 2008 and November 2009, 42 patients haboring CaSHs were treated with GKS at Gamma Knife Center of Huashan Hospital. Of these, 2 patients had regrowth of residual tumor and 1 patient habored still large volume of tumor after initial GKS. Repeat GKS was performed in all these three patients, 2 of whom were female. Results: The median age was 41 (range, 7-54) years old. The median tumor volume was 8.98 ml and 5.80 ml at initial and second GKS, respectively. Patients received a median prescription dose of 13.5 Gy and 14.0 Gy at first and second treatments, respectively. The median follow-up was 130 (range, 122-149) months. The median follow-up period after repeat GKS was 31 (range, 27-48) months and median interval between these interventions was 99 (range, 74-122) months. At last follow-up, we report no cases of failure in repeat GKS for CaSHs. All three patients demonstrated again a significant reduction in tumor volume. The median tumor volume reduction was 83.6% (range, 73.1%-84.3%) and 54.3% (range, 45.3%-58.3%) after initial and repeat GKS treatments compared with the pre-GKS volumes, respectively. Post-GKS clinical improvement was achieved in all three patients (100%). No radiation-induced neurological deficits or delayed complications secondary to GKS were observed during the long follow-up period. Conclusion: Regrowing of remnant CaSHs after GKS can be detected during long-term follow-up. Repeat GKS represents a safe and effective treatment in patients harboring regrowth of CaSHs that have previously been treated with GKS.