Plenary Oral Presentations - Macquarie University Hospital

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16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaBE-28Gamma Knife Radiosurgery for the Management of GlomusTumors: A Multicenter Study1Jason Sheehan, 9 Shota Tanaka, 2 Michael J Link, 3 Douglas Kondziolka, 4 David Mathieu,5Christopher Duma, 6 A. Byron Young, 7 Anthony M Kaufmann, 8 Heyoung McBride,1Zhiyuan Xu, 3 L. Dade Lunsford1University of Virginia, 2 Mayo Clinic, 3 University of Pittsburg, 4 University of Sherbrooke,5Hoag Memorial Hospital, 6 University of Kentucky, 7 University of Manitoba,8Barrow Neurological Institute and Arizona Oncology Services Foundation,9Massachusetts General Hospital,Objective: Glomus tumors are rare skull base neoplasms that frequently involve critical cerebrovascularstructures and lower cranial nerves. Complete resection is often difficult and may increase cranialnerve deficits. Stereotactic radiosurgery has gained an increasing role in the management of patientswith glomus tumors. This study examines the outcomes after radiosurgery in a large, multicenterpatient population.Methods: Under the auspices of the North American Gamma Knife Consortium (NAGKC), eightGamma Knife radiosurgery (GKRS) centers that treat glomus tumors retrospectively combined theiroutcome data. One hundred and thirty four patients were included in the study. Prior resection wasperformed in 51 patients and prior fractionated external beam radiotherapy was performed in sixpatients. Median age at the time of radiosurgery was 59 years. Forty percent of patients had pulsatiletinnitus at the time of radiosurgery. Patients received a median dose of 15 Gy to the tumor margin.The median follow-up was 50.5 months (range 5 to 220 months).Results: Overall tumor control was achieved in 93% of patients at last follow up; actuarial tumorcontrol was 88% at 5 years post-radiosurgery. The absence of trigeminal nerve dysfunction at the timeof radiosurgery (p=0.001), and higher number of isocenters (p=0.005) were statistically associatedwith progression free tumor survival. Those demonstrating new or progressive cranial nerve deficitswere also likely to demonstrate tumor progression (p=0.002). Pulsatile tinnitus improved in 49% ofpatients who demonstrated it at presentation. New or progressive cranial nerve deficits were noted in15% of patients; improvement in pre-existing cranial nerve deficits was observed in 11% of patients.No patient died as a result of tumor progression.Conclusions: Gamma Knife radiosurgery was a well tolerated management strategy that provided ahigh rate of long term glomus tumor control. Symptomatic tinnitus improved in almost one half of thepatients. Overall neurological status and cranial nerve function were preserved or improved in the vastmajority of patients after radiosurgery.2
16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaBE-30Gamma Knife Radiosurgery of Skull Base Meningiomas:Analysis of Long-Term ResultsJason SheehanDepartment of Neurological Surgery, University of VirginiaObjective: Skull base meningiomas are challenging tumors owing in part to their close proximity toimportant neurovascular structures. Complete microsurgical resection can be associated with significantmorbidity, and recurrence rates are not inconsequential. In this study, we evaluate the outcomesof skull base meningiomas treated with Gamma Knife radiosurgery (GKRS) both as an adjunct tomicrosurgery and as a primary treatment modality.Methods: We performed a retrospective review of a prospectively compiled database detailing theoutcomes of 290 patients with skull base meningiomas treated at the University of Virginia from1989 to 2006. All patients had a minimum follow-up of 24 months. There were 60 males and 230females with a median age of 55 years (range 19-85). One hundred sixty one patients were treatedwith upfront radiosurgery, and 129 patients were treated following surgical resection. Factors predictiveof new neurological deficit following GKRS were assessed via univariate and multivariateanalysis, and Kaplan-Meier analysis and Cox multivariate regression analysis was used to assessfactors predictive of tumor progression.Results: Patients had meningiomas centered over the tentorium (35; 12%), cerebellopontine angle(43; 15%), petroclival region (28; 10%), petrous region (6; 2%), clivus (40; 14%), and parasellar(138; 48%). The median follow-up was 6.3 years (range 2-18 years). The mean pre-radiosurgerytumor volume was 6.6 cc.251 patients (87%) displayed no change or decrease in tumor volume, and 39 (13%) displayed anincrease in volume. Kaplan Meier analysis demonstrated radiographic progression free survival at 3,5, and 10 years to be 99%, 95%, and 78% respectively. Pre-GKRS covariates associated with tumorprogression include age great then 65 (p=0.001) and decreasing dose to the margin of the tumor(p=0.05).At last clinical follow-up, 263 patients (91%) demonstrated no change or improvement in theirneurological condition and 27 patients deteriorated (9%). In multivariate analysis, the factorspredictive of new or worsening symptoms were increasing follow up (p=0.01), decreasing maximumdose (p=0.019), tumor progression (p=0.001), and parasellar, clival, or petrous location versuscerebellopontine angle, petroclival or tentorial location (p=0.018).Conclusions: GKRS offers a high rate of tumor control and neurological preservation in patients withskull base meningiomas. More favorable outcomes were observed for those receiving an optimalradiosurgery dose and harboring tumors located in a cerebellopontine angle, petroclival or tentoriallocation.3
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Author IndexAAhluwalia Manmeet 49,
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RRadatz Matthias 12, 16Radatz Matth
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