Multiple Modality Treatment Of Cranial Base Meningiomas Involving The Cavernous Sinus And Petroclival Region

Chain-Fa Su1, Tzu-Wen Loh2, Tsung-Lang Chiu2

1Hualien, Taiwan, Province Of China 2Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Buddhist Tzu Chi University, Hualien, Taiwan

Keywords: meningioma, cavernous sinus, gamma knife, skull base, resection

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     Surgical resection of cranial base meningiomas is often limited owing to involvement of crucial structures. Gamma Knife Radiosurgery (GKRS) has gained increasing importance as a treatment after the incomplete resection of tumor or as an alternative treatment to open surgery.
     We retrospectively analyzed our recent cases by the results in different modality treatments.
     Between 2002 and 2008, we treated 42 cases of cranial meningiomas involving the petroclival and/or cavernous sinus region of basal skull. (male:female ratio, 11:31, mean age: 55.6 yrs; range, 9-81 yrs). 
     In group I of 7 patients, only surgical resection was used. The surgical goal was set at the level to remove the tumor totally. In group II, 14 patients were treated with a combination of surgery and GKRS. The goal of surgical resection was mainly focusing on the petroclival region by taking out the tumors with compression of brain stem. Four cases were skull base extensive tumors (volume > 50 cc). Those patients were treated with volume-staged GKRS after operation (group IIa). The other 10 patients (group IIb) who were treated with GKRS after operation had the mean tumor volume of 9.75 cc (range 1-28.3), mean marginal dose 14.1 Gy (range, 12-18) and an isodose line of 50%. In group III, 21 patients were treated with GKRS alone. The mean tumor volume was 6 cc, mean marginal dose was 14 Gy and in most cases, the isodose line was set at the 50% with a mean of 49.6 %.
     In group I, two patients were expired within 6 months after surgical resection. In group II (mean follow up, 37.5 mos) and III (mean follow up, 36 mos) patients are kept in good Karnofsky Performance Status before and after the treatments.
     This is a retrospective study.
     We concluded that the urgent decompression by using the open surgery is mandatory in patients with basal meningiomas compressing the brain stem or optic apparatus.
     It is not necessary to remove the whole tumors whenever tumors involve the neurovascular structures because the excellent long term tumor control rate and the low morbidity rate in GKRS treatments can be achieved.


Project Roles:

C. Su (), T. Loh (), T. Chiu ()