Gamma Knife Radiosurgery For Cavernous Sinus Meningiomas: Experience In Han Subjects Of Southwestern China

Heng Wan1, Ohye Chihiro2, Davin Cuker3, Shubin Yuan4, Wei Wang5

1Chengdu, China 2China Hidaka Hospital 3Harvard Medical School 4Chengdu Air-force 452 Hospital 5West China hospital

Keywords: cavernous sinus, outcome, meningioma, radiosurgery, vision

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     Stereotactic radiosurgery has emerged as an important treatment modality in the management of cavernous sinus meningiomas in China.
     The goal of this research is to define accurately the efficacy, safety, complications, and role of stereotactic radiosurgery for treatment of cavernous sinus meningiomas especially in Han subjects.
     Between 1999 and 2004 a total of 186 patients with cavernous sinus meningiomas treated with the Leksell Gamma Knife (LGK) and with at least 48 months of follow-up data were identified. In 114 of these patients some form of prior treatment such as partial resection had been conducted. The others 72 were deemed ineligible for microsurgery because of body health or private choice, and LGK served as the primary treatment modality.
     The tumor volume ranges from 1.3 to 128.6 cm3, the median isodose line ranges from 40% to 60%, the marginal dose ranges from 7 to 18Gy, the tumor radiation dose ranges from 16 to 40Gy. Neurofunctional, ophthalmological, and neuroradiological responses were evaluated.
     All patients were followed up from 48 to 90 months with imaging exam once per year. LGK was tolerated well in these patients. 93 patients had transient headaches, 11 patients suffered transient visual impairment, 13 patients developed trigeminal and eye movement disturbances and 4 patients came up with transient pituitary endocrine deficiency. Tumor effacement was observed in 24 (12.9%), tumor regression was observed in 74 (39.8%), and growth was unchanged in 52 (27.9%). Regrowth or recurrence occurred in 36 (19.4%). The tumor growth control rate of long term follow-up following the Sekhar classification as Sekhar I, II, III, IV and V were 91.9%, 84.0%, 72.7%, 50.0% and 33.3%, respectively. Patients who underwent LGK as the initial treatment experienced statistically significant improvement of their nerve function and clinical symptoms.
     This is a retrospective study.
     LGK is safe and effective in treating cavernous sinus meningiomas. None of the patients in our study suffered death related with LGK.
     LGK may serve as a primary treatment method in some or as a salvage treatment in the others. However, treatment must be tailored to meet the patient’s symptoms, tumor location, tumor morphometry, and overall health.


Project Roles:

H. Wan (), O. Chihiro (), D. Cuker (), S. Yuan (), W. Wang ()