Gamma Knife Radiosurgery for Cavernous Sinus Meningiomas: Analysis of Outcome in 166 Patients.

OBJECTIVES: The outcomes of Gamma Knife radiosurgery (GKRS) for cavernous sinus meningioma (CSM) are presented, and factors possibly affecting outcome are investigated. METHODS: The medical records and imaging and procedural reports of 166 patients with CSM were retrospectively reviewed. Demographic data, procedural data, symptomatic improvement, radiological regression, and progression-free survival (PFS) rates were evaluated. RESULTS: There were 124 women and 42 men; including 44 postoperative and 122 primary GKRS cases. Mean follow-up was 32.4 months. Mean marginal dose was 13 Gy. Symptomatic improvement was seen in 40.4%, while neurologic deterioration occurred in 9.6%; 50% remained symptomatically stable. Radiological regression was noted in 57.2%; the tumor remained stable in 35.5%, and 7.2% of the patients experienced tumor progression. The actuarial 5- and 10-year PFS rates were 90.1% (±3.3) and 75.8% (±8.8), respectively. History of previous surgery or radiotherapy were associated with lower symptomatic improvement. Higher tumor coverage and isodose lines were accompanied with better radiological prognosis. However, a history of conventional radiotherapy, presence of facial sensory deficits at presentation, a higher tumor volume, and tumor extension to the suprasellar compartment affected the radiologic outcome negatively. CONCLUSION: This study revealed a high efficacy and safety for GKRS in both postoperative and primary GKRS patients. Achievability of a good profile of tumor coverage and isodose lines at radiosurgical planning predict a better outcome.

Gamma Knife stereotactic radiosurgery for cerebellopontine angle meningioma.

OBJECTIVE: Meningiomas comprise 6-15 % of cerebellopontine angle (CPA) tumors. Surgical treatment is a real challenge because this area is occupied by several critical neurovascular elements. Currently, surgery is the first choice of treatment, however several factors may be present that necessitate choosing the alternative treatments such as Gamma Knife Stereotactic Radiosurgery (GKS). PATIENTS AND METHODS: Ninety-three patients with CPA meningioma who were treated by GKS for a period of 8 years, were retrospectively reviewed. Factors affecting clinical and radiological improvement were analyzed. RESULTS: The median tumor volume was 6 cm3. The mean values for maximal and marginal dose were 20.2 and 13.6 Gy, respectively. The mean follow-up time was 31.5 months. Tumor control (lack of progression) was achieved in 96.8% of the patients and 55.9% of the patients showed tumor regression on follow-up MRI. The actuarial 3-year progression-free survival (PFS) rate was 96%. Clinical improvement was seen in 49.5% of the patients while 11.8% experienced worsening or new-onset symptoms. Adverse radiation effects were seen in 4.3% of the patients. A worse symptomatic outcome, male sex, a lower tumor coverage, and marginal doses <13.5 Gy were associated with worse radiologic outcomes. Worse radiologic outcomes and higher tumor volumes, especially tumor volumes ≥8.5 cc, were associated with worse symptomatic outcomes. The male sex was associated with a lower PFS. CONCLUSION: Gamma Knife radiosurgery, either primarily or post- operatively, offers a decent long-term tumor control in CPA meningioma, and is associated with an acceptable complication profile, especially in tumors with lower volumes.

Penetrating brain injury with a metal bar and a knife: Report of two interesting cases.

Introduction Penetrating brain injury (PBI) is uncommon among the civilian population. Here, we report two interesting cases of PBI. Case presentation The first patient was a 20-year-old male who sustained a penetrating head injury with a metal bar during an accident at work. The patient underwent early surgical intervention, and related meningitis was treated with antibiotics. The patient was discharged 45 days later with no deficit. The second patient was a 34-year-old male who was the victim of a violence attack and was admitted to hospital. He was struck by a knife to his right temporal bone. A brain computed tomography scan and magnetic resonance imaging (MRI) demonstrated the tract of the knife within the brain parenchyma. The patient underwent conservative treatment. After several weeks, the patient was discharged in good health. Conclusion Although severe PBI has a poorer prognosis than a blunt brain injury, in treating of these patients, aggressive and timely surgical intervention, proper wide-spectrum antibiotic administration, stringent and diligent care in the intensive-care unit and careful management of the associated complications are mandated.

Gamma Knife Radiosurgery in Sphenopetroclival Meningiomas: Preliminary Experience at the Iran Gamma Knife Center.

OBJECTIVE: The aims of this study were to characterize the epidemiologic, histologic, and radiologic aspects of sphenopetroclival meningiomas (SpPCMs) and to evaluate the outcome of Gamma Knife radiosurgery (GKRS) either as an adjunct to microsurgery or as a primary SpPCM treatment modality. METHODS: In this retrospective study, medical records of patients with SpPCM who underwent GKRS at the Iran Gamma Knife Center between April 2003 and March 2012 were analyzed. RESULTS: We assessed 122 patients with SpPCMs, including 101 women and 21 men, aged 24-94 years. The mean tumor volume was 12.24 ± 9.30 mL. Patients received 22.32 ± 3.29 Gy and 13.18 ± 1.02 Gy maximal and average marginal dose of GKRS, respectively. The most common complaint was visual impairment, followed by facial sensory impairment and headache. The most frequently involved cranial nerves were III, IV, and VI in 72.1% of patients, followed by II in 52.9%, and V in 35.5%. After radiosurgery, headaches improved in 90.0%, diplopia in 75.0%, and ptosis in 63.0% of patients. On magnetic resonance imaging, tumor size was reduced, unchanged, or increased in 77, 44, and 1 patient, respectively. Progression-free survival at the 5-year follow-up was 56.6%. Younger age (hazard ratio = 0.972, P = 0.011) and lower tumor volume (hazard ratio = 0.959, P = 0.009) were the main prognostic factors for progression-free survival. CONCLUSION: GKRS can be an effective alternative treatment for controlling the progression of SpPCM tumors, producing appropriate clinical outcomes and few complications.