Image-Guided Multisession Radiosurgery of Skull Base Meningiomas.

Alfredo Conti,Salvatore M Cardali,Giuseppe Iatì,Diego Mazzatenta,Matteo Zoli,Antonio Pontoriero,Vittoria Rosetti,Sara Lillo,Silvana Parisi,Stefano Pergolizzi,Filippo Friso,Anna Brogna,Alberto Cacciola

doi:10.3390/cancers12123569

Abstract

Simple SummaryStereotactic radiosurgery has changed the landscape of treatment for skull base meningiomas. Lesions encasing or compressing radiosensitive structures are considered not suitable for single session stereotactic radiosurgery because of the high risk of side effects. Multisession stereotactic radiosurgery can reduce these risks, allowing for normal tissue repair between fractions, while delivering a high dose per fraction. The aim of this study is to validate the role of multi-session stereotactic radiosurgery in the treatment of skull base meningiomas, through a retrospective analysis of 156 patients affected by skull base meningioma, treated at the University of Messina between 2008 and 2018. Our study suggests that multisession stereotactic radiosurgery represents a safe and effective profile in the treatment of skull base meningioma, providing a satisfactory local control and a low toxicity rate, together with patient comfort from a frameless procedure.Background: The efficacy of single-session stereotactic radiosurgery (sSRS) for the treatment of intracranial meningioma is widely recognized. However, sSRS is not always feasible in cases of large tumors and those lying close to critically radiation-sensitive structures. When surgery is not recommended, multi-session stereotactic radiosurgery (mSRS) can be applied. Even so, the efficacy and best treatment schedule of mSRS are not yet established. The aim of this study is to validate the role of mSRS in the treatment of skull base meningiomas. Methods: A retrospective analysis of patients with skull base meningiomas treated with mSRS (two to five fractions) at the University of Messina, Italy, from 2008 to 2018, was conducted. Results: 156 patients met the inclusion criteria. The median follow-up period was 36.2 ± 29.3 months. Progression-free survival at 2-, 5-, and 10- years was 95%, 90%, and 80.8%, respectively. There were no new visual or motor deficits, nor cranial nerves impairments, excluding trigeminal neuralgia, which was reported by 5.7% of patients. One patient reported carotid occlusion and one developed brain edema. Conclusion: Multisession radiosurgery is an effective approach for skull base meningiomas. The long-term control is comparable to that obtained with conventionally-fractionated radiotherapy, while the toxicity rate is very limited.

Highlights

We retrospectively reviewed the clinical, radiological, and surgical outcomes of patients with skull base meningiomas treated by multi-session stereotactic radiosurgery (mSRS) using a CyberKnife system, between January
Inclusion criteria: (I) histologically verified, or clinically and radiologically supposed diagnosis of WHO I meningioma, (II) age >18 years, (III) meningioma clearly originating from the base of the skull, (IV) irradiation schedule in multiple fractions, and (V) availability of complete pre- and post-operative clinical and radiological data
The patients’ characteristics were presented as percentages for the dichotomous data, and as means with standard deviations or medians with value ranges for continuous data

Summary

Introduction

Skull base meningiomas represent one of the greatest neurosurgical challenges, especially when they encase multiple neurovascular structures. The involvement of this critical structures makes complete surgical resection occasionally impossible or associated with a high risk of neurological sequelae. Multiple retrospective studies have shown the safety and efficacy of the SRS approach for meningiomas, highlighting its role in the upfront treatment of selected cases and as an adjuvant treatment for residual or recurrent tumors. The efficacy of single-session stereotactic radiosurgery (sSRS) for the treatment of intracranial meningioma is widely recognized. The aim of this study is to validate the role of mSRS in the treatment of skull base meningiomas.

Methods

Results

Discussion

Conclusion