Abstract Date: 4/8/2014
Jason P. Sheehan, MD, PhD (Charlottesville, VA)
Robert Starke (Charlottesville)
Hideyuki Kano (Pittsburgh)
Anthony Kaufmann (Winnipeg)
David Mathieu (Sherbrooke)
Michael West (Winnipeg)
Gandhi Varma (Cleveland)
James Yu (New Haven)
Norissa Honea (Phoenix)
Douglas Kondziolka (New York)
Robert Bailey (Philadelphia)
Paula Petti (Fremont)
Lawrence Lunsford (Pittsburgh)
Parasellar and sellar meningiomas are challenging tumors owing in part to their close proximity to important neurovascular and endocrine structures. Complete resection can be associated with significant morbidity, and incomplete resections are common. We evaluate the outcomes of parasellar and sellar meningiomas managed with Gamma Knife radiosurgery (GKRS).
A 10 center study of benign sellar and parasellar meningioma patients was conducted through the North American Gamma Knife Consortium. From a period of 1988 to 2011, 763 GKRS patients with sellar and/or parasellar meningiomas were identified. The median follow up was 66.7 months (range 6 to 216 months). Three-hundred and fifty-five (50.7%) underwent at least one prior resection, and 3.9% had prior radiation therapy (RT). Factors predictive of new neurological deficits following GKRS were assessed via univariate and multivariate analysis. Kaplan-Meier and Cox regression analyses were used to assess factors predictive of tumor progression.
Overall, tumor volumes remained stable or decreased in 90.2% of patients. Actuarial progression free survival rates at 3, 5, 8 and 10 years were 98%, 95%, 88%, and 82%, respectively. More than one prior surgery, prior RT, or a margin dose less than 13 Gy significantly increased the likelihood of tumor progression after GKRS.
At last clinical follow-up, 86.2% of patients demonstrated no change or improvement in their neurological condition whereas 13.8% of patients experienced progression of symptoms. New or worsening cranial nerve deficits were seen in 9.6% of patients with CN V being the most adversely affected nerve. Cranial nerve functional improvement (especially in CN V and VI) was observed in 34% of patients with pre-existing deficits. New or worsened endocrinopathies were demonstrated in 1.6% of patients. Unfavorable outcome with tumor growth and accompanying neurological decline was statistically more likely in those patients with larger tumor volumes (p=0.022) and more than 1 prior surgery (p=0.021).
GKRS provides a high rate of tumor control for patients with parasellar or sellar meningiomas; it is accompanied by neurological preservation or improvement in most patients.
Article ID: AA-28575