Skull Base Meningiomas in Patients with Neurofibromatosis Type 2: An International Multicenter Study Evaluating Stereotactic Radiosurgery

Overview

Journal J Neurol Surg B Skull Base

Publisher Thieme

Date 2022 Jul 14

PMID 35832959

Authors

Henry Ruiz-Garcia

Daniel M Trifiletti

Nasser Mohammed

Yi-Chieh Hung

Zhiyuan Xu

Tomas Chytka

Roman Liscak

Manjul Tripathi

David Arsanious

Christopher P Cifarelli

Marco Perez Caceres

David Mathieu

Herwin Speckter

Gautam U Mehta

Gregory P Lekovic

Jason P Sheehan

Affiliations

Soon will be listed here.

Abstract

Meningiomas are the second most common tumors in neurofibromatosis type 2 (NF-2). Microsurgery is challenging in NF-2 patients presenting with skull base meningiomas due to the intrinsic risks and need for multiple interventions over time. We analyzed treatment outcomes and complications after primary Gamma Knife radiosurgery (GKRS) to delineate its role in the management of these tumors. An international multicenter retrospective study approved by the International Radiosurgery Research Foundation was performed. NF-2 patients with at least one growing and/or symptomatic skull base meningioma and 6-month follow-up after primary GKRS were included. Clinical and radiosurgical parameters were recorded for analysis. In total, 22 NF-2 patients with 54 skull base meningiomas receiving GKRS as primary treatment met inclusion criteria. Median age at GKRS was 38 years (10-79 years). Most lesions were located in the posterior fossa (55.6%). Actuarial progression free survival (PFS) rates were 98.1% at 2 years and 90.0% at 5 and 10 years. The median follow-up time after initial GKRS was 5.0 years (0.6-25.5 years). Tumor volume at GKRS was a predictor of tumor control. Lesions >5.5 cc presented higher chances to progress after radiosurgery ( = 0.043). Three patients (13.64%) developed adverse radiation effects. No malignant transformation or death due to meningioma or radiosurgery was reported. GKRS is effective and safe in the management of skull base meningiomas in NF-2 patients. Tumor volume deserve greater relevance during clinical decision-making regarding the most appropriate time to treat. GKRS offers a minimally invasive approach of particular interest in this specific group of patients.

References

Birckhead B, Sio T, Pollock B, Link M, Laack N . Gamma Knife radiosurgery for neurofibromatosis type 2-associated meningiomas: a 22-year patient series. J Neurooncol. 2016; 130(3):553-560. DOI: 10.1007/s11060-016-2257-z. View

Pollock B, Stafford S, Link M . Gamma knife radiosurgery for skull base meningiomas. Neurosurg Clin N Am. 2000; 11(4):659-66. View

Nicolato A . 111Indium-octreotide brain scintigraphy: a prognostic factor in skull base meningiomas treated with gamma knife radiosurgery. Q J Nucl Med Mol Imaging. 2004; 48(1):26-32. View

Iwai Y, Yamanaka K, Ikeda H . Gamma Knife radiosurgery for skull base meningioma: long-term results of low-dose treatment. J Neurosurg. 2008; 109(5):804-10. DOI: 10.3171/JNS/2008/109/11/0804. View

Vermeulen S, Young R, Li F, Meier R, Raisis J, Klein S . A comparison of single fraction radiosurgery tumor control and toxicity in the treatment of basal and nonbasal meningiomas. Stereotact Funct Neurosurg. 2000; 72 Suppl 1:60-6. DOI: 10.1159/000056440. View

Kane A, Sughrue M, Rutkowski M, Shangari G, Fang S, McDermott M . Anatomic location is a risk factor for atypical and malignant meningiomas. Cancer. 2011; 117(6):1272-8. PMC: 3795515. DOI: 10.1002/cncr.25591. View

Kondziolka D, Mathieu D, Lunsford L, Martin J, Madhok R, Niranjan A . Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery. 2008; 62(1):53-8. DOI: 10.1227/01.NEU.0000311061.72626.0D. View

Lee S, Karas P, Hadley C, V J, Khan A, Jalali A . The Role of Merlin/NF2 Loss in Meningioma Biology. Cancers (Basel). 2019; 11(11). PMC: 6893739. DOI: 10.3390/cancers11111633. View

Pendl G, Schrottner O, Eustacchio S, Feichtinger K, Ganz J . Stereotactic radiosurgery of skull base meningiomas. Minim Invasive Neurosurg. 1997; 40(3):87-90. DOI: 10.1055/s-2008-1053423. View

10.

Kreil W, Luggin J, Fuchs I, Weigl V, Eustacchio S, Papaefthymiou G . Long term experience of gamma knife radiosurgery for benign skull base meningiomas. J Neurol Neurosurg Psychiatry. 2005; 76(10):1425-30. PMC: 1739368. DOI: 10.1136/jnnp.2004.049213. View

11.

Goutagny S, Bah A, Henin D, Parfait B, Bozorg Grayeli A, Sterkers O . Long-term follow-up of 287 meningiomas in neurofibromatosis type 2 patients: clinical, radiological, and molecular features. Neuro Oncol. 2012; 14(8):1090-6. PMC: 3408259. DOI: 10.1093/neuonc/nos129. View

12.

Bassiouni H, Asgari S, Stolke D . Tuberculum sellae meningiomas: functional outcome in a consecutive series treated microsurgically. Surg Neurol. 2006; 66(1):37-44. DOI: 10.1016/j.surneu.2005.11.059. View

13.

Park H, Lee J, Park K, Kim J, Jeong S, Kim J . Fractionated Gamma Knife Radiosurgery as Initial Treatment for Large Skull Base Meningioma. Exp Neurobiol. 2018; 27(3):245-255. PMC: 6050410. DOI: 10.5607/en.2018.27.3.245. View

14.

Gao F, Li M, Wang Z, Shi L, Lou L, Zhou J . Efficacy and Safety of Gamma Knife Radiosurgery for Meningiomas in Patients with Neurofibromatosis Type 2: A Long-Term Follow-Up Single-Center Study. World Neurosurg. 2019; 125:e929-e936. DOI: 10.1016/j.wneu.2019.01.211. View

15.

DiBiase S, Kwok Y, Yovino S, Arena C, Naqvi S, Temple R . Factors predicting local tumor control after gamma knife stereotactic radiosurgery for benign intracranial meningiomas. Int J Radiat Oncol Biol Phys. 2004; 60(5):1515-9. DOI: 10.1016/j.ijrobp.2004.05.073. View

16.

Liu A, Kuhn E, Lucas Jr J, Laxton A, Tatter S, Chan M . Gamma Knife radiosurgery for meningiomas in patients with neurofibromatosis Type 2. J Neurosurg. 2015; 122(3):536-42. PMC: 9168962. DOI: 10.3171/2014.10.JNS132593. View

17.

Aboukais R, Zairi F, Baroncini M, Bonne N, Schapira S, Vincent C . Intracranial meningiomas and neurofibromatosis type 2. Acta Neurochir (Wien). 2013; 155(6):997-1001. DOI: 10.1007/s00701-013-1692-2. View

18.

Evers S, Verbaan D, Sanchez E, Peerdeman S . 3D Volumetric Measurement of Neurofibromatosis Type 2-Associated Meningiomas: Association Between Tumor Location and Growth Rate. World Neurosurg. 2015; 84(4):1062-9. DOI: 10.1016/j.wneu.2015.05.068. View

19.

Reynolds M, Hawasli A, Murphy R, Ray W, Simpson J, Drzymala R . Acute Hemorrhage Following Gamma Knife Radiosurgery to a Clival Meningioma. J Spine Neurosurg. 2014; 2(2):108. PMC: 3998720. DOI: 10.4172/2325-9701.1000108. View

20.

Nakaya K, Chernov M, Kasuya H, Izawa M, Hayashi M, Kato K . Risk factors for regrowth of intracranial meningiomas after gamma knife radiosurgery: importance of the histopathological grade and MIB-1 index. Minim Invasive Neurosurg. 2010; 52(5-6):216-21. DOI: 10.1055/s-0029-1243244. View