Gamma knife radiosurgery for treatment of cavernous sinus meningioma patients in Tangerang, Indonesia: A preliminary study

Abstract

Background: Despite the advancement of microsurgery and other skull base techniques, complete resection of skull base meningiomas still remains a challenge for neuro-surgeons. The tumor in cavernous sinus meningioma is deep seated and total resection using open microsurgery can lead to various complications. The mortality and morbidity rates caused by total resection using open neurosurgery is still high. Over the past decade, there were many reports regarding the recurrence and progression rate of microsurgically treated cavernous sinus meningiomas. Gamma knife is an alternative which provides a more accurate and safer way of treating meningiomas. The aim of this study is to evaluate the tumor size and clinical symptoms in cavernous sinus meningi-oma patients after gamma knife radiosurgery. Method(s): This is a retrospective study that took place in Gamma Knife Centre Indonesia. We evaluated patients' clinical characteristics and tumor size pre and post gamma knife radiosurgery from 2012 to 2015. The data is presented in the form of descriptive statistics. Result(s): There was a total of 25 patients with skull base meningiomas, out of which 9 of them were located in the cavernous sinus area. There were 6 female and 3 male patients. The mean age of the patients was 50.6 (36-70) years. The mean follow-up time post-radiosurgery was 6.67 (4-12) months. The mean tumor volume before radiosurgery was 12.36 (1.51-34.45) cm3. The mean tumor volume after radiosurgery was 10.19 (0.98-28.80) cm3. The dose used was between 12 to 18 gray. Post-radiosurgery, clinical symptoms such as hypesthesia improved in 1 out of 2 patients (50%), seizures improved in 100% of patients, blurred vision improved in 2 out of 4 patients (50%), cranial nerve III, IV and VI function improved in 2 out of 4 patients (50%), headaches was no longer present in 50% patients and double vision improved in 100% of patients. Conclusion(s): Gamma knife radiosurgery reduces the tumor size and improves the clinical symptoms in patients with cavernous sinus meningiomas. However, large prospective studies should be done in order to further evaluate the long term effects of gamma knife for skull base meningiomas.