Document Detail


Aggressive surgery and focal radiation in the management of meningiomas of the skull base: preservation of function with maintenance of local control.
MedLine Citation:
PMID:  11534672     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Recent study series have reported that post-operative external beam radiation therapy and stereotactic radiosurgery with the linear accelerator or gamma knife improves long-term local control of subtotally resected or recurrent meningiomas. METHODS: Analysis of treatment results in 100 consecutive patients with skull base meningiomas managed by one surgeon with a median follow-up of five years. Treatment principles included observation for asymptomatic tumors; surgery for progressive or symptomatic tumors unless surgery was medically contraindicated or refused by the patient; to make surgery as aggressive as possible but with the goal of preserving full function of the patient; and to use radiosurgery or conformal fractionated radiation therapy if residual tumor was demonstrated. Preoperative, postoperative, and observational data were prospectively accumulated and stored in a large database system. Median follow up was 5 years with a range from 2 to 10 years. FINDINGS: The most frequent presenting symptoms were headache (45%) and changes in vision (29%). Cranial nerve deficits (49%) and cerebellar signs (24%) were the most common physical findings. Seventy-two patients had surgical resection. Of these, 93% had greater than 50% resection and 47% had radiographically complete resection. There were no perioperative deaths and there were five surgical complications for a rate of 7%. Complications included hemiparesis (2.8%), new cranial nerve palsy (2.8%), and indolent osteomyelitis (1.4%). Fifteen patients had observation only; none of who progressed. Thirteen patients had radiation only, primarily because of patient preference or medical contraindications to surgery in the setting of substantial symptoms. There were no complications of this therapy. With a median five-year follow-up, only one patient (1%) demonstrated tumor progression using the treatment paradigm outlined here. INTERPRETATION: These results demonstrate that skull base meningiomas which require treatment can be managed with a combination of aggressive surgery and conformal radiation with an acceptable functional status in 99% of cases.
Authors:
P M Black; A T Villavicencio; C Rhouddou; J S Loeffler
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta neurochirurgica     Volume:  143     ISSN:  0001-6268     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2001  
Date Detail:
Created Date:  2001-09-05     Completed Date:  2001-12-26     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  555-62     Citation Subset:  IM    
Affiliation:
The Brain Tumor Center at the Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Craniotomy
Diagnosis, Differential
Dose Fractionation
Female
Follow-Up Studies
Humans
Male
Meningeal Neoplasms / diagnosis,  physiopathology,  radiotherapy*,  surgery*
Meningioma / diagnosis,  physiopathology,  radiotherapy*,  surgery*
Middle Aged
Prospective Studies
Radiosurgery
Radiotherapy, Conformal
Skull Base Neoplasms / diagnosis,  physiopathology,  radiotherapy*,  surgery*
Survival Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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