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Outcomes after gamma knife radiosurgery for intraventricular meningiomas

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Abstract

Background

Intraventricular meningiomas (IVMs) are rare tumors with considerable treatment-associated morbidity due to their challenging location. Treatment with stereotactic radiosurgery (SRS) is sparsely reported in the literature. We describe our experience over the last 35 years using Gamma knife radiosurgery (GKRS) for IVMs.

Methods

We retrospectively reviewed the GKRS database identifying 2501 meningiomas treated at the University of Pittsburgh Medical Center over the last 35 years. Nineteen patients with (12 males, mean age = 53.2 years, range 14–84) 20 IVMs were identified. Headache was the most frequent presenting symptom (N = 12), and the trigone of the lateral ventricle was the most common location (N = 18). The median tumor volume was 4.8 cc (range, 0.8–17). The median margin dose was 14 Gy (range, 12–25) delivered at 50% isodose line.

Results

At a median follow-up of 63.1 months (range, 6–322.4) symptom control was achieved in 18 (94.7%) patients. The overall progression-free survival (PFS) was 95% at 5 years, and 85% at 10-years. After Log-rank test, patients who underwent GKRS within 12 months after diagnosis (vs. ≥ 12 months, X2: 4.455, p = 0.035), patients treated with primary GKRS without prior biopsy (vs. prior biopsy, X2: 4.000, p = 0.046), and patients with WHO grade I meningioma (vs. WHO II, X2: 9.000, p = 0.003) had a longer PFS. Imaging showed peritumoral edema in seven cases at a median of 10.5 (range, 6.13–24.3) months after GKRS. Only three of these patients were symptomatic and were successfully managed with oral medications. Cox´s regression revealed that a V12Gy ≥ 10 cc [HR: 10.09 (95% CI: 2.11–48.21), p = 0.004], and tumor volume ≥ 8 cc [HR: 5.87 (95% CI: 1.28–26.97), p = 0.023] were associated with a higher risk of peritumoral edema.

Conclusion

GKRS is an effective and safe management option for intraventricular meningiomas. Early GKRS should be considered as a primary management modality for small and medium sized IVM and adjuvant management for residual IVMs.

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Data availability

The authors confirm the availability of data per reasonable requests.

Code availability

Not applicable.

Abbreviations

IVMs:

Intraventricular meningiomas

SRS:

Stereotactic radiosurgery

GKRS:

Gamma Knife radiosurgery

WHO:

World Health Organization

V12Gy:

Volume of normal brain tissue exposed to 12 Gy

CSF:

Cerebrospinal fluid

STR:

Subtotal resection

ARE:

Adverse radiation effects

PFS:

Progression-free survival

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, Pittsburgh, PA, 15213, USA

    Alberto Daza-Ovalle, Othman Bin-Alamer, John Flickinger, Ajay Niranjan & L. Dade Lunsford

  2. Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Universidad del Rosario School of Medicine, Bogota, Colombia

    Alberto Daza-Ovalle

Authors
  1. Alberto Daza-Ovalle
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  2. Othman Bin-Alamer
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  3. John Flickinger
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  5. L. Dade Lunsford
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Contributions

Ajay Niranjan and L. Dade Lunsford designed the study. Material preparation, data collection and analysis were performed by Alberto Daza-Ovalle, and Othman Bin-Alamer. The first draft of the manuscript was written by Alberto Daza-Ovalle and all authors (Othman Bin-Alamer, John Flickinger, Ajay Niranjan, L. Dade Lunsford) commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ajay Niranjan.

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Conflicts of interest

Dr. Lunsford is a consultant for Insightec DSMB and has direct stock ownership in Elekta AB. The other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Daza-Ovalle, A., Bin-Alamer, O., Flickinger, J. et al. Outcomes after gamma knife radiosurgery for intraventricular meningiomas. J Neurooncol 160, 23–31 (2022). https://doi.org/10.1007/s11060-022-04091-8

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