• the Korean Society for Brain and Neural Sciences


Original Article

Exp Neurobiol 2018; 27(3): 245-255

Published online June 30, 2018

© The Korean Society for Brain and Neural Sciences

Fractionated Gamma Knife Radiosurgery as Initial Treatment for Large Skull Base Meningioma

Hye Ran Park1, Jae Meen Lee2, Kwang-Woo Park3, Jung Hoon Kim3, Sang Soon Jeong3, Jin Wook Kim3, Hyun-Tai Chung3, Dong Gyu Kim3 and Sun Ha Paek3,4,5*

1Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul 04401, 2Department of Neurosurgery, Pusan National University Hospital, Busan 49241, 3Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, 4Cancer Research Institute, Seoul National University, Seoul 03080, 5Ischemia Hypoxia Disease Institute, Seoul National University, Seoul 03080, Korea

Correspondence to: *To whom correspondence should be addressed.
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Received: March 26, 2018; Revised: May 2, 2018; Accepted: May 24, 2018

We present our experience on the hypofractionated Gamma Knife radiosurgery (FGKS) for large skull base meningioma as an initial treatment. We retrospectively reviewed 23 patients with large skull base meningioma ≥10 cm3 who underwent FGKS as the initial treatment option. The mean volume of tumors prior to radiosurgery was 21.2±15.63 cm3 (range, 10.09~71.42). The median total margin dose and marginal dose per fraction were 18 Gy (range, 15~20) and 6 Gy (range, 5~6), respectively. Patients underwent three or four fractionations in consecutive days with the same Leksell® frame. The mean follow-up duration was 38 months (range, 17~78). There was no mortality. At the last follow-up, the tumor volume was stationary in 15 patients (65.2%) and had decreased in 8 patients (34.8%). Six patients who had cranial neuropathy at the time of FGKS showed improvement at the last clinical follow-up. Following FGKS, 4 patients (17%) had new cranial neuropathy. The trigeminal neuropathy was the most common and all were transient. The mean Karnofsky Performance Status score at pre-FGKS and the last clinical follow-up was 97.0±10.4 points (median, 100) and 98.6±6.9 (median, 100) points, respectively. FGKS has showed satisfactory tumor control with functional preservation for large skull base meningiomas. Further prospective studies of large cohorts with long term follow-up are required to clarify the efficacy in the tumor control and functional outcome as well as radiation toxicity.

Graphical Abstract

Keywords: Gamma Knife Radiosurgery, Dose Hypofractionation, Meningioma, Skull Base, Stereotactic Radiosurgery