A Pathophysiological Approach to Reduce Peritumoral Edema with Gamma Knife Radiosurgery for Large Incidental Meningiomas

Cheng-Siu Chang; Cheng-Wei Huang; Hsi-Hsien Chou; Hsien-Tang Tu; Ming-Tsung Lee; Chuan-Fu Huang

doi:10.3390/life12111683

A Pathophysiological Approach to Reduce Peritumoral Edema with Gamma Knife Radiosurgery for Large Incidental Meningiomas

Life (Basel). 2022 Oct 23;12(11):1683. doi: 10.3390/life12111683.

Authors

Cheng-Siu Chang^{1

2}, Cheng-Wei Huang^{3

4}, Hsi-Hsien Chou², Hsien-Tang Tu⁵, Ming-Tsung Lee^{6

7}, Chuan-Fu Huang⁵

Affiliations

¹ Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung 402, Taiwan.
² School of Medicine, Chung-Shan Medical University, Taichung 402, Taiwan.
³ Department of Hospital Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027, USA.
⁴ Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA 91101, USA.
⁵ Gamma Knife Center, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Taiwan.
⁶ National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin 632, Taiwan.
⁷ Department of Nursing, Hungkuang University, Taichung 433, Taiwan.

Abstract

Background: Peritumoral edema may be a prohibitive side effect in treating large incidental meningiomas with stereotactic radiosurgery. An approach that limits peritumoral edema and achieves tumor control with SRS would be an attractive management option for large incidental meningiomas.

Methods: This is a retrospective cohort study of patients with large incidental meningiomas (≥2 mL in volume and/or 2 cm in diameter) treated with gamma knife radiosurgery (GKRS) between 2000 and 2019 in Taiwan and followed up for 5 years. The outcomes of a pathophysiological approach targeting the dural feeding artery site with a higher marginal dose (18-20 Gy) to enhance vascular damage and the parenchymal margin of the tumor with a lower dose (9-11 Gy) to reduce parenchymal damage were compared with those of a conventional approach targeting the tumor center with a higher dose and tumor margin with a lower dose (12-14 Gy).

Results: A total of 53 incidental meningiomas were identified, of which 23 (43.4%) were treated with a pathophysiological approach (4 cases underwent a two-stage approach) and 30 (56.7%) were treated with a conventional approach. During a median follow-up of 3.5 (range 1-5) years, tumor control was achieved in 19 (100%) incidental meningiomas that underwent a single-stage pathophysiological approach compared with 29 (96.7%) incidental meningiomas that underwent a conventional approach (log-rank test: p = 0.426). Peritumoral edema developed in zero (0%) incidental meningiomas that underwent a single stage pathophysiological approach compared to seven (23.3%) incidental meningiomas that underwent a conventional approach (log-rank test: p = 0.023).

Conclusions: Treatment of large incidental meningiomas with a pathophysiological approach with GKRS achieves similar rates of tumor control and reduces the risk of peritumoral edema. GKRS with a pathophysiological approach may be a reasonable management strategy for large incidental meningiomas.

Keywords: gamma knife; incidental meningioma; meningioma; peritumoral edema; radiosurgery; stereotactic radiosurgery.

Grants and funding

This research received no external funding.