Direct Comparison of Gamma Knife Radiosurgery and Microsurgery for Small Size Meningiomas

TY - JOUR

T1 - Direct Comparison of Gamma Knife Radiosurgery and Microsurgery for Small Size Meningiomas

AU - Bir, Shyamal C.

AU - Patra, Devi Prasad

AU - Maiti, Tanmoy Kumar

AU - Bollam, Papireddy

AU - Minagar, Alireza

AU - Nanda, Anil

N1 - Publisher Copyright: © 2017 Elsevier Inc.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background Patients with small (<3 cm) intracranial meningiomas can be either observed or treated. Treatment can be either radiosurgery or microsurgery if and when tumor progression occurs. We compared local tumor growth control and recurrence-free survival (RFS) of microsurgical resection and radiosurgery in small intracranial meningiomas and identified predictors of unfavorable outcome. Methods A retrospective review (2005–2016) was performed of 90 consecutive patients with intracranial meningiomas who underwent either microsurgery (n = 31) or Gamma Knife radiosurgery (GKRS) (n = 59). The study population was evaluated clinically and radiographically after treatment. Results GKRS in meningiomas showed a significantly higher percentage of local control of tumor growth compared with microsurgery (P = 0.02) 5 and 10 years (P = 0.003) after treatment. The median RFS was also significantly higher in the GKRS group compared with the microsurgery group (P = 0.04). There was no difference in RFS between Simpson grade I resection and GKRS (P = 0.69). In univariate analysis, RFS after procedures was significantly affected by tumor involvement of cranial nerves, presence of comorbidities, and preoperative Karnofsky performance scale score ≤70. In multivariate analysis, only preoperative Karnofsky performance scale score ≤70 was a predictor of unfavorable outcome. Conclusions GKRS offers a high rate of tumor control and longer RFS that is comparable to Simpson grade I resection. Subtotal resection is not a good choice for small meningiomas. The treatment procedure should be tailored according to the presence of comorbidities and the maximum benefit for the patient.

AB - Background Patients with small (<3 cm) intracranial meningiomas can be either observed or treated. Treatment can be either radiosurgery or microsurgery if and when tumor progression occurs. We compared local tumor growth control and recurrence-free survival (RFS) of microsurgical resection and radiosurgery in small intracranial meningiomas and identified predictors of unfavorable outcome. Methods A retrospective review (2005–2016) was performed of 90 consecutive patients with intracranial meningiomas who underwent either microsurgery (n = 31) or Gamma Knife radiosurgery (GKRS) (n = 59). The study population was evaluated clinically and radiographically after treatment. Results GKRS in meningiomas showed a significantly higher percentage of local control of tumor growth compared with microsurgery (P = 0.02) 5 and 10 years (P = 0.003) after treatment. The median RFS was also significantly higher in the GKRS group compared with the microsurgery group (P = 0.04). There was no difference in RFS between Simpson grade I resection and GKRS (P = 0.69). In univariate analysis, RFS after procedures was significantly affected by tumor involvement of cranial nerves, presence of comorbidities, and preoperative Karnofsky performance scale score ≤70. In multivariate analysis, only preoperative Karnofsky performance scale score ≤70 was a predictor of unfavorable outcome. Conclusions GKRS offers a high rate of tumor control and longer RFS that is comparable to Simpson grade I resection. Subtotal resection is not a good choice for small meningiomas. The treatment procedure should be tailored according to the presence of comorbidities and the maximum benefit for the patient.

KW - Gamma Knife radiosurgery

KW - Microsurgery

KW - Outcomes and complications

KW - Predictors

UR - http://www.scopus.com/inward/record.url?scp=85015698221&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85015698221&partnerID=8YFLogxK

U2 - https://doi.org/10.1016/j.wneu.2017.01.105

DO - https://doi.org/10.1016/j.wneu.2017.01.105

M3 - Article

C2 - 28185974

VL - 101

SP - 170

EP - 179

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -