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

Shyamal C. Bir, Devi Prasad Patra, Tanmoy Kumar Maiti, Papireddy Bollam, Alireza Minagar, Anil Nanda

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)170-179
Number of pages10
JournalWorld Neurosurgery
Volume101
DOIs
StatePublished - May 1 2017
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Keywords

  • Gamma Knife radiosurgery
  • Microsurgery
  • Outcomes and complications
  • Predictors

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