M.V. Galkin, P.A. Kudryavceva, T.M. Kotelnikova, G.E. Gorlachev, S.R. Ilyalov, I.N. Pronin, N.V. Arutyunov, V.V. Koctyuchenko, N.K. Serova, A.V. Golanov
Burdenko Research Institute of Neurosurgery, Moscow, Russia
Meningiomas of medial segments of anterior and middle cranial fossae entail considerable difficulties from the point of view of surgical treatment. Involvement of cranial nerves and vessels leads to a high risk of complications in their removal. Today such meningiomas are more often treated with methods of conformal stereotaxic irradiation.
There were 117 cases with meningiomas of medial segments of antrerior and middle cranial fossae, treated at the Department of Radiotherapy and Radiosurgery of the Burdenko Research Neurosurgical Institute during 3 years. Tumor removal preceded radiotherapy in 35 cases. The disease manifested itself in dysfunction of cranial nerves in the majority of cases (107). Visual disorders were watched in 43 cases. Irradiation was carried out with applying the Gamma-Knife C (Elekta) device and Novalis (BrainLab) apparatus with a micromultilobe collimator. Fractionated treatment was used, when the tumor involved optic tracts. A dose, delivered to a target margin during radiosurgery, was 14 Gy. It reached 54 Gy (an isodose line of 80-90%) in fractionation. Radiosurgery and radiotherapy were used in 27 and 90 cases, respectively.
A mean follow-up period was 15.7 months. The tumor growth was controlled in 97.8%. Meningioma size increased in 2 cases. Stabilization or improvement of visual functions was observed in 99% of cases. Vision deterioration was present in 1 case. There was no worsening of functions of other cranial nerves after treatment.
Stereotaxic irradiation is a method of choice in treatment of meningiomas of medial segments of anterior and middle cranial fossae, as it allows to achieve effective control of tumor growth against a background of a minimum number of complications and preserved visual function.