S.R. Ilyalov, A.V. Golanov, V.N. Kornienko, I.N. Pronin, V.V. Kostyuchenko, M.V. Zotova, M.V. Galkin
Burdenko Research Institute of Neurosurgery, Moscow, Russia
Today stereotaxic radiosurgery has become a worldwide method of meningioma treatment and an alternative of its removal. It is especially true of aged cases, basal localization of meningioma and its spread on eloquent cerebral structures.
There were 214 cases with 629 meningiomas of different localization, treated with the Leksell Gamma Knife C apparatus (Elekta, Sweden) in April 2005 - February 2009. Some cases (34) had two and more meningiomas. Radiosurgery was preceded by tumor removal with histological verification of diagnosis in 35% of cases. The majority of patients (90.7%) had benign meningiomas (grade I, WHO). Malignant meningiomas were watched in 9.3% of cases (grade III, WHO). Diagnosis was made on the basis of clinical and rentgenologic symptoms in 65% of cases. Tumors of basal localization were predominant. Meningiomas, being manifestation of neurofibromatosis of type I or II, were observed in 9 patients.
A follow-up period varied from 6 months up to 4 years. Control examination consisted in MR-examination with enhancement. Further growth of tumor, watched during 6-18 months, was revealed only in 7 cases. The rest patients had no signs, indicative of such growth. Stabilization or regression of focal neurological symptoms were typical of the majority of cases. Post-radiation responses of a different degree were present in 6% of cases.
The results confirm, that stereotaxic radiosurgery of small (up to 3-3.5 mm) intracranial meningiomas with applying the Gamma-Knife is a highly effective and safe method, which can be a substitute an addition to conventional neurosurgical intervention in many cases.