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

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

World Neurosurg. 2017 Feb 06;:

Authors: Bir SC, Patra DP, Maiti TK, Bollam P, Minagar A, Nanda A

Abstract
INTRODUCTION: A patient with a small (<3cm) intracranial meningioma can be either observed or treated. Treatment can be either radiosurgery or microsurgery if and when progression of the tumor occurs. We have compared the local tumor growth control and recurrence-free survival (RFS) of microsurgical resection and radiosurgery in small intracranial meningiomas, and we have identified the predictors of unfavorable outcome.
MATERIALS AND METHODS: Retrospective review (2005-2016) of 90 consecutive patients with intracranial meningiomas who underwent either microsurgery (n=31) or gamma knife radiosurgery (GKRS, n=59) was done. The study population was evaluated clinically and radiographically after treatment.
RESULTS: GKRS in meningiomas showed significantly higher percentage of local control of tumor growth compared to microsurgical resection (p=0.02) five and ten years (p=0.003) after treatment. The median recurrence-free survival (RFS) period was also significantly higher in radiosurgery compared to microsurgery (p=0.04). However, there was no difference in RFS between Simpson grade I resection and GKRS (p=0.69). In univariate analysis, recurrence-free survival after procedures was significantly affected by tumor involvement of cranial nerves, presence of comorbidities and pre-KPS ≤ 70. However, in multivariate analysis, only pre-KPS ≤ 70 was revealed as a predictor of unfavorable outcome.
CONCLUSION: GKRS offers a high rate of tumor control and longer RFS which is comparable to Simpson grade I resection. However, sub-total resection is not a good choice for small meningiomas. Thus, treatment procedure should be tailored according to the presence of comorbidities and the maximum benefit for the patients.

PMID: 28185974 [PubMed - as supplied by publisher]

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