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Cyberknife radiosurgery for cavernous sinus hemangiomas: a preliminary outcome

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Author:
No author available
Journal Title:
Chinese Journal of Neurosurgery
Issue:
10
DOI:
10.3760/cma.j.issn.1001-2346.2011.10.005
Key Word:
海绵窦;血管瘤;放射外科;射波刀;Cavernous sinus;Hemangioma;Radiosurgery;Cyberknife

Abstract: Objective Cavernous sinus hemangiomas (CSH)are rare vascular tumors.Gamma knife radiosurgery is proved to be effective treatment for CSH.The authors described their experience using fractionated cyberknife radiosurgery for large or giant cavernous sinus hemangiomas.Methods Twenty patients with CSH,including 13 females and 7 males patients with a mean age of 57 years (range:32 ~ 80 years),underwent cyberknife radiosurgery.Nineteen patients were diagnosed as CSH based on MRI findings and one patient had a recurrent tumor post surgery.The patients presented with slight headache,ptosis of the eyelid,proptosis,diplopia,facial numbness and visual impairment.On MRI T2 - weighted and Flair images,marked homogeneous hyperintensity were found in all lesions.This is the characteristics of CSH on MRI.Tumor maximum diameter ranged from 23.0 to 67.0 mm,with a mean of 42.0 mm and the mean tumor volume was 25.4 cm3( volume range:2.9 ~ 96.2 cm3).Sixteen tumor margin dose irradiated by cyberknife ranged from 18.4 ~21.0 Gy(maximum dose:28 ~30 Gy) in 3 fractions,3 tumor margin dose was 17.8 ~ 19.0 Gy (maximum dose:27.8 ~29.2 Gy) in 2 fractions,1 tumor margin dose was 13 Gy (maximum dose:20 Gy) in 1 fractiion.Follow -up time was 7 -36 months with a mean of 15 months.Results Five patients with giant CSH had slight headache after finishing cyberknife radiosurgery,and relieved after mannitol and dexamethasone treatment.Follow - up imaging demonstrated tumor decreased more than 90% in volume in 4 patients,more than 50% in volume in 9 patients,about 30% in volume in four patients post cyberknife.One tumor kept stable at 7 months post cyberknife.One patient with giant tumor did not have MRI examination although her symptoms was relieved post cyberknife.1 patient did not have MRI examination because of short follow - up time.Neurologically,slight headache,ptosis of the eyelid and diplopia in patients without open surgery had improved or disappeared at 4 to 10 months post cyberknife.None of these patients showed any deterioration in symptoms post radiosurgery.No brain edema happened and no cranial nerve deficits developed post cyberknife although most of these tumors were large or giant.Four patients had improvement in visual acuity 6 months post cyberknife,although optic nerve received 16 ~ 19 Gy in 3 fractions.Conclusion Fractionated Cyberknife radiosurgery is safe and effective modality for small - and medium - sized CSH and proved to be an effective treatment for large or giant CSH.Our experience demonstrated that cyberknife radiosurgery would be a better option for patients who have a clear neuroimaging diagnosis of CSH.

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