Evaluating the Neurological Outcomes after Gamma Knife Radiosurgery for Symptomatic Skull Base Meningiomas Based on Their Locations: Single Institution Experience | Chapter 6 | Medicine and Medical Research: New Perspectives Vol. 4

Background: Meningioma is the most common primary benign intracranial tumor. Gross total resection of skull base meningioma (SBM) is so challenging due to its relevant high morbidity. Gamma knife radiosurgery is concerned, by providing a favorable therapeutic option in the management of SBM.

 

Aim: This study aims to evaluate the neurological outcome after GKRS as an adjuvant or primary treatment for SBM according to their locations.

 

Methods: This retrospective cross-sectional study consisted of 108 patients with SBM who underwent GKRS as an adjuvant or primary treatment. Patient’s medical records were collected to assess their demographic characteristics, clinical presentation, and clinical evaluations in follow-up visits. We found 40 patients with cavernous sinus meningioma (CSM), 36 patients with petroclival meningioma (PCM), and 22 patients with cerebellopontine angle meningioma (CPM). Of these, 81.1% were female (n = 90) with a median age of 52.68 years. Statistical analysis was performed using the chi-square test to evaluate the relationship between the duration of symptoms, age, gender, modality of GKRS (fractionated or not fractionated), and tumor size change on the likelihood of improvement and deterioration of neurological symptoms. The mean tumor volume was 4.5 cm3 and the mean marginal dose was 13 Gy.

 

Results: Tumor control was achieved in 96.4% of patients at a median follow-up of 38.4 months. Overall, 17 of 108 patients (15.6%) report improvement in their neurological symptoms. The majority of neurological symptoms were related to tumors which were located in the cavernous sinus 36%, Petroclival region 32.4%, and CPA 19.8%, respectively. Patients with CPM demonstrated lower rates of neurological symptom improvement compared to patients with PCM and CSM. Deterioration of neurological symptoms after GKRS developed in 11 patients (10.1%) which was more reported by patients with CSM than the others. The most improvement in cranial nerve deficit was in CN VI, V, and VIII among patients with CSM, PCM, and CPM respectively.

 

Conclusion: GKRS is acceptable as a primary or adjuvant treatment for SBM by providing an appreciable rate of improvement in neurological symptoms.

 

Author (s) Details

Farid Kazemi
Skull Base Research Center, Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran and Department of Neurosurgery, Rasool Akram Hospital, Tehran, Iran.

Parisa Javadnia
Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Alireza Tabibkhooei
Skull Base Research Center, Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran and Department of Neurosurgery, Rasool Akram Hospital, Tehran, Iran.

 

Mobin Naghshbandi
Student Research Center, Iran University of Medical Sciences, Tehran, Iran.

 

Vahid Ghorbani kalkha
Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v4/1960

 

An Overview of Recent Advances on Pathophysiology, Diagnosis and Treatment of Trigeminal Neuralgia | Chapter 04 | New Horizons in Medicine and Medical Research Vol. 2

 Trigeminal Neuralgia (TN) is the most common type of neuropathic face pain, and it has a significant impact on the quality of life of those who suffer from it. The cause of the classic type has been identified as neurovascular conflict (NVC), however TN can be due to various disorders. There is no NVC or other aetiology of TN in the idiopathic form. However, the specific sequence of events and mechanisms that lead to TN remain unknown, although new research suggesting that an inflammatory environment may play a role. The development of novel magnetic resonance imaging (MRI) techniques such as voxel-based morphometry, diffusion tensor imaging, and three-dimensional time-of-flight magnetic resonance angiography has revealed fresh information on the pathophysiology of TN. Furthermore, the use of these enhanced MRI sequences in conjunction with volume-rendering software and neuronavigation techniques had a considerable impact on the surgical outcome of patients undergoing microvascular decompression. TN management is, in fact, pharmacological from the start; nonetheless, TN might gradually grow insensitive to medications, necessitating multimodal treatment. Despite the multiple techniques available, the outcomes are not entirely satisfactory, and the desire for more effective medications led to the development of new compounds and pharmacological procedures. Furthermore, some patients may develop drug resistance, necessitating a surgical surgery or radiation treatment. However, pain recurrence after one or more surgical procedures is common, and other rescue treatments, such as neuromodulation, may be required to manage the symptoms. These observations demonstrate the lack of a thorough understanding of TN pathophysiology. The purpose of this work was to review recent research on pathogenesis, diagnostics, medicinal and surgical treatments, and to discuss major developments in all of these domains.

Author(S) Details

Nicola Montano
Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario a Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

Alessandro Rapisarda
Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario a Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

View Book:- https://stm.bookpi.org/NHMMR-V2/article/view/6124