J Korean Neurosurg Soc.  2015 Oct;58(4):379-384. 10.3340/jkns.2015.58.4.379.

Peritumoral Brain Edema after Stereotactic Radiosurgery for Asymptomatic Intracranial Meningiomas: Risks and Pattern of Evolution

• Hoe Y
• Choi YJ
• Kim JH
• Kwon DH
• Kim CJ
• Cho YH

• KMID: 2114377
• DOI: http://doi.org/10.3340/jkns.2015.58.4.379

Abstract

OBJECTIVE
To investigate the risks and pattern of evolution of peritumoral brain edema (PTE) after stereotactic radiosurgery (SRS) for asymptomatic intracranial meningiomas.
METHODS
A retrospective study was conducted on 320 patients (median age 56 years, range 24-87 years) who underwent primary Gamma Knife radiosurgery for asymptomatic meningiomas between 1998 and 2012. The median tumor volume was 2.7 cc (range 0.2-10.5 cc) and the median follow-up was 48 months (range 24-168 months). Volumetric data sets for tumors and PTE on serial MRIs were analyzed. The edema index (EI) was defined as the ratio of the volume of PTE including tumor to the tumor volume, and the relative edema indices (rEIs) were calculated from serial EIs normalized against the baseline EI. Risk factors for PTE were analyzed using logistic regression.
RESULTS
Newly developed or increased PTE was noted in 49 patients (15.3%), among whom it was symptomatic in 28 patients (8.8%). Tumor volume larger than 4.2 cc (p<0.001), hemispheric tumor location (p=0.005), and pre-treatment PTE (p<0.001) were associated with an increased risk of PTE. rEI reached its maximum value at 11 months after SRS and decreased thereafter, and symptoms resolved within 24 months in most patients (85.7%).
CONCLUSION
Caution should be exercised in decision-making on SRS for asymptomatic meningiomas of large volume (>4.2 cc), of hemispheric location, or with pre-treatment PTE. PTE usually develops within months, reaches its maximum degree until a year, and resolves within 2 years after SRS.

Keyword

Meningioma; Stereotactic radiosurgery; Gamma Knife; Edema

MeSH Terms

Brain Edema*
Brain*
Dataset
Edema
Follow-Up Studies
Humans
Logistic Models
Magnetic Resonance Imaging
Meningioma*
Radiosurgery*
Retrospective Studies
Risk Factors
Tumor Burden

Figure

• 

  Fig. 1 The Kaplan-Meier curve for local tumor control.

• 

  Fig. 2 Spaghetti plots for relative edema indices over the time after stereotactic radiosurgery. The red line represents a fitted LOESS curve.

• 

  Fig. 3 A 38-year-old man with asymptomatic parasagittal meningioma. Each pair of gadolinium-enhanced T1-weighted MRI and fluid-attenuated inversion recovery MRI is presented before (A), 6 months (B), 10 months (C), and 13 months (D) after Gamma Knife (GK) with a marginal dose of 13 Gy. A : The tumor volume was 6.1 cc and no peritumoral edema is seen before GK. B : He developed seizure and hemiparesis 6 months after GK. Note the internal necrotic change of tumor combined with a substantial amount of peritumoral edema. C and D : Edema decreased at 10 months (C) and nearly disappeared at 13 months (D) after GK. His symptoms resolved completely.

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