Long-term control of XXXX through radiosurgery.

@entity1 @entity5 @entity1653 @entity892 @entity393
OBJECT: Because of their critical location adjacent to brain, cranial nerve, and vascular structures, @entity1653 remain a clinical challenge. The authors evaluated outcomes in 168 @entity1 with @entity1653 who underwent Gamma Knife surgery (GKS) during a 21-year interval. METHODS: Gamma Knife surgery was used as either primary or adjuvant treatment of 168 @entity1653 involving the region between the petrous apex and the upper two-thirds of the clivus. The most common presenting symptoms were trigeminal nerve dysfunction, balance problems, @entity892 , and @entity393 . The median @entity5 volume was 6.1 cm3 (range 0.3-32.5 cm3), and the median radiation dose to the @entity5 margin was 13 Gy (range 9-18 Gy). RESULTS: During a median follow-up of 72 months, neurological status improved in 44 @entity1 (26%), remained stable in 98 (58%), and worsened in 26 (15%). @entity5 volume decreased in 78 @entity1 (46%), remained stable in 74 (44%), and increased in 16 (10%), all of whom were subjected to additional management strategies. Overall 5- and 10-year progression-free survival rates were 91 and 86%, respectively. @entity1 followed up for at least 10 years (31 @entity1 ) had @entity5 and symptom control rates of 97 and 94%, respectively. Eight @entity1 had repeat radiosurgery, 4 underwent delayed resection, and 4 had fractionated radiation therapy. Cerebrospinal fluid diversion was performed in 7 @entity1 (4%). Significant risk factors for @entity5 progression were a @entity5 volume > or = 8 cm3 (p = 0.001) and male sex (p = 0.02). CONCLUSIONS: In this 21-year experience, GKS for @entity1653 obviated initial or further resection in 98% of @entity1 and was associated with a low risk of adverse radiation effects. The authors believe that radiosurgery should be considered as an initial option for @entity1 with smaller-volume, symptomatic @entity1653 .
