Although most meningiomas are benign tumors, when located under the brain along the base of the skull, these tumors can be difficult to treat. One particular location within the cranium is called the petroclival region. This region normally contains important structures called cranial nerves as well as important blood vessels that supply the brain and the brainstem. When a meningioma resides in this area of the skull base, it’s defined as petroclival meningiomas. Treatment for these benign tumors often involves microscopic neurosurgery, Gamma Knife radiosurgery (GKRS), or a combination of both techniques.
Recently, the Journal of Neuro-Oncology published a multicenter study conducted by the North American Gamma Knife Consortium in which 254 patients with a benign petroclival meningioma were treated with GKRS (reference). GKRS was used alone in 140 patients and, in the remaining 114 patients, GKRS was added in a delayed fashion after microscopic neurosurgery was performed. The authors concluded that GKRS for petroclival meningiomas results in a high rate of tumor growth control with excellent preservation of neurological function.
At The Valley Hospital’s Gamma Knife Center, we use a multidisciplinary approach before making any treatment recommendations for our benign brain tumor patients. When we think about treating meningiomas, several important variables need to be considered. The most important thing to remember about a meningioma is that most of them (greater than 90%) are benign. If a meningioma is not causing symptoms and is not growing over time, the majority of these tumors do not require treatment at all! As a matter of fact, most of these tumors can simply be followed with MRI scans at regularly scheduled intervals.
If treatment is necessary for a patient with a meningioma, it is critical that the physician team treating the patient have access to GKRS as well as high-quality skull base neurosurgical services as we do at The Valley Hospital. Patients need to be seen by both a fellowship-trained skull base neurosurgeon as well as an experienced Gamma Knife radiation oncologist prior to any treatment, as this first recommendation can make all the difference between remaining neurologically well versus suffering a significant injury after treatment is complete. By combining the advantages of both microscopic neurosurgery and GKRS for petroclival meningiomas requiring treatment, patient outcomes can be excellent as highlighted in the study above.