Intracranial meningiomas: Factors that influence the development of cerebral edema after stereotactic radiosurgery and radiation therapy

John A. Kalapurakal, Craig L. Silverman*, Naveed Akhtar, Douglas W. Laske, Leonard E. Braitman, Orrest B. Boyko, Patrick R M Thomas

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

47 Scopus citations

Abstract

PURPOSE: To evaluate causative factors of cerebral edema after stereotactic radiosurgery or stereotactic radiation therapy in intracranial meningiomas. MATERIALS AND METHODS: Of 43 adult patients with intracranial meningiomas, three received 13.5-18-Gy single-fraction stereotactic radiosurgery; one received 19.8 Gy in three fractions, one received 42 Gy in six fractions, and 31 received 32-36 Gy in six to eight fractions of stereotactic radiation therapy; and seven received 45-54-Gy external-beam radiation with 20-28 Gy in five to seven fractions as concomitant stereotactic boosts. Brain edema was estimated by calculating the edema index. RESULTS: After irradiation, all 11 patients with parasagittal and four patients with nonparasagittal tumors developed worsening cerebral edema that necessitated the administration of steroids (P < .001). The statistically significant factors for the development of edema were parasagittal location, presence of pretreatment edema, sagittal sinus occlusion, and the use of more than 6 Gy per fraction. Five patients with parasagittal tumors developed life-threatening panhemispheric edema, which was fatal in one. The causative factors of panhemispheric edema were a large tumor, single-fraction stereotactic radiosurgery, or use of more than 6 Gy per fraction. CONCLUSION: A smaller dose per fraction and aggressive use of steroids may help prevent life-threatening complications due to worsening edema.

Original languageEnglish (US)
Pages (from-to)461-465
Number of pages5
JournalRadiology
Volume204
Issue number2
DOIs
StatePublished - Jan 1 1997

Keywords

  • Brain, edema
  • Brain, effects of irradiation on
  • Dosimetry
  • Meninges, neoplasms
  • Radiations, injurious effects, complications of therapeutic radiology

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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