{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:05:48Z","timestamp":1780131948255,"version":"3.54.0"},"reference-count":92,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,6]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Gamma Knife radiosurgery (GKRS) has been successfully used for the treatment of intracranial meningiomas given its steep dose gradients and high-dose conformality. However, treatment of skull base meningiomas (SBMs) may pose significant risk to adjacent radiation-sensitive structures such as the cranial nerves. Fractionated GKRS (fGKRS) may decrease this risk, but until recently it has not been practical with traditional pin-based systems. This study reports the authors\u2019 experience in treating SBMs with fGKRS, using a relocatable, noninvasive immobilization system.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors performed a retrospective review of all patients who underwent fGKRS for SBMs between 2013 and 2018 delivered using the Extend relocatable frame system or the Icon system. Patient demographics, pre- and post-GKRS tumor characteristics, perilesional edema, prior treatment details, and clinical symptoms were evaluated. Volumetric analysis of pre-GKRS, post-GKRS, and subsequent follow-up visits was performed.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n Twenty-five patients met inclusion criteria. Nineteen patients were treated with the Icon system, and 6 patients were treated with the Extend system. The mean pre-fGKRS tumor volume was 7.62 cm\n 3<\/jats:sup>\n (range 4.57\u201313.07 cm\n 3<\/jats:sup>\n ). The median margin dose was 25 Gy delivered in 4 (8%) or 5 (92%) fractions. The median follow-up time was 12.4 months (range 4.7\u201317.4 months). Two patients (9%) experienced new-onset cranial neuropathy at the first follow-up. The mean postoperative tumor volume reduction was 15.9% with 6 patients (27%) experiencing improvement of cranial neuropathy at the first follow-up. Median first follow-up scans were obtained at 3.4 months (range 2.8\u20134.3 months). Three patients (12%) developed asymptomatic, mild perilesional edema by the first follow-up, which remained stable subsequently.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n fGKRS with relocatable, noninvasive immobilization systems is well tolerated in patients with SBMs and demonstrated satisfactory tumor control as well as limited radiation toxicity. Future prospective studies with long-term follow-up and comparison to single-session GKRS or fractionated stereotactic radiotherapy are necessary to validate these findings and determine the efficacy of this approach in the management of SBMs.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2019.3.focus1963","type":"journal-article","created":{"date-parts":[[2019,6,7]],"date-time":"2019-06-07T19:09:58Z","timestamp":1559934598000},"page":"E8","source":"Crossref","is-referenced-by-count":19,"title":["Fractionated Gamma Knife radiosurgery for skull base meningiomas: a single-institution experience"],"prefix":"10.3171","volume":"46","author":[{"given":"Krishna C.","family":"Joshi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University;"},{"name":"Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alankrita","family":"Raghavan","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baha\u2019eddin","family":"Muhsen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University;"},{"name":"Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamid","family":"Borghei-Razavi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University;"},{"name":"Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel T.","family":"Chao","sequence":"additional","affiliation":[{"name":"Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and"},{"name":"Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gene H.","family":"Barnett","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University;"},{"name":"Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; 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