Outcomes of Decompressive Surgery for the Management of Cavernous Sinus Meningiomas

Introduction: Cavernous sinus meningiomas are complex tumors that offer a perpetual challenge to skull base surgeons. The senior author has employed a management strategy for these lesions that emphasized combining “safe” tumor resection and direct decompression of the roof and lateral wall of the cavernous sinus as well as the optic nerve. Here, we review our experience with the application of this technique for the management of symptomatic cavernous sinus meningiomas with extracavernous extension over the past 15 years.

Methods: A retrospective analysis was performed for patients with cavernous sinus meningiomas treated over a 15-year period (2002–2017) with this standardized approach. Patient outcomes, including cranial nerve function, tumor control, and surgical complications were recorded.

Results: We reviewed 50 patients who underwent subtotal resection via frontotemporal craniotomy concurrently with decompression of the cavernous sinus and ipsilateral optic nerve. Of these, 25 (50%) underwent adjuvant radiation to the remaining tumor within the cavernous sinus. Patients most commonly presented with a cranial nerve palsy involving CN III–VI (70%), a visual deficit (62%), headaches (52%), or proptosis (44%). Of the patients with preoperative cranial nerve neuropathies, 52% improved postoperatively, 46% remained stable, and only 2% worsened. Notably, 10 patients experienced new cranial nerve deficits of which half were transient and ultimately resolved. Finally, radiographic recurrence was noted in five patients (10%) with a median time to recurrence of 4.6 years.

Conclusion: The treatment of cavernous sinus meningiomas using surgical decompression with or without adjuvant radiation is an effective oncologic strategy, achieving excellent tumor control rates with low risk of neurologic morbidity.

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