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Outcomes of decompressive surgery for cavernous sinus meningiomas: long-term follow-up in 50 patients.

Abstract：

OBJECTIVE: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 aimed at maximizing tumor control while minimizing neurological morbidity. This approach emphasizes combining "safe" tumor resection and direct decompression of the roof and lateral wall of the cavernous sinus as well as the optic nerve. Here, the authors review their experience with the application of this technique for the management of cavernous sinus meningiomas 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 approach. Patient outcomes, including cranial nerve function, tumor control, and surgical complications were recorded. RESULTS:The authors identified 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 (CN) palsy involving CN III-VI (70%), a visual deficit (62%), headaches (52%), or proptosis (44%). Thirty-five patients had cranial nerve deficits preoperatively. In 52% of these cases, the neuropathy improved postoperatively; it remained stable in 46%; and it worsened in only 2%. Similarly, 97% of preoperative visual deficits either improved or were stable postoperatively. Notably, 12 new cranial nerve deficits occurred postoperatively in 10 patients. Of these, half were transient and ultimately resolved. Finally, radiographic recurrence was noted in 5 patients (10%), with a median time to recurrence of 4.6 years. CONCLUSIONS:The treatment of cavernous sinus meningiomas using surgical decompression with or without adjuvant radiation is an effective oncological strategy, achieving excellent tumor control rates with low risk of neurological morbidity.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Gozal YM,Alzhrani G,Abou-Al-Shaar H,Azab MA,Walsh MT,Couldwell WT

doi

10.3171/2018.10.JNS181480

subject

Has Abstract

pub_date

2020-02-01 00:00:00

pages

380-387

issue

eissn

0022-3085

issn

1933-0693

pii

2018.10.JNS181480

journal_volume

132

pub_type

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Outcomes of decompressive surgery for cavernous sinus meningiomas: long-term follow-up in 50 patients.