Abstract
Background: The efficacy and safety of radiosurgery led to paradigm shift in the management of cavernous sinus meningiomas. Nevertheless, patients are still significantly affected by cranial nerve deficits related to the mass effect of these tumors. Our management strategy involves the combination of a functional surgical decompression followed by radiation therapy.Methods: We reviewed a single institution's cohort of patients who underwent endoscopic endonasal decompression (EED) for symptomatic meningiomas primarily involving the cavernous sinus (CS) from 2010 to 2016. The preoperative neuro-ophthalmological exam was compared to the 1- and 6-month postoperative exams. The patient's length of hospital stay, complications, and radiological and clinical follow-up were noted.Results: A total of 17 patients underwent EED for CS meningiomas that fit our radiological criteria. The final outcome at the 6-month visit showed five patients (62.5%) with normalization of deficit and three patients (37.5%) with partial improvement of the CNII deficit. Out of the 12 patients who had cavernous sinus cranial nerves (CSCN) deficits, the final outcome at the 6-month visit showed four patients (33.33%) with normalization of deficit, seven patients (58.3%) with partial improvement, and one patient (8.33%) with no improvement. There were no intraoperative complications.Conclusion: The EED for CS meningiomas is a valuable technique when addressing acute/subacute CNII and CSCN deficits. This conservative surgical approach showed good functional outcomes, low morbidity, and low complication rates. However, it does not exempt the need for radiosurgery/radiation therapy for control of tumor growth.
Highlights
The management of cavernous sinus (CS) meningiomas changed significantly in the past two decades
We describe and discuss our treatment algorithm for symptomatic CS meningiomas with a focus on the endoscopic endonasal decompression (EED) technique and outcomes
When the ocular motility grading system was applied to the 12 patients with cavernous sinus cranial nerves (CSCN) deficit who underwent EED, we found that preoperatively two patients had “Good” function, six patients had “Fair” function, and four patients had “Poor” function
Summary
The management of cavernous sinus (CS) meningiomas changed significantly in the past two decades. Suboptimal reports on postoperative cavernous sinus cranial nerves (CSCN) function resulted in a gradual reconsideration of the management strategy [1, 2]. The paradigm shift in the management of CS meningiomas was driven by the efficacy and safety of radiosurgery, histological evidence of cranial nerve (CN) infiltration by meningiomas, and greater consideration of the impact of postoperative outcomes on the patients’ quality of life [2, 5,6,7]. The combination of a functional surgical decompression with adjuvant radiation therapy for tumor growth control appears to be an optimal management strategy for CS meningiomas [5, 7]. The efficacy and safety of radiosurgery led to paradigm shift in the management of cavernous sinus meningiomas. Our management strategy involves the combination of a functional surgical decompression followed by radiation therapy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
