Abstract
Stereotactic radiosurgery (SRS) is an effective and less invasive therapeutic option for cavernous sinus (CS) tumors. However, its long-term effectiveness and neurological outcomes have yet to be fully elucidated. We aimed to examine the long-term outcomes of SRS for CS tumors. Overall, a cohort of 113 patients with benign CS tumors, including 91 with meningioma, 14 with trigeminal schwannoma (TS), and eight with cavernous hemangioma, treated with SRS at our institution from 1990 to 2018, was included. Tumor control and functional preservation/recovery were evaluated in detail. The median post-SRS follow-up period was 77months (interquartile range, 39-177). Progression-free survival (PFS) was 97% at 5years, 89% at 10years, and 87% at 15years for the entire cohort; 96% at 5years and 87% at 10years for meningiomas; and 100% at 10years for the other tumors. No significant difference was observed between meningiomas and non-meningiomas (log-rank test, p = 0.107). Improvement in cranial nerve (CN) function was observed in 35 (27%) patients. TSs tended to show CN improvements more often than meningiomas did (total improvements, 62% vs. 23%; p = 0.004; eye movement function, 100% vs. 20%; p = 0.002). CN deterioration or development of new CN deficits was observed in 11 (10%) patients. SRS provides good tumor control and acceptable long-term outcome with sufficient preservation of CN function in patients with benign CS tumors.
Highlights
The cavernous sinus (CS) is an important anatomical structure containing the internal carotid artery (ICA), and the third, fourth, fifth, and sixth cranial nerves (CNs)
No significant difference was observed among the tumor types
trigeminal schwannomas (TS) tended to show CN improvements more often than meningiomas did
Summary
The cavernous sinus (CS) is an important anatomical structure containing the internal carotid artery (ICA), and the third, fourth, fifth, and sixth cranial nerves (CNs). A variety of benign tumors, such as meningiomas, trigeminal schwannomas (TS), pituitary adenomas (PA), and cavernous hemangiomas (CH), can arise in or extend into this structure, causing impairment of visual function, extraocular movement, facial sensory function, and other CN functions [1,2,3,4]. Despite well-established microscopic and endoscopic skull base techniques, surgical interventions for such tumors remain challenging due to their deep skull base location and proximity to the ICA, CNs, visual pathways, and pituitary gland. Radiotherapy plays an important role in balancing tumor control and functional preservation, but whether functional recovery is achievable following radiotherapy remains questionable, especially in cases of large symptomatic tumors, since immediate mass reduction is not achievable [6]
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