Cavernous sinus meningiomas: retrospective analysis and proposal of a treatment algorithm

OBJECTIVE: Today, meningiomas with primary or, more commonly, secondary involvement of the cavernous sinus remain a surgical challenge. Anatomic research on cadaver specimens, together with the advances made in cranial base and microvascular surgery over the past 2 decades, have made it possible to completely resect lesions within the cavernous sinus. However, the technical complexity of some procedures, coupled with the current availability of less-invasive therapeutic options, makes the rate of complications related to surgical extirpation of intracavernous meningiomas unacceptably high, especially regarding permanent neurological morbidity and mortality. Currently, indications, timing, and multimodal treatments with surgery and radiotherapy represent the main topics of discussion concerning these lesions. METHODS: One hundred forty-seven patients underwent surgery between 1985 and 2003. The patients were retrospectively divided into 2 groups according to the type of surgical treatment: group A (open sinus surgery) and group B (closed sinus surgery). The mean follow-up time was 9.7 years. RESULTS: Early postoperative morbidity and permanent postoperative morbidity showed significant differences between the groups. At long-term follow-up, we found no statistical differences in the incidence of recurrences and progressions. Only patients treated with postoperative radiation therapy (81.5%) showed clinicoradiological stability. CONCLUSION: Growth control and preservation of neurological functions are the primary goals in the treatment of cavernous sinus meningiomas. In most cases, surgery and radiosurgery alone do not reach the primary goals, and unresolved issues remain. Therefore, we have developed a treatment algorithm as a guide to the best therapeutic options for the most common presentations of the diseas