Optimizing Management of Cavernous Sinus Meningiomas: A Novel Strategy Integrating Endoscopic Endonasal and Transorbital Surgery with Adjuvant Stereotactic Radiotherapy.

Abstract

Background: Cavernous sinus meningiomas (CSMs) are challenging skull base tumors due to their proximity to vital neurovascular structures. Traditional aggressive transcranial resection often leads to significant morbidities with limited improvement of cranial nerve (CN) deficits. Recent advancements in endoscopic skull base surgery and stereotactic radiation therapy (SRT) offer a more conservative approach, facilitating tumor decompression while preserving critical structures.

Methods: This retrospective study reviewed medical records of patients with symptomatic CSMs who underwent endoscopic endonasal and/or transorbital surgery, followed by adjuvant SRT, at our institution between January 2017 and April 2022. Patient demographics, tumor characteristics, surgical approaches, radiation, treatment outcomes, complications, and follow-up time were analyzed.

Results: Thirty nine patients with CSMs were included. Endoscopic endonasal approach (EEA) was performed in 24 patients (61.5%), endoscopic transorbital approach (ETOA) in 10 patients (25.6%), and combined approaches in 5 patients (15.2%). Adjuvant SRT was administered to 79.5% of patients. Postoperative outcomes showed recovery of CN 3-6 deficits and vision in 60.8% and 65% of cases, respectively. Complications included postoperative CN 3-6 deficits in 5 cases, and post-radiation visual deterioration in 1 case. During a mean follow-up period of 44 months, tumor progression occurred in 4 patients (12%), with 3 diagnosed as WHO grade II meningiomas and 1 as WHO grade I.

Conclusions: This study supports the use of endoscopic skull base surgery combined with adjuvant SRT for symptomatic CSMs, demonstrating both safety and efficacy. This approach yielded favorable outcomes in symptom improvement, tumor control, and positive safety profile.