title: Factors affecting outcome following treatment of patients with cavernous sinus meningiomas.
abstract: OBJECTIVE
  Although there is a considerable volume of literature available on the treatment of patients with cavernous sinus meningiomas (CSMs), most of the data regarding tumor control and survival come from case studies or single-institution series. The authors performed a meta-analysis of reported tumor control and survival rates of patients described in the published literature, with an emphasis on specific prognostic factors.
  
  
  METHODS
  The authors systematically analyzed the published literature and found more than 3000 patients treated for CSMs. Separate meta-analyses were performed to calculate pooled rates of recurrence and cranial neuropathy after 1) gross-total resection, 2) subtotal resection without adjuvant postoperative radiotherapy or radiosurgery, and 3) stereotactic radiosurgery (SRS) alone. Results were expressed as pooled proportions, and random-effects models were used to incorporate any heterogeneity present to generate a pooled proportion. Individual studies were weighted using the inverse variance method, and 95% CIs for each group were calculated from the pooled proportions.
  
  
  RESULTS
  A total of 2065 nonduplicated patients treated for CSM met inclusion criteria for the analysis. Comparisons of the 95% CIs for recurrence of these 3 cohorts revealed that SRS-treated patients experienced improved rates of recurrence (3.2% [95% CI 1.9-4.5%]) compared with either gross-total resection (11.8% [95% CI 7.4-16.1%]) or subtotal resection alone (11.1% [95% CI 6.6-15.7%]) (p < 0.01). The authors found that the pooled mixed-effects rate of cranial neuropathy was markedly higher in patients undergoing resection (59.6% [95% CI 50.3-67.5%]) than for those undergoing SRS alone (25.7% [95% CI 11.5-38.9%]) (p < 0.05).
  
  
  CONCLUSIONS
  Radiosurgery provided improved rates of tumor control compared with surgery alone, regardless of the subjective extent of resection.
authors.affiliation: Department of Neurological Surgery, University of California at San Francisco, California 94143, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Sughrue
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Rutkowski
authors.forename: Derick
authors.initials: D
authors.lastname: Aranda
authors.forename: Igor J
authors.initials: IJ
authors.lastname: Barani
authors.forename: Michael W
authors.initials: MW
authors.lastname: McDermott
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
mesh_terms: D000704:Analysis of Variance; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002426:Cavernous Sinus / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery; D016896:Treatment Outcome