title: Microsurgical resectability, outcomes, and tumor control in meningiomas occupying the cavernous sinus.
abstract: OBJECTIVE Cavernous sinus meningiomas (CSMs) represent a cohort of challenging skull base tumors. Proper management requires achieving a balance between optimal resection, restoration of cranial nerve (CN) function, and maintaining or improving quality of life. The objective of this study was to assess the pre-, intra-, and postoperative factors related to clinical and neurological outcomes, morbidity, mortality, and tumor control in patients with CSM. METHODS A retrospective review of a single surgeon's experience with microsurgical removal of CSM in 65 patients between January 1996 and August 2013 was done. Sekhar's classification, modified Kobayashi grading, and the Karnofsky Performance Scale were used to define tumor extension, tumor removal, and clinical outcomes, respectively. RESULTS Preoperative CN dysfunction was evident in 64.6% of patients. CN II deficits were most common. The greatest improvement was seen for CN V deficits, whereas CN II and CN IV deficits showed the smallest degree of recovery. Complete resection was achieved in 41.5% of cases and was not significantly associated with functional CN recovery. Internal carotid artery encasement significantly limited the complete microscopic resection of CSM (p < 0.0001). Overall, 18.5% of patients showed symptomatic recurrence after their initial surgery (mean follow-up 60.8 months [range 3-199 months]). The use of adjuvant stereotactic radiosurgery (SRS) after microsurgery independently decreased the recurrence rate (p = 0.009; OR 0.036; 95% CI 0.003-0.430). CONCLUSIONS Modified Kobayashi tumor resection (Grades I-IIIB) was possible in 41.5% of patients. CN recovery and tumor control were independent of extent of tumor removal. The combination of resection and adjuvant SRS can achieve excellent tumor control. Furthermore, the use of adjuvant SRS independently decreases the recurrence rates of CSM.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana; and.
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana; and.
authors.forename: Jai Deep
authors.initials: JD
authors.lastname: Thakur
authors.affiliation: Department of Neurosurgery, Gates Vascular Institute, Buffalo General Medical Center, Buffalo, New York.
authors.forename: Ashish
authors.initials: A
authors.lastname: Sonig
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana; and.
authors.forename: Symeon
authors.initials: S
authors.lastname: Missios
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002426:Cavernous Sinus; D005260:Female; D006801:Humans; D008297:Male; D008579:Meningioma / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: CN = cranial nerve; CND = CN dysfunction; CS = cavernous sinus; CSM = CS meningioma; ECA = external carotid artery; FT = frontotemporal; FTO = FT craniotomy with orbital osteotomy; FTOZ = FT orbitozygomatic; Gamma Knife; ICA = internal carotid artery; KPS = Karnofsky Performance Scale; MF = middle fossa; RT = radiotherapy; SRS = stereotactic radiosurgery; cavernous sinus; meningiomas; microsurgery; oncology; stereotactic radiosurgery