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Visual Symptoms Outcomes in Cavernous Sinus Radiosurgery and a Systematic Review
Alejandra Moreira1, Kaory C Barahona2, Juliana Ramirez3
1Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV.
Cureus
|May 9, 2022
Summary
Stereotactic radiosurgery (SRS) effectively treats benign tumors in the cavernous sinus, improving visual symptoms in over 50% of patients. This non-invasive approach offers a viable alternative to surgery for both symptomatic and asymptomatic cases.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Ophthalmology
Background:
- The cavernous sinus presents complex anatomical challenges for surgical tumor resection.
- Stereotactic radiosurgery (SRS) offers a less invasive alternative to microsurgery with potentially lower morbidity and mortality rates.
Purpose of the Study:
- To evaluate clinical outcomes, specifically visual symptoms, following SRS for benign tumors invading the cavernous sinus.
- To conduct a systematic literature review for a comprehensive analysis of visual outcomes after SRS.
Main Methods:
- A cohort of 58 patients with benign cavernous sinus tumors (pituitary adenomas and meningiomas) treated with SRS between 2011 and 2021.
- Systematic literature search of PubMed, LILACS, and Google Scholar for studies on radiosurgery and cavernous sinus, focusing on visual outcomes.
- Analysis of pre-existing cranial nerve symptoms (CN II, III, IV, VI) and tumor response using RECIST criteria.
Main Results:
- 100% tumor control rate with a median follow-up of 33 months.
- Tumor volume reduction (>30%) observed in 12.1% of patients; 87.9% had stable disease (RECIST III).
- Visual symptoms improved in 51.7% of patients; systematic review showed a mean visual improvement of 36%.
Conclusions:
- Stereotactic radiosurgery is an effective treatment for benign tumors of the cavernous sinus.
- Primary SRS treatment led to improvements in pre-existing cranial neuropathy and visual symptoms.
- Considering SRS for asymptomatic patients with cavernous sinus tumors is a feasible approach due to tumor growth potential and risk of visual decline.
