Functional and Radiographic Outcomes of Cavernous Meningiomas Based on Treatment Modality

Introduction  Cavernous sinus meningiomas (CSMs) are challenging given their proximity to neurovascular structures. Treatments include surgery, radiation, or observation. There are little data comparing outcomes based on treatment. This study presents the radiographic and functional outcomes of patients with CSMs treated with either radiation, surgical resection ± radiation, or radiographic surveillance. Methods  This is a retrospective review of adults diagnosed with CSMs between 2009 and 2016. Patient and tumor characteristics and outcomes were obtained from chart review. Categorical and continuous variables were compared via nonparametric tests. Results  Sixty-four patients were diagnosed with CSMs between 2009 and 2016. Thirty-four had radiation. Thirteen had surgical resection with adjuvant radiation and 14 underwent observation. Fifty-four patients had a pretreatment deficit (84.4%). Radiographic control rates were 100% in the surgery group, 97.1% in the radiation group, 69.2% in the surgery + adjuvant radiation, and 90.9% in the observation group ( p  = 0.035). The radiotherapy group had complete improvement of symptoms in 32.4% and partial improvement in 23.1% ( p  = 0.022). In the surgery group, one patient had complete resolution of symptoms (6.3%), eight had partial improvement (50.0%), and seven patients had no improvement ( p  = 0.002). Surgery was more likely to lead to progression of symptoms posttreatment (odds ratio: 5.16, confidence interval: 1.309-20.34) ( p  = 0.019). Conclusion  Radiation has an excellent rate of radiographic control. Surgery is an option for large or symptomatic lesions. The role of surgery is primarily for vision preservation, decompression of cranial nerves, and tumor debulking and patients should be counseled extensively regarding treatment goals and expectations prior to surgery.