Giant Meningiomas Invading the Cavernous Sinus: The "Inevitable Ones"

Area of Science:

• Neurosurgery
• Oncology
• Skull Base Surgery

Background:

• Giant meningiomas invading the cavernous sinus (GMICS) present significant surgical challenges due to tumor size and potential neurological deficits.
• Preserving patient quality of life is a primary goal in managing these complex tumors.

Purpose of the Study:

• To evaluate the efficacy and safety of surgical treatment for GMICS.
• To analyze factors influencing surgical outcomes, including resection extent and morbimortality.

Main Methods:

• Retrospective analysis of 33 patients with GMICS treated surgically between 2012 and 2022.
• Review of surgical intervention details, Simpson grade of resection, tumor location, and morbimortality.
• Assessment of long-term tumor control and functional outcomes using Karnofsky Performance Status.

Main Results:

• The study included 25 women and 8 men (median age 56 years) with a mean follow-up of 52 months.
• Simpson grades I-III resection was achieved in 70% of cases; 94% were WHO grade 1 meningiomas.
• Overall mortality was 3%; permanent and transient cranial nerve deficits occurred in 21% and 42%, respectively. Recurrence/regrowth rate was 6%.

Conclusions:

• Surgical treatment for GMICS is an effective modality with acceptable morbimortality and good long-term tumor control.
• Internal carotid artery involvement is critical for determining the extent of cavernous sinus resection.
• Mandatory microsurgical laboratory training is essential for safe surgical management of GMICS.