Efficacy and Safety of Radiosurgery in Cavernous Sinus Meningioma: A Systematic Review and Single Meta-Analysis

Meningiomas are the most common primary central nervous system tumors, with cavernous sinus meningiomas (CSMs) making up a small fraction (1% of intracranial tumors). CSMs are challenging to treat due to their location and potential invasion. Therapy methods have shifted from aggressive resections to less invasive techniques such as stereotactic radiosurgery, reducing morbidity and improving survival. This study reviews the effectiveness and safety of radiosurgery for CSMs, blending historical and contemporary approaches to guide future treatments.

A search was performed in MEDlINE, Embase, and Cochrane databases, following Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eligible studies included randomized or observational studies with ≥4 patients reporting on radiosurgery for CSM. The random-effects model was used to calculate a single proportion analysis with 95% CIs. Statistical analyses were performed using RStudio.

Twenty seven studies, encompassing 1851 patients, were included in this analysis, with a population median age of 27 years. Outcomes were assessed as follows: the 10-year progression-free survival rate was 87% (323 patients; 95% CI: 73%-100%; I² = 89.6%), clinical deterioration occurred in 6% of cases (957 patients; 95% CI: 3%-8%; I² = 71.3%), clinical improvement was observed in 35% of patients (1106 patients; 95% CI: 27%-43%; I² = 86.6%), major complications rate was 4% (688 patients; 95% CI: 1%-6%; I² = 71.8%), and minor complications was 2% (653 patients; 95% CI: 0%-3%; I² = 68.6%).

This study reveals stereotactic radiosurgery as an effective treatment of CSMs, showing high long-term progression-free survival and significant tumor control with few complications.