Mid- to Long-Term Visual Outcomes After Surgical Treatment of Cavernous Sinus Meningioma

Cavernous sinus meningiomas (CSMs) are surgically challenging due to their proximity to the internal carotid artery and multiple cranial nerves, and long-term visual trajectories after treatment remain incompletely characterized. This study aimed to define mid- to long-term outcomes, with an emphasis on temporal patterns of visual change, in patients undergoing surgical treatment for CSMs.

We retrospectively analyzed 30 patients with CSM who underwent initial surgical treatment between April 2004 and October 2024. Clinical, radiological, and pathological data were reviewed, including surgical approach, extent of resection, optic canal decompression, complications, adjuvant radiotherapy, tumor control, visual outcomes, and Karnofsky Performance Status score. Extent of resection was calculated volumetrically using contrast-enhanced magnetic resonance imaging. Visual outcomes were evaluated at 4 to 6 months postoperatively and at final follow-up.

The median age was 56 years, and 76.7% were women. Radical intracavernous resection was not attempted. Optic canal decompression was performed in 20 patients. World Health Organization grade 1 tumors accounted for 92.6% of cases. Median follow-up was 81.0 months, and the mean number of surgeries was 1.7 per patient. Early visual improvement was observed in 7 of 11 patients (63.6%) with preoperative deficits. Four patients (13.3%) developed severe visual deterioration to perception of hand motion or worse, with a mean time to event of 94 months; all had received radiotherapy. Tumor irradiation with radiosurgery or radiotherapy provided durable tumor control in selected cases but was associated with higher rates of progression, reflecting selection bias. The mean final Karnofsky Performance Status score was 81.0.

These findings suggest the possibility of a biphasic visual trajectory after surgical management of CSM. Optic canal decompression may facilitate early visual improvement, although delayed visual deterioration can occur despite prolonged disease control, as observed in a limited number of patients. A function-preserving, multimodal strategy may optimize long-term outcomes.