Introduction: To evaluate cranial nerve outcomes in patients who undergo stereotactic radiosurgery (SRS) for cavernous sinus meningiomas.
Methods: During a 23-year interval, 303 patients underwent Gamma Knife SRS for skull base meningiomas located in the cavernous sinus. There were 81 males and 222 females with a median age of 56 years (range, 15-86 years). The median tumor volume was 8.0 cc (range, 0.1-43.1 cc). The median marginal dose was 13 Gy (10-20 Gy). The median follow-up period was 60 months (6-212 months).
Results: In this series, 103 (91%) of 113 patients who underwent prior surgical resection had cranial nerve dysfunction at the time of SRS. In comparison 74 (39%) of 190 patients who had not undergone prior surgical resection had cranial nerve dysfunction. The median duration of cranial nerve dysfunction before SRS was 8 months (range, 0.5-274 months). The progression-free survival after SRS was 92% and 85 % at 5 and 10 years, respectively. Sixty-eight (26%) of 258 patients with cranial nerve dysfunction and clinical follow-up had improvement in cranial nerve function. Using Kaplan-Meier analysis, the improvement rate of cranial nerve dysfunction in patients with prior surgical resection was 8%, 13%, and 15% at 1, 3, and 5 years, respectively. The improvement rate of cranial nerve dysfunction in patients without prior resection was 17%, 33%, and 35% at 1, 3, and 5 years, respectively. Tumor volume, margin dose, age, and symptom duration were not associated with improvement of cranial nerve dysfunction. Forty three patients (14%) developed new or worsening of cranial nerve function; eight had tumor progression and seven had adjacent tumor related brain edema or adverse radiation effect.
Conclusions: Stereotactic radiosurgery provided effective tumor control with a low risk of new cranial nerve dysfunction. Improvement in preexisting cranial neuropathy was noted in one-fourth of these patients.
Patient Care: A knowledge of cranial nerve outcomes in patients with cavernous sinus meningioma after stereotactic radiosurgery.
Learning Objectives: By the conclusion of this session, participants should understand the long term outcomes of SRS for cavernous sinus meningioma.