Introduction: Ophthalmic dysfunctions represent one of the most common preoperative disabilities in patients harboring cavernous sinus meningiomas (CSM). The objective of this study is to elucidate the feasibility of improvement in ophthalmic functions after microsurgery or stereotactic radiosurgery/radiotherapy (SRS/RT) of CSM.
Methods: Review of literature and retrospective analysis and was done to determine the improvement in neuro-ophthalmic functions after either microsurgery or SRS/RT. Pubmed search from the year 1994 to 2011 revealed 38 studies. Of these, data on cranial nerve (CN) II, CN III, CN IV and CN VI was available in 23, 21, 20, 19 studies respectively. In our series, a total of 57 patients underwent surgical removal of CSM by the senior author (A.N.) from 1996-2011. For intergroup analysis, the studies were divided into two groups, a) Microsurgical series b) SRS/RT series.
Results: A total of 452 CN II, 361 CN III, 105 CN IV and 325 CN VI were analyzed. The most commonly involved cranial nerve was CN II followed by CN III>VI>IV. Overall, CN II function improved in 32.7%, CN III in 31.6%, CN IV in 24.8% and CN VI in 30.7% of the involved cranial nerves (Fig 1). On characterizing the data based on treatment modality, we found CN II (37% vs. 28%, p=0.04) and CN III (36.5% vs. 26.7%, p=0.05) had significantly better improvement rates in the microsurgical series as compared to SRS/RT series, while CN IV (31.6% vs. 20%, p=0.2) and CN VI (33.6% vs. 29.8%, p=0.5) improvement rates were not significantly higher in microsurgical series from SRS/RT series (Fig 2).
Conclusions: Overall, the chances of improvement in preoperative ophthalmic dysfunction following surgery and/or SRS/RT are low. Improvement in CN II and III functions were significantly better among the microsurgical series. Further prospective controlled studies are required to validate the results of the study.
Patient Care: Ophthalmic dysfunctions represent one of the most common cause of disability in a patient with cavernous sinus meningioma. The results of this systematic review will help the physicians to make their patients aware regarding the chances of improvement of ophthalmic outcomes after either radiosurgery or microsurgery of the meningiomas involving the parasellar compartment.
Learning Objectives: By the conclusion of this session, participants should be able to appreciate the feasibility of improvement in ophthalmic functions after microsurgery and/or radiosurgery of Cavernous Sinus Meningiomas.