Introduction: Treatment of cavernous sinus (CS) meningioma remains a controversy. Radical resection of these lesions through the transcranial route is associated with a significant amount of new neurosurgical deficits. Previous studies described the use of endoscopic endonasal approach (EEA) for decompression of CS meningiomas. Here we outline a treatment algorithm that incorporates the EEA in a comprehensive approach to CS meningiomas.
Methods: We describe our experience with this approach in 13 patients with symptomatic CS meningiomas. All patients presented with at least one cranial nerve deficits. All patients underwent EEA for medial decompression and biopsy of the CS meningioma as well decompression of the orbital apparatus as needed. Five patients subsequently underwent lateral decompression of the CS through craniotomy. All patients underwent radiation therapy.
Results: Eight patients (62%) experienced improvement of their presenting symptoms. Two patients (15%) showed no improvement. Three patients (23%) had worsening of their symptoms. Overall 14 of 23 (60%) cranial nerve deficits improved with this treatment alorithm. Four of six cranial nerve 2 (80%) deficits improved after optic apparatus decompression. Improvement for deficits involving cranial nerves 3 through 6 was 4/7 (60%), 1/1 (100%), 1/1 (100%), 5/7 (55%), respectively. There were no surgical complications.
Conclusions: We show that the endoscopic endonasal approach (EEA) can be used as part of a comprehensive algorithm that include lateral decompression through craniotomy along with radiation therapy to approach cavernous meningioma. The proposed algorithm may lead to significant improvement in symptoms without significant surgical morbidity. Further studies will be needed to compare this approach to radiation alone and longer follow up may be needed to understand the longterm tumor control rates.
Patient Care: Cavernous sinus meningioma are extremely morbid entities because of their growth in difficult location surrounding delicate cranial nerve and because of the significant surgical morbidity of the classical surgical approaches. Describing new surgical approaches to these lesions offer patients a way to alleviate their symptoms without incurring the price of increased surgical morbidity.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the role of endoscopic endonasal approaches to cavernous sinus meningioma.