Volumetric Growth Rates of Untreated Cavernous Sinus Meningiomas

Cavernous Sinus Meningiomas are indolent tumors that initiate within the cavernous sinus and can expand along the skull base as well as intracranially. Given the involvement of vital neurovascular structures within the cavernous sinus including the internal carotid artery as well as cranial nerves II–VI, cavernous sinus meningiomas can have significant neurologic deficits. Management includes observation with serial imaging, stereotactic radiosurgery, or microsurgical debulking of the extracavernous components and decompression of neural elements. Prior studies suggest that such tumors are indolent, and favor observation with symptomatic medical management.1

Between January 2013 and July 31, 2017, 38 patients with cavernous sinus meningiomas were retrospectively evaluated. The average age of patients was 60 years. There was a female preponderance in this cohort, with 82% of patients being females. Most patients (79%) were asymptomatic. All MR images preceded any intervention. Of the 38 patients analyzed, 66% never underwent treatment, 21% underwent stereotactic radiosurgery (SRS), 8% underwent microsurgical resection, and 5% underwent a combined approach with SRS, and craniotomy. To precisely calculate tumor volumes, the tumor area was outlined on every slice, and the products of the area and slice thickness were summed (55% of scans were done). The mean cavernous sinus volumetric growth rate was 35% per year. An assessment of the frequencies of individual tumor annual growth rates revealed that 21% demonstrated growth (5% fast growing), 79% were stable on an average interval of 51 months. There was no relationship between patient age and tumor growth rate.

This study is a comprehensive measure of cavernous sinus meningioma volumetric growth rates using high-resolution imaging. The majority of the tumors remained stable over time, as predicted in previous studies. These findings provide volumetric data regarding the tumor behavior which can assist in the clinical decision making for the management of cavernous sinus meningiomas.