Abstract
Cavernous sinus meningioma (CSM) with orbital involvement presents a unique challenge
to modern-day neurosurgeons. In the modern era of preventive medicine with enhanced
screening tools, physicians encounter CSM more frequently. An indolent natural history,
late clinical presentation, close proximity to vital neurovascular structures, poor
tumor-to-normal tissue interface, and high risk of iatrogenic morbidity and mortality
with aggressive resection add to the complexity of decision-making and optimal management
of these lesions. The clinical dilemma of deciding whether to observe or intervene
first for asymptomatic lesions remains an enigma in current practice. The concepts
of management for CSM with orbital involvement have gradually evolved from radical
resection to a more conservative surgical approach with maximal safe resection, with
the specific goals of preserving function and reducing proptosis. This change in surgical
attitude has enabled better long-term functional outcomes with conservative approaches
as compared with functionally disabled outcomes resulting from the pursuit of anatomical
cure from disease with radical resection. The advent of stereotactic radiosurgery
as an adjunct tool to treat residual CSM has greatly shaped our resection principles
and planning. Interdisciplinary collaboration for multimodality management is key
to successful management of these difficult to treat lesions and tailor management
as per individual's requirement.
Keywords
cavernous sinus meningioma - multimodality management - stereotactic radiosurgery
- treatment strategy - orbital involvement
