J Neurol Surg B Skull Base 2025; 86(S 01): S1-S576
DOI: 10.1055/s-0045-1803381
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Systematic Review and Meta-analysis: Radiosurgery Outcomes in Cavernous Sinus Meningioma

Authors

  • Lucca B. Palavani

    1   Max Planck University Center

  • Raphael Camerotte

    2   Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

  • Marina Vilardo

    3   Catholic University of Brasília, Brasília, Distrito Federal, Brazil

  • Bernardo Nogueira

    4   Serra dos Órgãos University Center, Teresópolis, Rio de Janeiro, Brazil

  • Lucas Pari Mitre

    5   Faculty of Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil

  • Paulo Victor Zattar Ribeiro

    6   Department of Medical Genetics, State University of São Paulo, Ribeirão Preto, Brazil

  • Henrique Lepine

    7   University of São Paulo School of Medicine (FMUSP), São Paulo, SP, Brazil

  • Filipi Fim Andreão

    2   Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

  • Fábio Torregrossa

    8   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States

  • Thiago Montenegro

    9   Department of Neurosurgery, Spectrum Health/Michigan State University, Grand Rapids, Michigan, United States

  • Raphael Bertani

    7   University of São Paulo School of Medicine (FMUSP), São Paulo, SP, Brazil

  • Fábio Ynoe Moraes

    10   Department of Oncology, Queen's University, Kingston, Canada

  • Marcos Vinicius Calfat Maldaun

    11   Sírio Libanês Hospital, São Paulo, SP, Brazil

  • Cleiton Formentin

    12   Department of Neurosurgery, State University of Campinas, Campinas, SP, Brazil
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Introduction: Meningiomas are the most common primary CNS tumors, with cavernous sinus meningiomas (CSMs) constituting 1% of intracranial tumors. Due to their location and potential invasion, CSMs are challenging to treat. Treatment methods have evolved from aggressive resections to less invasive techniques like stereotactic radiosurgery (SRS), which reduce morbidity and improve survival. This study reviews the effectiveness and safety of radiosurgery for CSMs, integrating historical and contemporary approaches to guide future treatments.

Methods: A search was conducted in Medline, Embase, and Cochrane databases, adhering to Cochrane and PRISMA guidelines. Eligible studies included randomized or observational studies with at least four patients reporting on radiosurgery for CSM. A random-effects model was used to calculate a single proportion analysis with 95% confidence intervals. Statistical analyses were performed using RStudio. Clinical improvement was defined as partial or complete recovery of at least one preexisting cranial nerve or neurological deficit. Clinical deterioration was defined as the worsening or onset of new cranial nerve or neurological deficits. The design of progression-free survival analysis was considered according to the included studies.

Results: The analysis included 51 studies with a total of 4,168 patients, and the median age was 57 years, ranging from 32 to 107 years. Males made up 60% of the cohort, and females 40%. The mean tumor volume was 10.9 cm3. Previous surgeries were reported in 569 patients (13.65%). Cranial nerve deficits were the most common symptom (80%), followed by extraocular neuropathy (55%), trigeminal neuropathy (31%), and visual acuity impairment (12%). Gamma Knife was the most used radiotherapy modality (45%), followed by LINAC (25%) and Cyber Knife (5%). The marginal dose ranged from 10 to 80 Gy, with an average of 18 Gy. The mean follow-up duration was about 50 months, ranging from 15 to 300 months. These data provide insights into patient demographics, treatment methods, and posttreatment monitoring strategies. Outcomes were as follows: the 10-year progression-free survival (PFS) rate was 90% (95% CI: 80–99%; I 2 = 85%; [Fig. 1]), clinical deterioration occurred in 6% of cases (95% CI: 3–9%; I 2 = 71%; [Fig. 2]), clinical improvement was observed in 36% of patients (95% CI: 28–43%; I 2 = 86%; [Fig. 3]).

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Fig. 1 10-year progression-free survival.
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Fig. 2 Clinical deterioration.
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Fig. 3 Clinical improvement.

Conclusion: This study demonstrates that SRS is an effective treatment for CSMs, offering high long-term PFS and significant tumor control with few complications. However, variations in SRS techniques and tumor characteristics highlight the need for standardized methods to refine treatment approaches.



Publication History

Article published online:
07 February 2025

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