Introduction: Gamma Knife Radiosurgery (GKRS) is a commonly used modality for treating patients
with cavernous sinus (CS) lesions. However, when treated primarily, making a diagnosis
of either meningioma, hemangioma or schwannoma may be difficult. Response to these
tumor types is different after GKRS and knowing response rates is crucial for Counselling
patients about prognosis. Our aim was to evaluate the response in different tumor
types.
Methods: We did a retrospective chart review of all patients who underwent GKRS for cavernous
sinus tumor in our institute from 2006 to 2021. All patients with a minimum clinical
and radiological follow-up of 6 months were included. Tumor control and clinical recovery
was evaluated.
Results: 105 patients with CS tumors were treated in the study period. 17 patients were excluded
due to unavailability of data. 38 were meningiomas, 8 schwannomas and 42 hemangiomas
in the study. The median follow-up available was 22 months. Progression-free survival
was 100% for cavernous sinus hemangiomas at a median follow-up of 38months, 96% for
meningiomas at a median follow-up of 32months and 100% for schwannomas at a median
follow-up of 30months. Cranial improvement was seen in all lesions with the fastest
improvement seen in hemangiomas. When compared longitudinally, hemangiomas showed
the most rapid response to treatment followed by Schwannomas. Complete disappearance
of lesion happened only in hemangiomas compared to other tumor types.
Conclusion: Cavernous sinus hemangiomas have a rapid and complete response compared to schwannomas
and meningiomas. The improvement in cranial nerve palsies happened faster and more
dramatic. It is important to counsel patients according to their probable diagnosis
rather than including all cavernous sinus lesions together. Radiologists play an important
role in diagnosis based on imaging so that patients can be counselled accordingly.
