Micro-Neurosurgical Management of Cavernous Sinus Meningioma: Single-Surgeon Experience from Louisiana State University, Shreveport

Introduction: Cavernous sinus meningiomas (CSM) continue to represent a cohort of challenging skull base tumors where the technical success of surgery may not parallel good outcomes. Because different levels of expertise may be a potential confounding factor in assessing outcomes, this study focuses on long-term outcomes of patients operated on for CSM by the senior author (AN).

Methods: A total of 43 CSM (primary + secondary) patients underwent microsurgical removal by the senior author from 1996 to 2010. Retrospective analysis to elucidate perioperative complications and long-term clinicoradiological outcomes was done. Sekhar classification, Modified Kobayashi grading, and GOS were used to define tumor extension, tumor removal and clinical outcomes, respectively.

Results: The mean age of the predominantly female (78%) patients in our study was 55 years. Mean follow-up time was 54.5 months (range, 6–187 months). The most common presenting symptom was headache (74%). Preoperative cranial nerve dysfunction (CND) was evident in 67% of the patients, of which the most common was second CN deficit. Complete or partial recovery of CN was significantly better in patients with CND inflicted postoperatively compared with those having CND preoperatively (89% vs. 63%, P = 0.037). Overall, 35% of the patients showed radiological recurrence after their initial surgery. No significant difference in recurrence was found among grades of Sekhar classification. The mean time of recurrence in the patients treated by surgery alone vs. surgery plus adjuvant SRS was 49 months vs. 50 months, and recurrence rate among the two groups was not significant( 21% vs. 53%, P = 0.23 ). On linear regression analysis, preoperative CND was predictive of tumor recurrence after surgery (P = 0.006). At their latest follow-up, 74% of patients had good outcomes (GOS 4 or 5). Extent of tumor removal and extension were not predictive of good outcomes.

Conclusion: Although fraught with unavoidable postoperative morbidity, long-term good outcomes and tumor control is possible in CSM with microsurgery and appropriate use of SRS. In our study, preoperative CND improved in majority of patients and was predictive of tumor recurrence after surgery.