Comparison of Primary and Adjuvant Stereotactic Radiosurgery for Treatment of Cavernous Sinus Meningiomas: A Meta-analysis

Meningiomas are the most common tumor involving the cavernous sinus. Despite typically carrying a benign pathology, their involvement with intracavernous and adjacent parasellar neurovascular structures can cause significant morbidity. Less-invasive treatment strategies such as stereotactic radiosurgery (SRS) and radiotherapies have become an optimal part of therapy for these tumors. The purpose of this study was to generate a systematic review assessing treatment-related outcomes between primary single-fraction SRS and open microsurgery followed by adjuvant SRS in treatment of cavernous sinus meningiomas (CSMs). Articles were identified using relevant keywords from PubMed, Embase, Web of Science, Scopus, and Cochrane Library. Multifraction radiotherapy, linear accelerator SRS, and endoscopic endonasal surgical interventions were excluded from analysis. The search identified studies including 3,368 patients with CSMs treated with primary SRS and 768 patients treated with surgery and adjuvant SRS. Separate meta-analyses were conducted to compare outcomes including tumor regression, cranial neuropathy improvement, cranial neuropathy worsening, and postoperative complications, when reported. The pooled proportion of patients demonstrated less tumor regression in the primary SRS group compared to the adjuvant SRS group (48 vs. 69%; 95% CI: 41–56% vs. 52–85%, respectively, p = 0.03). Regarding cranial neuropathies, a higher proportion of patients who underwent primary SRS showed improvement in symptoms compared to the adjuvant SRS group (34 vs. 22%; 95% CI: 27–41% vs. 12–31%, respectively, p = 0.03). No significant difference was observed in postoperative worsening of cranial neuropathies between the primary SRS and adjuvant SRS groups (6.8 vs. 10%, 95% CI: 4.5–9.1% vs. 3.7–17%, respectively, p = 0.33). Any postoperative complications, including but not limited to new cranial nerve deficits, ischemic stroke, diplopia, hypopituitarism, were analyzed. No significant difference was noted in the proportion of complications in the primary SRS group compared to the adjuvant SRS group (6.2 vs. 5.8%; 95% CI: 3.7–8.7% vs. 1.8–9.9%, respectively, p = 0.88). There was significant heterogeneity among the studies in each group. The results of this meta-analysis demonstrate greater tumor control achieved with surgery and adjuvant SRS at the cost of a reduced rate of cranial neuropathy improvement. Further prospective and randomized trials are needed to identify optimal treatment strategies for this condition.

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Artikel online veröffentlicht:
07. Februar 2025