MENINGIOMAS IN THE REGION OF THE CAVERNOUS SINUS - A REVIEW OF 21 PATIENTS

This is a review of 21 patients with meningiomas involving the region of the cavernous sinus. All underwent surgery, and the fronto-zygomati c (F-Z) approach, first described by Fujitsu and Kubawara, was employe d in every case. The mean age at presentation was 47 years; seven pati ents were male and 14 female. The mean duration of symptoms before sur gery was 4 years. In 10 patients, resection was considered to be compl ete. Peri-operatively there were two deaths, but the majority of defic its in the survivors were temporary and quickly resolved. The mean fol low-up period was 48 months. In that time, five patients experienced r ecurrence or progression of tumour, of whom three required repeat oper ation (followed by radiotherapy); and two patients were referred for r adiotherapy alone. These five patients appear to be disease-free 2-5 y ears after their additional treatment. Of the 19 patients who left hos pital, 17 were able to live independent lives. It would appear from th is review that: (1) F-Z craniotomy usually gives excellent exposure to the region of the cavernous sinus; (2) selected patients should under go angiography with balloon occlusion to evaluate the collateral vascu lar supply; (3) regular review should include annual MRI. Evaluation o ver a much longer time of both surgery and radiotherapy, individually and in combination, is needed before it will be possible to furnish a treatment protocol for individual cases at initial presentation or rec urrence.