THE SURGICAL RESECTABILITY OF MENINGIOMAS OF THE CAVERNOUS SINUS

OBJECTIVE: The optimal management for patients with cavernous sinus me ningiomas remains controversial. We attempt to contribute to the ongoi ng debate of appropriate surgical indications. METHODS: In this retros pective review, 39 patients, including 27 women and 12 men ranging in age from 24 to 73 years (median, 48 yr), underwent surgical treatment for this condition. Completeness of tumor resection cranial nerve morb idity, general morbidity, and long-term outcome were studied. The cave rnous internal carotid artery was partially encased in 15 patients, to tally encased in 11 patients, and narrowed by tumor in 13 patients. RE SULTS: Of eight patients who underwent complete tumor resection, seven had partial encasement of the internal carotid artery. Of 31 patients who underwent subtotal resection, 11 underwent postoperative radiothe rapy. There were no deaths in the series. Morbidity was 17.9% for cran ial nerves controlling extraocular motor function. Trigeminal nerve fu nction did not improve after surgical treatment. The median follow-up period was 2 years (range, 6 mo-5.3 yr). Symptomatic and radiographic recurrence occurred in two patients who underwent complete tumor resec tion and in two patients who underwent subtotal resection. CONCLUSION: Based on our findings and a review of the literature, we conclude the following: 1) the resectability of meningiomas of the cavernous sinus depends on the degree of internal carotid artery involvement; 2) tota l excision of cavernous sinus meningiomas is possible but rarely achie ved in holocavernous meningiomas; 3) cranial nerve morbidity is signif icant; and 4) subtotal excision with or without postoperative radiothe rapy is an effective short-term oncological strategy.