The treatment of meningiomas in the region of the cavernous sinus

The diagnosis and treatment of meningiomas of the cavernous sinus remains a controversial part of skull base surgery practice. The most common present ing symptom headache is nonspecific. Visual loss and oculomotor disturbance are the next likely symptoms and signs. It is possible to achieve total tu mor removal in about 50% of patients, but an increase in cranial nerve dysf unction occurs in nearly as many. Improvement of neurological function, exc ept for vision, is unusual. Because of the risk of complicating cranial ner ve dysfunction by surgery, focused radiation as an alternative treatment ha s been explored in a small number of patients. Unfortunately, volume reduct ion is only seen in about one-third, but risks do appear to be low and near ly 60% of patients recorded have improvement in preoperative cranial nerve deficits. With these indolent tumors, much longer follow-ups are required b efore the role of focused radiation can be assessed.