Factors affecting outcome following treatment of patients with cavernous sinus meningiomas

Clinical article

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Although there is a considerable volume of literature available on the treatment of patients with cavernous sinus meningiomas (CSMs), most of the data regarding tumor control and survival come from case studies or single-institution series. The authors performed a meta-analysis of reported tumor control and survival rates of patients described in the published literature, with an emphasis on specific prognostic factors.


The authors systematically analyzed the published literature and found more than 3000 patients treated for CSMs. Separate meta-analyses were performed to calculate pooled rates of recurrence and cranial neuropathy after 1) gross-total resection, 2) subtotal resection without adjuvant postoperative radiotherapy or radiosurgery, and 3) stereotactic radiosurgery (SRS) alone. Results were expressed as pooled proportions, and random-effects models were used to incorporate any heterogeneity present to generate a pooled proportion. Individual studies were weighted using the inverse variance method, and 95% CIs for each group were calculated from the pooled proportions.


A total of 2065 nonduplicated patients treated for CSM met inclusion criteria for the analysis. Comparisons of the 95% CIs for recurrence of these 3 cohorts revealed that SRS-treated patients experienced improved rates of recurrence (3.2% [95% CI 1.9–4.5%]) compared with either gross-total resection (11.8% [95% CI 7.4–16.1%]) or subtotal resection alone (11.1% [95% CI 6.6–15.7%]) (p < 0.01). The authors found that the pooled mixed-effects rate of cranial neuropathy was markedly higher in patients undergoing resection (59.6% [95% CI 50.3–67.5%]) than for those undergoing SRS alone (25.7% [95% CI 11.5–38.9%]) (p < 0.05).


Radiosurgery provided improved rates of tumor control compared with surgery alone, regardless of the subjective extent of resection.

Abbreviations used in this paper: CSM = cavernous sinus meningioma; SRS = stereotactic radiosurgery.

Article Information

Address correspondence to: Andrew T. Parsa, M.D., Ph.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, California 94143. email: parsaa@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online May 7, 2010; DOI: 10.3171/2010.3.JNS091807.

© AANS, except where prohibited by US copyright law.



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    Forest plots depicting 95% CIs for recurrence rates of studies in this analysis and the pooled proportion calculated from our analysis. Individual studies are indicated by PubMed identification number at the left: forest plots for patients receiving gross-total resection (A), forest plots for patients receiving subtotal resection (B), forest plots for patients receiving SRS alone (C).


  • 1

    Abeloos LLevivier MDevriendt DMassager N: Internal carotid occlusion following gamma knife radiosurgery for cavernous sinus meningioma. Stereotact Funct Neurosurg 85:3033062007

  • 2

    Black PMMorokoff APZauberman J: Surgery for extra-axial tumors of the cerebral convexity and midline. Neurosurgery 62:3 Suppl111511232008

  • 3

    Brell MVillà STeixidor PLucas AFerrán EMarín S: Fractionated stereotactic radiotherapy in the treatment of exclusive cavernous sinus meningioma: functional outcome, local control, and tolerance. Surg Neurol 65:28342006

  • 4

    Chang SDAdler JR JrMartin DP: LINAC radiosurgery for cavernous sinus meningiomas. Stereotact Funct Neurosurg 71:43501998

  • 5

    Cioffi FABernini FPPunzo ANatale MMuras I: Cavernous sinus meningiomas. Neurochirurgia (Stuttg) 30:40471987

  • 6

    Couldwell WTKan PLiu JKApfelbaum RI: Decompression of cavernous sinus meningioma for preservation and improvement of cranial nerve function. Technical note. J Neurosurg 105:1481522006

  • 7

    De Jesús OSekhar LNParikh HKWright DCWagner DP: Long-term follow-up of patients with meningiomas involving the cavernous sinus: recurrence, progression, and quality of life. Neurosurgery 39:9159201996

  • 8

    DeMonte FSmith HKal-Mefty O: Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 81:2452511994

  • 9

    DerSimonian R: Combining evidence from clinical trials. Anesth Analg 70:4754761990

  • 10

    DerSimonian R: Meta-analysis in the design and monitoring of clinical trials. Stat Med 15:123712521996

  • 11

    DerSimonian RCharette LJMcPeek BMosteller F: Reporting on methods in clinical trials. N Engl J Med 306:133213371982

  • 12

    DerSimonian RLaird N: Meta-analysis in clinical trials. Control Clin Trials 7:1771881986

  • 13

    Ducic Y: Orbitozygomatic resection of meningiomas of the orbit. Laryngoscope 114:1641702004

  • 14

    Dufour HMuracciole XMétellus PRégis JChinot OGrisoli F: Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with or without previous surgery: is there an alternative to aggressive tumor removal?. Neurosurgery 48:2852962001

  • 15

    Duma CMLunsford LDKondziolka DHarsh GR IVFlickinger JC: Stereotactic radiosurgery of cavernous sinus meningiomas as an addition or alternative to microsurgery. Neurosurgery 32:6997051993

  • 16

    Erşahin YOzdamar NDemirtaş EKarabiyikoğlu M: Meningioma of the cavernous sinus in a child. Childs Nerv Syst 15:8101999

  • 17

    Franzin AVimercati AMedone MSerra CMarzoli SBForti M: Neuroophthalmological evaluation after Gamma Knife surgery for cavernous sinus meningiomas. Neurosurg Focus 23:6E102007

  • 18

    George BFerrario CABlanquet AKolb F: Cavernous sinus exenteration for invasive cranial base tumors. Neurosurgery 52:7727822003

  • 19

    Glass JPHalpern JGrossman RG: Uncovering ocular pseudomyasthenia. Ann Ophthalmol 25:4184211993

  • 20

    Goel A: The extradural approach to lesions involving the cavernous sinus. Br J Neurosurg 11:1341381997

  • 21

    Goldsmith BJRosenthal SAWara WMLarson DA: Optic neuropathy after irradiation of meningioma. Radiology 185:71761992

  • 22

    Hasegawa TKida YYoshimoto MKoike JIizuka HIshii D: Long-term outcomes of Gamma Knife surgery for cavernous sinus meningioma. J Neurosurg 107:7457512007

  • 23

    Honegger JFahlbusch RBuchfelder MHuk WJThierauf P: The role of transsphenoidal microsurgery in the management of sellar and parasellar meningioma. Surg Neurol 39:18241993

  • 24

    Ikawa FUozumi TKiya KArita KKurisu KHarada K: Cavernous sinus meningioma presenting as orbital apex syndrome. Diagnostic methods of dynamic MRI, spoiled GRASS (SPGR) image. Neurosurg Rev 18:2772801995

  • 25

    Iwai YYamanaka KIshiguro T: Gamma knife radiosurgery for the treatment of cavernous sinus meningiomas. Neurosurgery 52:5175242003

  • 26

    Iwai YYamanaka KNakajima H: Two-staged gamma knife radiosurgery for the treatment of large petroclival and cavernous sinus meningiomas. Surg Neurol 56:3083142001

  • 27

    Iwai YYamanaka KYasui TKomiyama MNishikawa MNakajima H: Gamma knife surgery for skull base meningiomas. The effectiveness of low-dose treatment. Surg Neurol 52:40451999

  • 28

    Jääskeläinen J: Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis. Surg Neurol 26:4614691986

  • 29

    Jungreis CA: Skull-base tumors: ethanol embolization of the cavernous carotid artery. Radiology 181:7417431991

  • 30

    Kawase TGotoh KToya S: A wrapping clip combined with silastic sheet for emergent hemostasis: technical note. Neurosurgery 35:7697711994

  • 31

    Kim DKGrieve JArcher DJUttley D: Meningiomas in the region of the cavernous sinus: a review of 21 patients. Br J Neurosurg 10:4394441996

  • 32

    Klink DFSampath PMiller NRBrem HLong DM: Long-term visual outcome after nonradical microsurgery patients with parasellar and cavernous sinus meningiomas. Neurosurgery 47:24322000

  • 33

    Knosp EPerneczky AKoos WTFries GMatula C: Meningiomas of the space of the cavernous sinus. Neurosurgery 38:4344441996

  • 34

    Kobayashi TKida YMori Y: Long-term results of stereotactic gamma radiosurgery of meningiomas. Surg Neurol 55:3253312001

  • 35

    Koch MUHoutman ACde Keizer RJ: Gaze-evoked amaurosis with cavernous sinus meningioma. Eye (Lond) 20:8408432006

  • 36

    Kondziolka DMathieu DLunsford LDMartin JJMadhok RNiranjan A: Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 62:53602008

  • 37

    Kuratsu JOkamura AKamiryo TUshio Y: A paediatric patient with meningioma arising from the cavernous sinus wall. Acta Neurochir (Wien) 139:2592601997

  • 38

    Kurita HSasaki TKawamoto STaniguchi MTerahara ATago M: Role of radiosurgery in the management of cavernous sinus meningiomas. Acta Neurol Scand 96:2973041997

  • 39

    Landeiro JAFlores MSLapenta MAGaldino ACLázaro BC: Remote hemorrhage from the site of craniotomy. Arq Neuropsiquiatr 62:3B8328342004

  • 40

    Lee JPTsai MSChen YR: Orbitozygomatic infratemporal approach to lateral skull base tumors. Acta Neurol Scand 87:4034091993

  • 41

    Leijzer CTPrevo RLHageman G: Meningioma presenting as Tolosa-Hunt syndrome. Clin Neurol Neurosurg 101:19221999

  • 42

    Lesoin FJomin M: Direct microsurgical approach to intracavernous tumors. Surg Neurol 28:17221987

  • 43

    Liscák RSimonová GVymazal JJanousková LVladyka V: Gamma knife radiosurgery of meningiomas in the cavernous sinus region. Acta Neurochir (Wien) 141:4734801999

  • 44

    Maguire PDClough RFriedman AHHalperin EC: Fractionated external-beam radiation therapy for meningiomas of the cavernous sinus. Int J Radiat Oncol Biol Phys 44:75791999

  • 45

    Malik IRowe JGWalton LRadatz MWKemeny AA: The use of stereotactic radiosurgery in the management of meningiomas. Br J Neurosurg 19:13202005

  • 46

    Maruyama KShin MKurita HKawahara NMorita AKirino T: Proposed treatment strategy for cavernous sinus meningiomas: a prospective study. Neurosurgery 55:106810752004

  • 47

    McBain VAHolder GE: Abnormal flash but normal pattern VEP in a cavernous sinus meningioma. Doc Ophthalmol 107:2012022003

  • 48

    Metellus PRegis JMuracciole XFuentes SDufour HNanni I: Evaluation of fractionated radiotherapy and gamma knife radiosurgery in cavernous sinus meningiomas: treatment strategy. Neurosurgery 57:8738862005

  • 49

    Milker-Zabel SZabel-du Bois AHuber PSchlegel WDebus J: Fractionated stereotactic radiation therapy in the management of benign cavernous sinus meningiomas: long-term experience and review of the literature. Strahlenther Onkol 182:6356402006

  • 50

    Morita ACoffey RJFoote RLSchiff DGorman D: Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients. J Neurosurg 90:42491999

  • 51

    Muzumdar DPGoel AFattepurkar S: Petroclival mixed meningioma. J Clin Neurosci 12:3013032005

  • 52

    Nakase HOhnishi HMatsuyama TMorimoto TSakaki T: Two-stage skull base surgery for tumours extending to the sub- and epidural spaces. Acta Neurochir (Wien) 140:8918981998

  • 53

    Nicolato AForoni RAlessandrini FBricolo AGerosa M: Radiosurgical treatment of cavernous sinus meningiomas: experience with 122 treated patients. Neurosurgery 51:115311612002

  • 54

    Nicolato AForoni RAlessandrini FMaluta SBricolo AGerosa M: The role of Gamma Knife radiosurgery in the management of cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 53:99210002002

  • 55

    O'Sullivan MGvan Loveren HRTew JM Jr: The surgical resectability of meningiomas of the cavernous sinus. Neurosurgery 40:2382471997

  • 56

    Pamir MNKiliç TBayrakli FPeker S: Changing treatment strategy of cavernous sinus meningiomas: experience of a single institution. Surg Neurol 64:2 SupplS58S662005

  • 57

    Phillips PHNewman NJ: Here today… gone tomorrow. Surv Ophthalmol 41:3543561997

  • 58

    Pollock BEStafford SL: Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 62:142714312005

  • 59

    Pontius ATDucic Y: Extended orbitozygomatic approach to the skull base to improve access to the cavernous sinus and optic chiasm. Otolaryngol Head Neck Surg 130:5195252004

  • 60

    Roche PHRégis JDufour HFournier HDDelsanti CPellet W: Gamma knife radiosurgery in the management of cavernous sinus meningiomas. J Neurosurg 93:3 Suppl68732000

  • 61

    Schatz NJSavino PJCorbett JJ: Primary aberrant aculomotor regeneration. A sign of intracavernous meningioma. Arch Neurol 34:29321977

  • 62

    Schlegel WPastyr OBortfeld TBecker GSchad LGademann G: Computer systems and mechanical tools for stereotactically guided conformation therapy with linear accelerators. Int J Radiat Oncol Biol Phys 24:7817871992

  • 63

    Sekhar LNSen CNJho HDJanecka IP: Surgical treatment of intracavernous neoplasms: a four-year experience. Neurosurgery 24:18301989

  • 64

    Selch MTAhn ELaskari ALee SPAgazaryan NSolberg TD: Stereotactic radiotherapy for treatment of cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 59:1011112004

  • 65

    Sen CHague K: Meningiomas involving the cavernous sinus: histological factors affecting the degree of resection. J Neurosurg 87:5355431997

  • 66

    Sepehrnia ASamii MTatagiba M: Management of intracavernous tumours: an 11-year experience. Acta Neurochir Suppl (Wien) 53:1221261991

  • 67

    Shaffrey MEDolenc VVLanzino GWolcott WPShaffrey CI: Invasion of the internal carotid artery by cavernous sinus meningiomas. Surg Neurol 52:1671711999

  • 68

    Shechtman DLWoods ADTyler JA: Pupil sparing incomplete third nerve palsy secondary to a cavernous sinus meningioma: challenges in management. Clin Exp Optom 90:1321382007

  • 69

    Shrivastava RKSen CCostantino PDDella Rocca R: Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg 103:4914972005

  • 70

    Sibtain APlowman PN: Stereotactic radiosurgery. VII. Radiosurgery versus conventionally-fractionated radiotherapy in the treatment of cavernous sinus meningiomas. Br J Neurosurg 13:1581661999

  • 71

    Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22391957

  • 72

    Sindou MWydh EJouanneau ENebbal MLieutaud T: Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone. J Neurosurg 107:9379442007

  • 73

    Spiegelmann RNissim OMenhel JAlezra DPfeffer MR: Linear accelerator radiosurgery for meningiomas in and around the cavernous sinus. Neurosurgery 51:137313802002

  • 74

    Stafford SLPerry ASuman VJMeyer FBScheithauer BWLohse CM: Primarily resected meningiomas: outcome and prognostic factors in 581 Mayo Clinic patients, 1978 through 1988. Mayo Clin Proc 73:9369421998

  • 75

    Suzuki MMizoi KYoshimoto T: Should meningiomas involving the cavernous sinus be totally resected?. Surg Neurol 44:3131995

  • 76

    Trobe JDGlaser JSPost JD: Meningiomas and aneurysms of the cavernous sinus. Neuro-ophthalmologic features. Arch Ophthalmol 96:4574671978

  • 77

    van Effenterre RBataïni JPCabanis EAIba-Zizen MT: High energy radiotherapy in the treatment of meningiomas of the cavernous sinus. Acta Neurochir Suppl (Wien) 28:4644671979

  • 78

    van Overbeeke JJCruysberg JRMenovsky T: Intracranial repair of a divided trochlear nerve. Case report. J Neurosurg 88:3363391998

  • 79

    White WAMohney BGWoog JJ: Cavernous sinus meningioma presenting as intermittent exotropia in a 2-year-old girl. Can J Ophthalmol 42:3412007

  • 80

    Ziyal IMOzgen T: Cavernous sinus meningioma. J Neurosurg 96:6406412002




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