Natural history of cavernous sinus meningiomas

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OBJECTIVE

Meningiomas confined to the cavernous sinus (MCSs) are benign tumors. Due to the high risk of severe complications, the intracavernous surgical procedure was abandoned in favor of radiotherapy. However, the choice of treatment remains complicated due to the fact that the natural history of this lesion has not yet been described.

METHODS

The authors studied the natural history of this lesion using a prospective series of 53 consecutive patients suffering from MCSs. The median follow-up duration was 10.2 years (range 2–25 years), from 1990 to 2016.

RESULTS

Patients ranged in age from 30 to 72 years (mean 53 years). The meningiomas were diagnosed by major symptoms (mainly oculomotor palsy and neuralgia experienced in 28 patients), minor symptoms (headache, intermittent diplopia in 15 patients), or incidental findings (10 patients). Simple symptomatic treatment (short courses of corticosteroids and carbamazepine) allowed patients to become asymptomatic in 19 (67.9%) of 28 cases experiencing major symptoms, and for 12 (80%) of 15 patients with initial minor symptoms (p < 0.0001). All patients with incidental findings remained asymptomatic. Forty four (83%) of 53 MCSs did not show any significant growth and 42 (80%) of 53 patients were not symptomatic at the end of follow-up (p < 0.001). The radiographic progression-free survival rates (± SD) at 5, 10, and 20 years were 90% ± 4.2%, 82% ± 5.7%, and 70% ± 10.2%, respectively. Five patients (9.4%) with no evidence of any effect of the initial medical treatment desired additional conventional radiation therapy.

CONCLUSIONS

Because of the capricious, unpredictable, and slow growth of MCSs, together with high growth variability from one patient to the next, the symptomatic medical treatment of these tumors is a highly effective method. This series shows that these lesions are naturally, clinically, and radiologically indolent.

ABBREVIATIONS CN = cranial nerve; CS = cavernous sinus; MCS = meningioma of the CS; PFS = progression-free survival.

Article Information

Correspondence Aymeric Amelot: Groupe Hospitalier Pitié-Salpêtrière, Paris, France. aymmed@hotmail.fr.

INCLUDE WHEN CITING Published online March 30, 2018; DOI: 10.3171/2017.7.JNS17662.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Axial brain T1-weighted MRI with Gd in CS meningiomas showing examples in patients with an incidental finding (A), minor symptoms (B), and major symptoms (C).

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    Follow-up years for the incidental findings group (dark gray = asymptomatic).

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    Follow-up data for patients in minor and major symptomatic groups (dark gray = become asymptomatic, light gray = became or remain symptomatic). g = Gamma Knife surgery; II–VI = CNs; HyperP = hyperprolactinemia; M = medical symptomatic treatment; R = radiotherapy.

  • View in gallery

    A: Kaplan-Meier curve for development of new symptoms. B and C: Kaplan-Meier curves of years to progression of cavernous sinus meningiomas within the whole series (B) and according to incidental findings (C; 18.8 months, dashed line), minor symptoms (15.6 months, black line), and major symptoms (20.2 months, gray line). Figure is available in color online only.

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