Stereotactic radiosurgery for the management of cavernous sinus meningiomas: A narrative review

Authors : Mehmet Denizhan Yurtluk
Pages : 307-312
Doi:10.29058/mjwbs.1826035
View : 66 | Download : 60
Publication Date : 2025-12-31
Article Type : Review Paper
Abstract :Cavernous sinus meningiomas (CSMs) are a challenging subgroup of intracranial meningiomas because of their close relationship with vital neurovascular structures. This systematic review evaluates the effectiveness and safety of stereotactic radiosurgery (SRS) for both primary and adjuvant treatment of CSMs. We analyzed data from 24 studies involving 2,302 patients treated with SRS using various platforms, such as Gamma Knife, LINAC-based systems, and CyberKnife. The median marginal doses ranged from 11 to 19 Gy, with the most recent series using 12 to 14 Gy. Long-term tumor control was excellent, with 5-year progression-free survival rates between 86% and 99%, and 10-year rates from 69% to 97%. Neurological improvement was seen in 20% to 46% of symptomatic patients, especially in cranial nerve function, notably abducens nerve palsy. Radiation-related complications were rare (0-12%) and usually temporary, with permanent deficits occurring in less than 7% of patients. Comparative analysis showed better neurological outcomes with primary SRS compared to adjuvant SRS after microsurgical resection, suggesting that early intervention with SRS may be preferable to watchful waiting or aggressive surgery for carefully selected patients. This review provides Class III, including retrospective comparative studies, and case series evidence that SRS has an excellent risk-benefit profile for CSMs, achieving durable tumor control with minimal morbidity. We recommend a treatment approach favoring primary SRS for small to medium-sized, asymptomatic, or minimally symptomatic CSMs, while advocating for surgical decompression followed by adjuvant SRS in larger lesions with significant mass effect or worsening neurological deficits.
Keywords : Kavernöz sinüs menenjiyomu, stereotaktik radyocerrahi, Gamma Knife, kraniyal sinir fonksiyonu, primer radyocerrahi

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