Noiphithak Raywat, Yanez-Siller Juan C, Nimmannitya Pree, Yodwisithsak Pornchai
Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Department of Otolaryngology-Head and Neck Surgery, Northwestern Memorial Hospital, McGaw Medical Center of Northwestern University, Chicago, Illinois, USA.
World Neurosurg. 2024 Nov;191:e538-e546. doi: 10.1016/j.wneu.2024.08.164. Epub 2024 Sep 5.
Cavernous sinus meningiomas (CSMs) are challenging skull base tumors due to their proximity to vital neurovascular structures. Traditional aggressive transcranial resection often leads to significant morbidities with limited improvement of cranial nerve (CN) deficits. Recent advancements in endoscopic skull base surgery and stereotactic radiation therapy (SRT) offer a more conservative approach, facilitating tumor decompression while preserving critical structures.
This retrospective study reviewed medical records of patients with symptomatic CSMs who underwent endoscopic endonasal and/or transorbital surgery, followed by adjuvant SRT, at our institution between January 2017 and April 2022. Patient demographics, tumor characteristics, surgical approaches, radiation, treatment outcomes, complications, and follow-up time were analyzed.
Thirty-nine patients with CSMs were included. Endoscopic endonasal approach was performed in 24 patients (61.5%), endoscopic transorbital approach in 10 patients (25.6%), and combined approaches in 5 patients (12.8%). Adjuvant SRT was administered to 79.5% of patients. Postoperative outcomes showed recovery of CN 3-6 deficits and vision in 60.9% and 65% of cases, respectively. Complications included postoperative CN 3-6 deficits in 5 cases and postradiation visual deterioration in 1 case. During a mean follow-up period of 44 months, tumor progression occurred in 4 patients (10.3%), with 3 diagnosed as World Health Organization grade II meningiomas and 1 as World Health Organization grade I.
This study supports the use of endoscopic skull base surgery combined with adjuvant SRT for symptomatic CSMs, demonstrating both safety and efficacy. This approach yielded favorable outcomes in symptom improvement, tumor control, and positive safety profile.
海绵窦脑膜瘤（CSMs）因其靠近重要神经血管结构，是具有挑战性的颅底肿瘤。传统的积极经颅切除术常导致严重的并发症，而颅神经（CN）功能缺损的改善有限。内镜颅底手术和立体定向放射治疗（SRT）的最新进展提供了一种更保守的方法，在保留关键结构的同时促进肿瘤减压。
这项回顾性研究回顾了2017年1月至2022年4月期间在我们机构接受内镜鼻内和/或经眶手术，随后进行辅助SRT的有症状CSM患者的病历。分析了患者的人口统计学、肿瘤特征、手术方法、放疗、治疗结果、并发症和随访时间。
纳入39例CSM患者。24例（61.5%）患者采用内镜鼻内入路，10例（25.6%）患者采用内镜经眶入路，5例（12.8%）患者采用联合入路。79.5%的患者接受了辅助SRT。术后结果显示，分别有60.9%和65%的病例中CN 3-6功能缺损和视力恢复。并发症包括5例术后CN 3-6功能缺损和1例放疗后视力恶化。在平均44个月的随访期内，4例患者（10.3%）出现肿瘤进展，其中3例诊断为世界卫生组织II级脑膜瘤，1例为世界卫生组织I级。
本研究支持使用内镜颅底手术联合辅助SRT治疗有症状的CSM，证明了其安全性和有效性。这种方法在症状改善、肿瘤控制和良好的安全性方面产生了良好的结果。
