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 presenting symptom headache is nonspecific. Visual loss and oculomotor disturbance are the next likely symptoms and signs. It is possible to achieve total tumor removal in about 50% of patients, but an increase in cranial nerve dysfunction occurs in nearly as many. Improvement of neurological function, except for vision, is unusual. Because of the risk of complicating cranial nerve dysfunction by surgery, focused radiation as an alternative treatment has been explored in a small number of patients. Unfortunately, volume reduction is only seen in about one-third, but risks do appear to be low and nearly 60% of patients recorded have improvement in preoperative cranial nerve deficits. With these indolent tumors, much longer follow-ups are required before the role of focused radiation can be assessed.