Radiosurgery: an effective treatment for cavernous sinus meningiomas?

Meningiomas involving the cavernous sinus present the neurosurgeon with different choices: observation, microsurgery, or radiosurgery. During the last decade, advances in microsurgical techniques have significantly lowered the treatment-related morbidity, and some neurosurgeons have reported long-term follow-up results. Recently, several radiosurgical series have reported excellent tumor control and good functional preservation for tumors in this area. Most of these series do not provide complete information about the patient's cranial nerve function, and objective and subjective outcome data. The follow-up provided has also been short, considering that meningiomas have a tendency to recur or regrow up to 20 years postoperatively. There is also the concern about those patients who fail radiosurgical treatment, since microsurgery does not yield good results in such cases. In this paper, several radiosurgical series are critically reviewed, with a discussion about the pros and cons of microsurgery versus radiosurgery. The authors suggest that a uniform reporting strategy be adopted by all surgeons treating tumors of this area, which will allow comparative studies to be conducted. Additionally, we suggest a treatment algorithm for cavernous sinus meningiomas, based on the patients age, occupation and preference, preoperative binocular function, and curability of the tumor.