Skip to main content
SpringerLink
Log in

Cavernous sinus meningiomas: a large LINAC radiosurgery series

  • Clinical Study/Patient Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

One hundred and seventeen patients with cavernous sinus meningiomas had LINAC radiosurgery at our institution in the period 1993–2007. Six cases were lost and 9 had less than 1 year follow up. The remaining 102 patients were prospectively followed up at 1 y intervals with clinical, neuro-ophthalmological and MRI examinations. Patients’ age ranged between 31 and 86 years (mean 57). Seventy percent were females. The mean tumor volume was 7 cc. Thirty-three patients had previous microsurgery. Tumors were defined with high resolution MRI obtained 1–2 days before treatment and fused to stereotactic CT. Treatment was mostly delivered through a minimultileaf collimator and multiple dynamic arcs. The minimal dose to the tumor margin was 12–17.5 Gy (mean 13.5) encompassed by the 80% isodose shell. Radiation dose to the optic apparatus was kept below 10 Gy. Follow up ranged from 12 to 180 months (mean 67 months). Tumor control (lack of growth) was 98% (58% of the tumors reduced their volumes). Sixty-four patients presented with cranial nerve deficit. Thirty-nine percent improved or resolved following radiosurgery. Cranial neuropathy had significantly higher resolution rates when radiosurgery was performed early (<1 year) after its appearance (53% as opposed to 26%) even in patients with deficits post surgery. Complications were seen in five patients (1 with deafferentation pain, 1 with facial hypesthesia, 1 with visual loss and 2 with partial VI neuropathy). Radiosurgery had a high control rate for meningiomas of the cavernous sinus with few and mild complications. Cranial neuropathy can be solved by treatment, particularly those of recent onset.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Couldwell WT, Fukushima T, Giannotta SL, Weiss MH (1996) Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 84:20–28

    Article  CAS  PubMed  Google Scholar 

  2. Cusimano MD, Sekhar LN, Sen CN, Pomonis S, Wright DC, Biglan AW, Jannetta PJ (1995) The results of surgery for benign tumors of the cavernous sinus. Neurosurgery 37:1–9; discussion 9–10

    Article  CAS  PubMed  Google Scholar 

  3. De Jesus O, Sekhar LN, Parikh HK, Wright DC, Wagner DP (1996) Long-term follow-up of patients with meningiomas involving the cavernous sinus: recurrence, progression, and quality of life. Neurosurgery 39:915–919; discussion 919–920

    Article  PubMed  Google Scholar 

  4. DeMonte F, Smith HK, Al-Mefty O (1994) Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 81:245–251

    Article  CAS  PubMed  Google Scholar 

  5. Dolenc V (1983) Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg 58:824–831

    Article  CAS  PubMed  Google Scholar 

  6. Dolenc VV, Kregar T, Ferluga M, Fettich M, Morina A (1987) Treatment of tumors involving the cavernous sinus. In: Dolenc VV (ed) The cavernous sinus: a multidisciplinary approach to vascular and tumorous lesions. Springer, New York

    Google Scholar 

  7. Dufour H, Muracciole X, Metellus P, Regis J, Chinot O, Grisoli F (2001) Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with or without previous surgery: is there an alternative to aggressive tumor removal? Neurosurgery 48:285–294; discussion 294–296

    Article  CAS  PubMed  Google Scholar 

  8. Hasegawa T, Kida Y, Yoshimoto M, Koike J, Iizuka H, Ishii D (2007) Long-term outcomes of Gamma Knife surgery for cavernous sinus meningioma. J Neurosurg 107:745–751

    Article  PubMed  Google Scholar 

  9. Heth JA, Al-Mefty O (2003) Cavernous sinus meningiomas. Neurosurg Focus 14:e3

    Article  PubMed  Google Scholar 

  10. Iwai Y, Yamanaka K, Ishiguro T (2003) Gamma knife radiosurgery for the treatment of cavernous sinus meningiomas. Neurosurgery 52:517–524; discussion 523–524

    Article  PubMed  Google Scholar 

  11. Kallio M, Sankila R, Hakulinen T, Jaaskelainen J (1992) Factors affecting operative and excess long-term mortality in 935 patients with intracranial meningioma. Neurosurgery 31:2–12

    Article  CAS  PubMed  Google Scholar 

  12. Kim DK, Grieve J, Archer DJ, Uttley D (1996) Meningiomas in the region of the cavernous sinus: a review of 21 patients. Br J Neurosurg 10:439–444

    Article  CAS  PubMed  Google Scholar 

  13. Kimball MM, Friedman WA, Foote KD, Bova FJ, Chi YY (2009) Linear accelerator radiosurgery for cavernous sinus meningiomas. Stereotact Funct Neurosurg 87:120–127

    Article  PubMed  Google Scholar 

  14. Knosp E, Perneczky A, Koos WT, Fries G, Matula C (1996) Meningiomas of the space of the cavernous sinus. Neurosurgery 38:434–442; discussion 442–444

    Article  CAS  PubMed  Google Scholar 

  15. Kotapka MJ, Kalia KK, Martinez AJ, Sekhar LN (1994) Infiltration of the carotid artery by cavernous sinus meningioma. J Neurosurg 81:252–255

    Article  CAS  PubMed  Google Scholar 

  16. Lam WW, Yuen HY, Wong KS, Leung SF, Liu KH, Metreweli C (2001) Clinically underdetected asymptomatic and symptomatic carotid stenosis as a late complication of radiotherapy in Chinese nasopharyngeal carcinoma patients. Head Neck 23:780–784

    Article  CAS  PubMed  Google Scholar 

  17. Larson JJ, van Loveren HR, Balko MG, Tew JM Jr (1995) Evidence of meningioma infiltration into cranial nerves: clinical implications for cavernous sinus meningiomas. J Neurosurg 83:596–599

    Article  CAS  PubMed  Google Scholar 

  18. Lee JY, Niranjan A, McInerney J, Kondziolka D, Flickinger JC, Lunsford LD (2002) Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurg 97:65–72

    Article  PubMed  Google Scholar 

  19. Nicolato A, Foroni R, Alessandrini F, Bricolo A, Gerosa M (2002) Radiosurgical treatment of cavernous sinus meningiomas: experience with 122 treated patients. Neurosurgery 51:1153–1159; discussion 1159–1161

    Article  PubMed  Google Scholar 

  20. O’Sullivan MG, van Loveren HR, Tew JM Jr (1997) The surgical resectability of meningiomas of the cavernous sinus. Neurosurgery 40:238–244; discussion 245–247

    Article  PubMed  Google Scholar 

  21. Roche PH, Regis J, Dufour H, Fournier HD, Delsanti C, Pellet W, Grisoli F, Peragut JC (2000) Gamma knife radiosurgery in the management of cavernous sinus meningiomas. J Neurosurg 93(Suppl 3):68–73

    PubMed  Google Scholar 

  22. Sindou M, Wydh E, Jouanneau E, Nebbal M, Lieutaud T (2007) Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone. J Neurosurg 107:937–944

    Article  PubMed  Google Scholar 

  23. Spiegelmann R, Nissim O, Menhel J, Alezra D, Pfeffer MR (2002) Linear accelerator radiosurgery for meningiomas in and around the cavernous sinus. Neurosurgery 51:1373–1379; discussion 1379–1380

    Article  PubMed  Google Scholar 

  24. Stafford SL, Pollock BE, Foote RL, Link MJ, Gorman DA, Schomberg PJ, Leavitt JA (2001) Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients. Neurosurgery 49:1029–1037; discussion 1037–1038

    Article  CAS  PubMed  Google Scholar 

  25. Tishler RB, Loeffler JS, Lunsford LD, Duma C, Alexander E III, Kooy HM, Flickinger JC (1993) Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27:215–221

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, The Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel

    Roberto Spiegelmann, Zvi R. Cohen, Ouzi Nissim, Dror Alezra & Raphael Pfeffer

  2. LINAC Radiosurgery Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel

    Roberto Spiegelmann, Zvi R. Cohen, Ouzi Nissim, Dror Alezra & Raphael Pfeffer

  3. The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Roberto Spiegelmann, Zvi R. Cohen, Ouzi Nissim, Dror Alezra & Raphael Pfeffer

Authors
  1. Roberto Spiegelmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zvi R. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ouzi Nissim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dror Alezra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raphael Pfeffer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Spiegelmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Spiegelmann, R., Cohen, Z.R., Nissim, O. et al. Cavernous sinus meningiomas: a large LINAC radiosurgery series. J Neurooncol 98, 195–202 (2010). https://doi.org/10.1007/s11060-010-0173-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-010-0173-1

Keywords

Search

Navigation