Türk Nöroşirürji Dergisi 2011 , Vol 21 , Num 2
Treatment Options in Cavernous Sinus Meningiomas
Türker KILIÇ
Marmara Üniversitesi, Tıp Fakültesi, Nöroşirürji Anabilim Dalı, İstanbul AIM: Oncological treatment of a neoplasm is more than just removing the tumor surgically. This fact is probably the source of ongoing discussion on cavernous sinus meningiomas during last decade. The discussion on optimal treatment of cavernous sinus meningiomas is focused on comparing the different treatment strategies: (a) radical surgical resection and (b) conservative surgical resection completed with radiosurgery.

MATERIAL and METHODS: Natural history of the change in the management strategy of cavernous sinus meningiomas in our department before and afterthe GK facility became available in 1997 allowed us to compare the 2 aforementioned strategies. Before installation of a Leksell GK unit at the hospital in 1997, the neurosurgical team at Marmara University Institute of Neurological Sciences and Faculty of Medicine (Istanbul, Turkey) treated patients with cavernous sinus meningioma using radical resection (radical strategy, group A, 10 patients). After 1997, the same neurosurgical team used surgical removal of the extracavernous sinus tumor component with GK irradiation of the intracavernous part (conservative strategy, group B, 12 patients). Another group of patients, who were treated with GK as a first-step treatment, was analyzed (GK group, group C, 26 patients).

RESULTS: At the end of the third year, more stable tumor volume control was achieved in groups B and C; after the second year, an incline in the tumor volume-time graph was detected. Group B resulted in less cranial nerve-related complications; a certain degree of improvement in cranial nerve deficits was observed.

CONCLUSION: Comparing two different management strategies for cavernous sinus meningiomas in the same hospital setting using the same neurosurgical group, we conclude that that extracavernous resection completed with radiosurgery is as successful as radical surgery. Considering cranial nerve complications and the success of the third-year tumor volume control, the results of the conservative approach was better. Longer follow-up with larger series is required. Anahtar Kelimeler : Cavernous sinus, Meningioma, Radical surgery, Radiosurgery, Prognosis, Gamma knife