Symptomatic treatment sufficient for most meningiomas of the cavernous sinus

This study describes the natural history of meningiomas confined to the cavernous sinus (MCSs) to better inform the choice of treatment.

Study design

The authors prospectively examined 53 consecutive patients over a mean duration of 10 years. A diagnosis of CSM was given when patients presented with either “major symptoms” of oculomotor or neuralgia, “minor symptoms” of headache or diplopia, or incidental findings.

Outcomes

Symptomatic treatment—cessation of hormone therapy, short term steroids for diplopia or carbamazepine for neuralgic pain and prism for diplopia in case of failure of steroid treatment—allowed patients to become asymptomatic in 19 of 28 major symptom patients and in 12 of 15 minor symptom patients. Of the 53 patients diagnosed with CSM, 44 did not show significant growth and 42 were nonsymptomatic at the end of follow-up.

Limitations

The study was limited in detail regarding the details of prescription of prism lenses for correction of double vision due to a cranial nerve palsy and whether or not prisms were needed temporarily or permanently.

Clinical significance

These tumors represent less than 1% of all intracranial tumors, and cause symptoms related to the compression of neighboring cranial nerves 2, 3, 4, 5 and 6. Radiation therapy is now the standard treatment for these tumors since surgery is associated with significant morbidity.

The authors conclude that CSMs are naturally, clinically and radiologically indolent in the majority of cases and that symptomatic medical treatment of these tumors is effective.