• Stylianos Pikis, Georgios Mantziaris, Yavuz Samanci, Selcuk Peker, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, El-ShehabyAmr M NAMNGamma Knife Center Cairo-Nasser Institute, Cairo, Egypt; Department of Neurosurgery, Ain Shams University, Cairo, Egypt., Khaled Abdelkarim, Reem M Emad, Cheng-Chia Lee, Huai-Che Yang, Roman Liscak, Jaromir Hanuska, Roberto Martinez Alvarez, Nuria Martinez Moreno, Manjul Tripathi, Herwin Speckter, Camilo Albert, and Jason Sheehan.
• Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
• World Neurosurg. 2022 Feb 1; 158: e675-e680.

BackgroundThe initial management of asymptomatic, incidentally discovered, cavernous sinus (CS) meningiomas remains incompletely defined. This study evaluated the safety and efficacy of stereotactic radiosurgery (SRS) for patients presenting with an asymptomatic CS meningioma.MethodsThis is an international, retrospective study included patients treated with upfront SRS for an asymptomatic CS meningioma. Local tumor control, tumor and SRS-related complications, and the development of new neurologic deficits after SRS were evaluated.ResultsA total of 37 patients (29 men; mean ± SD age: 55.05 ± 11.56 years) treated with upfront SRS for an asymptomatic, CS meningioma were included in the study. The mean ± SD margin dose was 12.27 ± 2.3 Gy. The median clinical and radiological follow-up periods were 66 (IQR 84) and 72 (IQR 84) months, respectively. At the last follow-up, tumor regression and stability were noted in 19 (51.35%) and 18 (48.65%) of CS meningiomas, respectively. SRS-related complications occurred in 2 patients (5.4%) and were managed conservatively.ConclusionsUpfront SRS is a safe and effective treatment option for asymptomatic CS meningiomas. SRS may be considered at the time of initial diagnosis of a CS meningioma. If observation is the initial management chosen, SRS should be recommended when CS meningioma growth is documented on follow-up imaging.Copyright © 2021 Elsevier Inc. All rights reserved.

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