The Efficacy and Safety of Combining Surgery and Stereotactic Radiosurgery versus Stereotactic Radiosurgery Alone for Treating Cavernous Sinus Meningiomas

Introduction: Cavernous sinus meningioma (CSM) presents significant treatment challenges due to its complex location. Stereotactic radiosurgery (SRS) is a promising non-invasive option, but its efficacy and safety compared to surgery and combined SRS need further evaluation.

Methods: Following Cochrane and PRISMA guidelines, a search was conducted in Medline, EMBASE, and Cochrane databases. Eligible studies included randomized or observational studies with ≥4 patients reporting on radiosurgery for CSMs. A random-effects model calculated a single proportion analysis with 95% confidence intervals. Odds Ratio was used for binary events analyses. Statistical analyses were performed using RStudio.

Results: Twelve studies, involving 808 patients (median age 52 years), assessed neurological and visual outcomes following SRS and Surgery + SRS. Neurological improvement was reported in three studies, showing a significant advantage for Surgery + SRS (OR=2.27, CI=1.32–3.88, p=0.18, I²=42%). Stabilization outcomes from three studies showed no significant difference between groups (OR=0.48, CI=0.19–1.22, p=0.10, I²=56%), as did deterioration rates (OR=0.95, CI=0.20–4.58, p=0.21, I²=36%). Extraocular neuropathy was analyzed across three studies, indicating no association between treatments (OR=0.47, CI=0.08–2.58, p=0.86, I²=0%). Visual acuity impairment was found in 35% of cases (CI=21%-49%; I²=88%). Major complications, assessed in four studies (n=53), had an estimated rate of 5% (CI=0%-20%; I²=57%), while minor complications in three studies (n=62) were estimated at 2% (CI=0%-9%; I²=4%).

Conclusion : Surgery + SRS offers significant neurological improvement over SRS alone for CSMs, with comparable rates of stabilization, deterioration, and extraocular neuropathy. Visual acuity impairment remains notable, and major complications are relatively infrequent. These findings support Surgery + SRS as a viable option, but further studies are needed to refine treatment decisions for this complex condition.