gms | German Medical Science

Despite recent advances in microsurgical techniques, meningiomas involving the cavernous sinus remain a therapeutic challenge. Stereotactic radiotherapy is now playing an important role in the management of such lesions either as a primary treatment, or to control residual or recurrent tumours after previous surgery. Goal of this study was to evaluate quality of life (QOL) after different interdisciplinary tumour treatment protocols.

104 patients harbouring cavernous sinus meningiomas, treated between 1997 and 2003 were retrospectively analyzed to evaluate post-treatment QOL, as well as morbidity and outcome. QOL was assessed by Short Form 36 (SF36), which measures patients’ responses regarding 8 different health domains. Our series comprised 20 men and 84 women aged 31-79 years (mean = 55.9 years ±0.96). Follow-up was achieved in 96 patients. Mean follow-up of operated patients was 44 months, patients treated by radiotherapy alone 24 months. The study group was divided into 3 therapeutic categories: patients treated surgically only (group I, 22 patients), patients treated with stereotactic fractionated radiotherapy delivered by a linear accelerator (group II, 34 patients), and patients treated with both surgery and radiotherapy (group III, 40 patients). 75% of tumours in group I could be excised totally.

There was no mortality in this series. Post-operative cranial nerves impairment was encountered in 47% of surgical patients, 12% remained permanent, one patient suffered from infarction in the gyrus angularis region. After irradiation acute toxicity was seen rarely (3%). Clinically significant late morbidity and new neurological palsies were not encountered. No tumour progression or regrowth was observed in group I and III, in group II one tumour progression occurred. No statistically significant difference in quality of life was found between the 3 treatment modalities and compared with values of normal USA population. However, patients in group II had the best QOL in all but one health domains.

Gross total excision provides a long-term recurrence free survival with acceptable morbidity. Quality of life (QOL) after radiotherapy is excellent and the combination of initial surgical tumour volume reduction and stereotactic radiotherapy offers an alternative treatment option with subsequent good QoL. These findings should be taken into consideration to optimize management of these tumours.