Background: The efficacy and safety of radiosurgery led to paradigm shift in the management of cavernous sinus
meningiomas. Nevertheless, patients are still significantly affected by cranial nerve deficits related to the mass effect of these
tumors. Our management strategy involves the combination of a functional
surgical decompression followed by
radiation therapy. Methods: We reviewed a single institution's cohort of patients who underwent endoscopic endonasal
decompression (EED) for symptomatic
meningiomas primarily involving the cavernous sinus (CS) from 2010 to 2016. The preoperative neuro-ophthalmological exam was compared to the 1- and 6-month postoperative exams. The patient's length of
hospital stay, complications, and radiological and clinical follow-up were noted. Results: A total of 17 patients underwent EED for CS
meningiomas that fit our radiological criteria. The final outcome at the 6-month visit showed five patients (62.5%) with normalization of deficit and three patients (37.5%) with partial improvement of the CNII deficit. Out of the 12 patients who had cavernous sinus cranial nerves (CSCN) deficits, the final outcome at the 6-month visit showed four patients (33.33%) with normalization of deficit, seven patients (58.3%) with partial improvement, and one patient (8.33%) with no improvement. There were no
intraoperative complications. Conclusion: The EED for CS
meningiomas is a valuable technique when addressing acute/subacute CNII and CSCN deficits. This conservative surgical approach showed good functional outcomes, low morbidity, and low complication rates. However, it does not exempt the need for radiosurgery/
radiation therapy for control of
tumor growth.