해면정맥동을 침범하는 뇌수막종의 치료

Treatment of cavernous sinus meningioma: long-term outcome and lessons learned

OBJECTIVE : We retrospectively analyzed the long-term outcomes in patients with cavernous sinus meningiomas (CSMNGs) treated with the various treatment modalities including surgical resection, radiotherapy, radiosurgery, and clinical observation to find out an optimal strategy in selecting a treatment option. PATIENTS AND METHOD : Of the 77 consecutive patients with CSMNGs treated between 1986 and 2004, 60 were followed up for more than 36 months. Thirty-six (60.0%) patients were female. The mean age of the patients was 52±12 years, and the mean follow-up duration was 83±46 months. The population was divided into four groups including the microsurgery group (n=26, 43.3%), the observation group (n=11, 18.3%), the conventional radiotherapy (CRT) group (n=10, 16.7%), and the radiosurgery group (n=13, 21.7%) according to the initial treatment modality. RESULTS : The actuarial tumor control rates were 84.9%, 78.3%, and 41.8% at 5, 10, and 15 years, respectively. Adjuvant radiation therapy using (CRT) after surgery seemed to be positively associated with tumor control, however it did not reach the statistical significance (p=0.277). The patients treated with CRT or radiosurgery as an initial management also showed better outcome in terms of tumor control, however which was not statistically significant (p=0.138). Tumor progression was observed in 12 patients; 7 (26.9%) of the surgery group, 3 (27.3%) of the observation group, 1 (11.1%) of the CRT group, and 1 (7.7%) of the radiosurgery group. Unfavorable KPS was identified in a total of 13 patients; 7 (26.9%) of the surgery group, 1 (9.1%) of the observation group, 4 (44.4%) of the CRT group, and 1 (7.7%) of the radiosurgery group. Finally, aggravation of the cranial neuropathy mostly developed in 8 (30.8%) patients of the surgery group. Failure of tumor control was negatively related with the outcome of the functional status and the cranial neuropathy after long-term follow-up period. Conclusion : Considering a high rate of tumor progression after long-term follow-up period, CRT and radiosurgery seem to be optimal. However, in terms of the functional status and cranial neuropathy, observation also seems to be an effective modality. Based on our experience, selection of a treatment among various modalities for patients with CSMNGs should be done considering the age of patient, the presence of cranial neuropathy, and the tumor size.