Kavernöz sinüs menenjiyomlarının yönetiminde stereotaktik radyocerrahi: Bir derleme

Abstract

Kavernöz sinüs menenjiyomları (KSM'ler), hayati nörovasküler yapılarla yakın ilişkileri nedeniyle intrakraniyal menenjiyomların zorlu bir alt grubunu oluşturmaktadır. Bu sistematik derleme, KSM'lerin hem primer hem de adjuvan tedavisinde stereotaktik radyocerrahinin (SRC) etkinliğini ve güvenliğini değerlendirmektedir. Gamma Knife, LINAC tabanlı sistemler ve CyberKnife gibi çeşitli platformlar kullanılarak SRC ile tedavi edilen 2.302 hastayı içeren 24 çalışmadan elde edilen verileri analiz ettik. Medyan marjinal dozlar 11 ile 19 Gy arasında değişmekte olup, en son serilerde 12 ile 14 Gy kullanılmıştır. Uzun dönem tümör kontrolü mükemmel olup, 5 yıllık progresyonsuz sağkalım oranları %86 ile %99 arasında ve 10 yıllık oranlar %69 ile %97 arasında bulunmuştur. Semptomatik hastaların %20 ile %46'sında, özellikle kraniyal sinir fonksiyonlarında, bilhassa abdusens sinir felcinde nörolojik iyileşme gözlenmiştir. Radyasyonla ilişkili komplikasyonlar nadir (%0-12) ve genellikle geçici olup, kalıcı defisitler hastaların %7'sinden azında görülmüştür. Karşılaştırmalı analiz, mikrocerrahi rezeksiyon sonrası adjuvan SRC'ye kıyasla primer SRC ile daha iyi nörolojik sonuçlar göstermiş olup, bu durum dikkatli seçilmiş hastalar için SRC ile erken müdahalenin bekle-gör yaklaşımına veya agresif cerrahiye tercih edilebileceğini düşündürmektedir. Bu derleme, SRC'nin KSM'ler için mükemmel bir risk-fayda profiline sahip olduğuna, minimal morbidite ile kalıcı tümör kontrolü sağladığına dair Sınıf III kanıt sunmaktadır. Küçük-orta boyutlu, asemptomatik veya minimal semptomatik KSM'ler için primer SRC'yi tercih eden bir tedavi yaklaşımı önerirken, belirgin kitle etkisi veya kötüleşen nörolojik defisitleri olan daha büyük lezyonlarda cerrahi dekompresyon ardından adjuvan SRC'yi savunuyoruz.

Keywords

• Kavernöz sinüs menenjiyomu
• stereotaktik radyocerrahi
• Gamma Knife
• kraniyal sinir fonksiyonu
• primer radyocerrahi

Stereotactic radiosurgery for the management of cavernous sinus meningiomas: A narrative review

Abstract

Cavernous sinus meningiomas (CSMs) are a challenging subgroup of intracranial meningiomas because of their close relationship with vital neurovascular structures. This systematic review evaluates the effectiveness and safety of stereotactic radiosurgery (SRS) for both primary and adjuvant treatment of CSMs. We analyzed data from 24 studies involving 2,302 patients treated with SRS using various platforms, such as Gamma Knife, LINAC-based systems, and CyberKnife. The median marginal doses ranged from 11 to 19 Gy, with the most recent series using 12 to 14 Gy. Long-term tumor control was excellent, with 5-year progression-free survival rates between 86% and 99%, and 10-year rates from 69% to 97%. Neurological improvement was seen in 20% to 46% of symptomatic patients, especially in cranial nerve function, notably abducens nerve palsy. Radiation-related complications were rare (0-12%) and usually temporary, with permanent deficits occurring in less than 7% of patients. Comparative analysis showed better neurological outcomes with primary SRS compared to adjuvant SRS after microsurgical resection, suggesting that early intervention with SRS may be preferable to watchful waiting or aggressive surgery for carefully selected patients. This review provides Class III, including retrospective comparative studies, and case series evidence that SRS has an excellent risk-benefit profile for CSMs, achieving durable tumor control with minimal morbidity. We recommend a treatment approach favoring primary SRS for small to medium-sized, asymptomatic, or minimally symptomatic CSMs, while advocating for surgical decompression followed by adjuvant SRS in larger lesions with significant mass effect or worsening neurological deficits.

Keywords

• Cavernous sinus meningioma
• stereotactic radiosurgery
• Gamma Knife
• cranial nerve function
• primary radiosurgery

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