Systematic Review and Meta-analysis: Radiosurgery Outcomes in Cavernous Sinus Meningioma
Bibliographic record
Abstract
Introduction: Meningiomas are the most common primary CNS tumors, with cavernous sinus meningiomas (CSMs) constituting 1% of intracranial tumors. Due to their location and potential invasion, CSMs are challenging to treat. Treatment methods have evolved from aggressive resections to less invasive techniques like stereotactic radiosurgery (SRS), which reduce morbidity and improve survival. This study reviews the effectiveness and safety of radiosurgery for CSMs, integrating historical and contemporary approaches to guide future treatments. Methods: A search was conducted in Medline, Embase, and Cochrane databases, adhering to Cochrane and PRISMA guidelines. Eligible studies included randomized or observational studies with at least four patients reporting on radiosurgery for CSM. A random-effects model was used to calculate a single proportion analysis with 95% confidence intervals. Statistical analyses were performed using RStudio. Clinical improvement was defined as partial or complete recovery of at least one preexisting cranial nerve or neurological deficit. Clinical deterioration was defined as the worsening or onset of new cranial nerve or neurological deficits. The design of progression-free survival analysis was considered according to the included studies. Results: The analysis included 51 studies with a total of 4,168 patients, and the median age was 57 years, ranging from 32 to 107 years. Males made up 60% of the cohort, and females 40%. The mean tumor volume was 10.9 cm 3 . Previous surgeries were reported in 569 patients (13.65%). Cranial nerve deficits were the most common symptom (80%), followed by extraocular neuropathy (55%), trigeminal neuropathy (31%), and visual acuity impairment (12%). Gamma Knife was the most used radiotherapy modality (45%), followed by LINAC (25%) and Cyber Knife (5%). The marginal dose ranged from 10 to 80 Gy, with an average of 18 Gy. The mean follow-up duration was about 50 months, ranging from 15 to 300 months. These data provide insights into patient demographics, treatment methods, and posttreatment monitoring strategies. Outcomes were as follows: the 10-year progression-free survival (PFS) rate was 90% (95% CI: 80–99%; I 2 = 85%; [ Fig. 1 ]), clinical deterioration occurred in 6% of cases (95% CI: 3–9%; I 2 = 71%; [ Fig. 2 ]), clinical improvement was observed in 36% of patients (95% CI: 28–43%; I 2 = 86%; [ Fig. 3 ]). Fig. 1 10-year progression-free survival. Fig. 2 Clinical deterioration. Fig. 3 Clinical improvement. Conclusion: This study demonstrates that SRS is an effective treatment for CSMs, offering high long-term PFS and significant tumor control with few complications. However, variations in SRS techniques and tumor characteristics highlight the need for standardized methods to refine treatment approaches. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.051 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.016 | 0.052 |
| Bibliometrics | 0.004 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".