Cavernous sinus meningiomas (CSMs) remain a surgical challenge due to the intimate involvement of their contained nerves and blood vessels. Stereotactic radiosurgery (SRS) is a safe and effective minimally invasive alternative for the treatment of small- to medium-sized CSMs. Objective: To assess the medium- to long-term outcomes of SRS for CSMs with respect to tumour growth, prevention of further neurological deterioration and improvement of existing neurological deficits. This multicentric study included data from 15 European institutions. We performed a retrospective observational analysis of 1222 consecutive patients harbouring 1272 benign CSMs. All were treated with Gamma Knife stereotactic radiosurgery (SRS). Clinical and imaging data were retrieved from each centre and entered into a common database. All tumours with imaging follow-up of less than 24 months were excluded. Detailed results from 945 meningiomas (86%) were then analysed. Clinical neurological outcomes were available for 1042 patients (85%). Median imaging follow-up was 67 months (mean 73.4, range 24-233). Median tumour volume was 6.2 cc (+/-7), and the median marginal dose was 14 Gy (+/-3). The post-treatment tumour volume decreased in 549 (58.1%), remained stable in 336 (35.6%) and increased in only 60 lesions (6.3%), yielding a local tumour control rate of 93.7%. Only 27 (2.8%) of the 60 enlarging tumours required further treatment. Five- and ten-year actuarial progression-free survival (PFS) rates were 96.7% and 90.1%, respectively. Tumour control rates were higher for women than men (p = 0.0031), and also for solitary sporadic meningiomas (p = 0.0201). There was no statistically significant difference in outcome for imaging-defined meningiomas when compared with histologically proven WHO Grade-I meningiomas (p = 0.1212). Median clinical follow up was 61 months (mean 64, range 6-233). Permanent morbidity occurred in 5.9% of cases at last follow-up. Stereotactic radiosurgery is a safe and effective method for treating benign CSM in the medium term to long term.

Assisstance Publique Hôpitaux de Paris Hôpitaux Universitaires Paris Sud Centre Hospitalier Universitaire Bicêtre Service de Neurochirurgie 94270 Le Kremlin Bicêtre France

Department of Mathematics and Technology University of Applied Sciences Koblenz Joseph Rovan Allee 2 53424 Remagen Germany

Department of Medicine Faculty of Health Witten Herdecke University 58455 Witten Germany

Department of Neurosurgery Academic Hospital Köln Merheim 51058 Köln Germany

Department of Neurosurgery Haukeland University Hospital 5021 Bergen Norway

Department of Neurosurgery Heinrich Heine Universität Düsseldorf 40225 Düsseldorf Germany

Department of Neurosurgery Jena University Hospital Friedrich Schiller University Jena 07747 Jena Germany

Department of Neurosurgery Medical University Graz 8036 Graz Austria

Department of Neurosurgery Medical University of Vienna 1090 Vienna Austria

Department of Neurosurgery St Barbara Klinik Hamm Heessen 59073 Hamm Germany

Department of Neurosurgery University Hospital Münster Albert Schweitzer Campus 1 A1 48149 Munster Germany

Department of Radiosurgery Rúber International Hospital 28034 Madrid Spain

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital 15000 Prague Czech Republic

Dipartimento di Neuroscienze Neurochirurgia Università degli Studi di Milano 20122 Milano Italy; Villa Maria Cecilia Hospital 48033 Cotignola Italy

Faculté de Biologie et de Médecine 1005 Lausanne Switzerland

Faculté de Médecine Sorbonné Université 70513 Paris France

Gamma Knife Center Zurich Klinik Im Park Hirslanden 8002 Zurich Switzerland

Gamma Knife Centre Bupa Cromwell Hospital London SW5 0TU UK

Gamma Knife Unit Wellington Hospital London NW8 7JA UK

Gamma Knife Zentrum Hannover 30167 Hannover Germany

Gamma Knife Zentrum Krefeld 47805 Krefeld Germany

Institute of Medical Biometry Epidemiology and Informatics University Medical Center of Mainz Langenbeckstrasse 1 55131 Mainz Germany

Interdisciplinary Centre for Radiosurgery Radiological Alliance 22767 Hamburg Germany

National Centre for Stereotactic Radiosurgery Royal Hallamshire Hospital Sheffield S10 2JF UK

Neurosurgery Service and Gamma Knife Center Lausanne University Hospital 1011 Lausanne Switzerland

Service de Neurochirurgie Fonctionnelle et Stereotaxique Hôpital D'adulte de la Timone 13354 Marseille France

Signal Processing Laboratory 1015 Lausanne Switzerland

Unit of Radiosurgery and Stereotactic Neurosurgery Department of Neurosciences Azienda Ospedaliera Universitaria 37126 Verona Italy

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