Cavernous sinus meningiomas: A retrospective study of natural history, growth dynamics, and treatment response over two decades.

[BACKGROUND] Cavernous sinus meningiomas (CSM) pose therapeutic challenges due to their location near critical neurovascular structures. Although microsurgery has been standard, many CSM grow slowly, favoring conservative and radiotherapeutic strategies. This study aimed to describe the natural history, growth patterns, and treatment outcomes of CSM over 20 years.

[METHODS] We retrospectively analyzed 38 patients diagnosed with CSM between 2004 and 2024. Clinical and radiological data were collected, including symptoms, tumor characteristics, growth rates, and treatment. Tumor size and volumetric progression were measured through magnetic resonance imaging. Outcomes were compared by management strategy, and statistical analyses explored associations between demographic, clinical, and radiological factors and the need for intervention.

[RESULTS] The cohort included 31 women (81.6%) and 7 men (18.4%), mean age 54.5 years, mean follow-up 6.6 years. Diagnosis was incidental in 31.6% and symptom-driven in 68.4%, with ophthalmoplegia most common. Twenty-four patients (63.2%) were managed conservatively, while 14 (36.8%) underwent surgery, radiosurgery, or both. Symptom presence and tumor growth pattern predicted the need for treatment ( < 0.05). Average annual tumor growth was 0.077 cm in diameter and 0.86 cm in volume, with volumetric progression exceeding linear growth ( = 0.001). Most conservatively managed patients remained stable, while active treatment achieved variable radiological control; 71.4% of treated patients showed progression.

[CONCLUSION] CSM generally behave indolently, supporting conservative management in selected patients. Volumetric assessment is more accurate than linear measurement for monitoring growth. Individualized treatment remains essential, and prospective multicenter studies are needed to identify prognostic markers and optimize management strategies.