{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T01:03:55Z","timestamp":1788397435675,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Resection of tumors invading the cavernous sinus (CS) carries a risk of injury to the cranial nerves and internal carotid artery. Therefore, radical surgery involving lesions around the CS remains challenging, especially for lesions invading the CS, optic sheath, and oculomotor cave. Here, we describe a surgical strategy for meningiomas invading these structures and report on the clinical outcomes. Methods: Surgical resection was indicated in patients with neurological symptoms or rapid tumor growth for the restoration of cranial nerve function. We investigated 13 patients who had preoperative images of CS invasion, underwent surgical resection, and were followed-up with magnetic resonance imaging for at least 1 year between July 2017 and July 2024. Their preoperative symptoms, postoperative course, adjuvant therapy, postoperative complications, degree of resection, and recurrence were evaluated. Results: The mean patient age was 59.1 years (range, 23\u201373 years), and 10 were female. Major preoperative symptoms included oculomotor nerve paresis in 8 patients (61.5%), abducens nerve paresis in 6 (46.2%), visual disturbance in 7 (53.8%), and brain swelling in 3 (23.1%). These symptoms improved at least partially after surgery in 7 (87.5%), 5 (83.3%), 7 (100%), and 3 (100%) patients, respectively. Major postoperative complications included contralateral visual deterioration in 1 patient (7.7%) and brief transient slight hemiparesis caused by internal carotid vasospasm or dissection in 2 (15.4%). Four patients with residual atypical meningioma in the CS underwent intensity-modulated radiotherapy (IMRT). The lesions in 6 patients recurred or regrew, resulting in additional treatment with stereotactic radiosurgery in 2 patients, IMRT in 3, and resection in 1. Conclusions: Our surgical strategy for the surgical resection of meningiomas in and around the CS for the restoration of cranial nerve function is safe and effective, with only transient acceptable injuries. Even if the tumor in the CS is too stiff to be removed, it is important to open the optic nerve sheath and oculomotor cave widely to effectively remove the tumor.<\/jats:p>","DOI":"10.3390\/cancers17020276","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T04:55:19Z","timestamp":1737003319000},"page":"276","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Resection of Meningiomas Invading the Cavernous Sinus: Treatment Strategy and Clinical Outcomes"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4621-8710","authenticated-orcid":false,"given":"Takashi","family":"Sugawara","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, International University of Health and Welfare, Chiba 2868520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6804-4665","authenticated-orcid":false,"given":"Taketoshi","family":"Maehara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Institute of Science Tokyo Hospital, Tokyo 1130034, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1007\/s00701-016-2940-z","article-title":"Surgical Anatomy of the Cavernous Sinus, Superior Orbital Fissure, and Orbital Apex via a Lateral Orbitotomy Approach: A Cadaveric Anatomical Study","volume":"158","author":"Ulutas","year":"2016","journal-title":"Acta Neurochir."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/foc.2003.14.6.3","article-title":"Cavernous Sinus Meningiomas","volume":"14","author":"Heth","year":"2003","journal-title":"Neurosurg. Focus"},{"key":"ref_3","first-page":"1","article-title":"Transcavernous Approach to Diseases of the Anterior Upper Third of the Posterior Fossa","volume":"19","author":"Krisht","year":"2005","journal-title":"Neurosurg. Focus"},{"key":"ref_4","first-page":"e2192","article-title":"Transcavernous Approach to the Basilar Apex: A Cadaveric Prosection","volume":"10","author":"Sellin","year":"2018","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1007\/s003819900246","article-title":"The Treatment of Meningiomas in the Region of the Cavernous Sinus","volume":"17","author":"Long","year":"2001","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"vdab114","DOI":"10.1093\/noajnl\/vdab114","article-title":"Multimodal Therapy of Cavernous Sinus Meningioma: Impact of Surgery and 68Ga-DOTATATE PET-Guided Radiation Therapy on Tumor Control and Functional Outcome","volume":"3","author":"Hadi","year":"2021","journal-title":"Neuro-Oncol. Adv."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Nowak, A., Maj, E., Marchel, A., and Kunert, P. (2024). Risk of Tumor Progression after Microsurgery for Parasellar Meningioma Invading the Cavernous Sinus. Cancers, 16.","DOI":"10.3390\/cancers16122217"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Masalha, W., Heiland, D.H., Steiert, C., Kr\u00fcger, M.T., Schnell, D., Heiland, P., Bissolo, M., Grosu, A.L., Schnell, O., and Beck, J. (2022). Management of Medial Sphenoid Wing Meningioma Involving the Cavernous Sinus: A Single-Center Series of 105 Cases. Cancers, 14.","DOI":"10.3390\/cancers14092201"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1007\/s11060-021-03921-5","article-title":"Long-Term Outcomes of Stereotactic Radiosurgery for Skull Base Tumors Involving the Cavernous Sinus","volume":"156","author":"Umekawa","year":"2022","journal-title":"J. Neurooncol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Santacroce, A., Tuleasca, C., Li\u0161\u010d\u00e1k, R., Motti, E., Lindquist, C., Radatz, M., Gatterbauer, B., Lippitz, B.E., Mart\u00ednez \u00c1lvarez, R., and Mart\u00ednez Moreno, N. (2022). Stereotactic Radiosurgery for Benign Cavernous Sinus Meningiomas: A Multicentre Study and Review of the Literature. Cancers, 14.","DOI":"10.3390\/cancers14164047"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s11060-021-03732-8","article-title":"Long-Term Disease Control and Treatment Outcomes of Stereotactic Radiosurgery in Cavernous Sinus Meningiomas","volume":"152","author":"Freeman","year":"2021","journal-title":"J. Neurooncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1055\/s-0039-1683430","article-title":"Stereotactic Radiosurgery of Cavernous Sinus Meningiomas","volume":"81","author":"Fritsche","year":"2020","journal-title":"J. Neurol. Surg. B Skull Base"},{"key":"ref_13","first-page":"1799","article-title":"Gamma Knife Stereotactic Radiosurgery for Cavernous Sinus Meningioma: Long-Term Follow-up in 200 Patients","volume":"1306","author":"Park","year":"2018","journal-title":"J. Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"545","DOI":"10.4103\/njcp.njcp_2033_21","article-title":"Single-Fraction Gamma-Knife Radiosurgery with or without Previous Surgery for Cavernous Sinus Meningiomas: A Single-Center Experience and Systematic Literature Review","volume":"26","author":"Basak","year":"2023","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100864","DOI":"10.1016\/j.bas.2022.100864","article-title":"Management of Cavernous Sinus Meningiomas: Consensus Statement on Behalf of the EANS Skull Base Section","volume":"2","author":"Corniola","year":"2022","journal-title":"Brain Spine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/B978-0-12-822198-3.00029-X","article-title":"Cavernous Sinus Meningioma","volume":"170","author":"Raheja","year":"2020","journal-title":"Handb. Clin. Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.3171\/2020.2.JNS193009","article-title":"Predictors of Visual Functional Outcome Following Treatment for Cavernous Sinus Meningioma","volume":"134","author":"Fatima","year":"2020","journal-title":"J. Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"380","DOI":"10.3171\/2018.10.JNS181480","article-title":"Outcomes of Decompressive Surgery for Cavernous Sinus Meningiomas: Long-Term Follow-up in 50 Patients","volume":"132","author":"Gozal","year":"2020","journal-title":"J. Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E11","DOI":"10.3171\/2018.1.FOCUS17703","article-title":"Safe Maximal Resection of Primary Cavernous Sinus Meningiomas via a Minimal Anterior and Posterior Combined Transpetrosal Approach","volume":"44","author":"Morisako","year":"2018","journal-title":"Neurosurg. Focus"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"E8","DOI":"10.3171\/2013.9.FOCUS13345","article-title":"The Treatment of Cavernous Sinus Meningiomas: Evolution of a Modern Approach","volume":"35","author":"Klinger","year":"2013","journal-title":"Neurosurg. Focus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"148","DOI":"10.3171\/jns.2006.105.1.148","article-title":"Decompression of Cavernous Sinus Meningioma for Preservation and Improvement of Cranial Nerve Function: Technical Note","volume":"105","author":"Couldwell","year":"2006","journal-title":"J. Neurosurg."},{"key":"ref_22","first-page":"815","article-title":"Benefits and Pitfalls of Re-Operation for Recurrent Meningioma","volume":"52","author":"Eguchi","year":"2024","journal-title":"No Shinkei Geka."},{"key":"ref_23","first-page":"4478561","article-title":"Stereotactic Radiosurgery (SRS) Induced Higher-Grade Transformation of a Benign Meningioma into Atypical Meningioma","volume":"2022","author":"Basalamah","year":"2022","journal-title":"Case Rep. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"vdaa129","DOI":"10.1093\/noajnl\/vdaa129","article-title":"Malignant Transformation of WHO Grade I Meningiomas after Surgery or Radiosurgery: Systematic Review and Meta-Analysis of Observational Studies","volume":"2","author":"Nakasu","year":"2020","journal-title":"Neuro-Oncol. Adv."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.4103\/0028-3886.373645","article-title":"Adverse Radiation Effects Following Gamma Knife Radiosurgery","volume":"71","author":"Kedia","year":"2023","journal-title":"Neurol. India"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S1470-2045(18)30659-4","article-title":"Risk of Radiation-Associated Intracranial Malignancy after Stereotactic Radiosurgery: A Retrospective, Multicentre, Cohort Study","volume":"20","author":"Wolf","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"407","DOI":"10.4103\/0028-3886.227306","article-title":"Mobilization of the Outer Cavernous Membrane Decreases Bleeding and Improves Resection in Spheno-Clinoidal Meningiomas without Cavernous Sinus Extension: A Randomized Controlled Trial","volume":"66","author":"Hegazy","year":"2018","journal-title":"Neurol. India"},{"key":"ref_28","first-page":"106","article-title":"Mobilization of the Transcavernous Oculomotor Nerve during Basilar Aneurysm Surgery: Biomechanical Bases for Better Outcome","volume":"10","author":"Basma","year":"1982","journal-title":"Neurosurgery"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/S0090-3019(99)00108-1","article-title":"Vasospasm after Cranial Base Tumor Resection: Pathogenesis, Diagnosis, and Therapy","volume":"52","author":"Bejjani","year":"1999","journal-title":"Surg. Neurol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"fcae372","DOI":"10.1093\/braincomms\/fcae372","article-title":"Enhanced MRI-Based Brain Tumour Classification with a Novel Pix2pix Generative Adversarial Network Augmentation Framework","volume":"6","author":"Onakpojeruo","year":"2024","journal-title":"Brain Commun."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Onakpojeruo, E.P., Mustapha, M.T., Ozsahin, D.U., and Ozsahin, I. (2024). A Comparative Analysis of the Novel Conditional Deep Convolutional Neural Network Model, Using Conditional Deep Convolutional Generative Adversarial Network-Generated Synthetic and Augmented Brain Tumor Datasets for Image Classification. Brain Sci., 14.","DOI":"10.3390\/brainsci14060559"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/2\/276\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:29:39Z","timestamp":1759919379000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/2\/276"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,16]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["cancers17020276"],"URL":"https:\/\/doi.org\/10.3390\/cancers17020276","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,16]]}}}