Cavernous Sinus and Optic Nerve Sheath Meningiomas

Cavernous sinus meningiomas (CSMs) and optic nerve sheath meningiomas (ONSMs) are benign tumors located in areas with significant neurovascular structures, posing considerable therapeutic challenges. CSMs can present with ocular motor deficits, trigeminal impairment, or visual disturbances. ONSMs typically cause progressive visual loss. Magnetic resonance imaging (MRI) is essential for evaluating tumor location and its relationship with surrounding structures, while computed tomography (CT) helps identify calcifications, relations to bony structures, and hyperostosis. Historically, aggressive surgical resection was the primary treatment for CSMs, but due to high morbidity, modern strategies favor a more conservative approach focusing on functional preservation. Due to their efficacy and safety, stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) have become the preferred treatments for both CSMs and ONSMs. Surgery is reserved for cases where tumors cause significant mass-effect-related symptoms. The integration of multi-modal therapies, such as subtotal resection followed by irradiation of the residual tumor, when necessary, represents the best strategy for managing these complex tumors, aiming to preserve neurological function and control tumor growth.