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Cossu et al. Mini-invasive Surg 2020;4:60 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.52

Review Open Access

The role of endoscopy and radiosurgery in the
management of cavernous sinus meningiomas

Giulia Cossu , Javier Abarca , Marc Levivier , Daniele Starnoni , Roy T. Daniel , Moncef Berhouma ,
3
1
1
1
2
1
Mahmoud Messerer 1
1 Department of Neurosurgery, University Hospital of Lausanne, Lausanne 1011, Switzerland.
2 Department of Neurosurgery, University Hospital of Alicante, Alicante 03010, Spain.
3 Department of Neurosurgery B, Pierre Wertheimer University Hospital. Hospices Civils de Lyon, Bron 69500, France.
Correspondence to: Dr. Giulia Cossu, Department of Neurosurgery, University Hospital of Lausanne, Rue du Bugnon 44,
Lausanne 1011, Switzerland. E-mail: giulia.cossu@chuv.ch
How to cite this article: Cossu G, Abarca J, Levivier M, Starnoni D, Daniel RT, Berhouma M, Messerer M. The role of endoscopy
and radiosurgery in the management of cavernous sinus meningiomas. Mini-invasive Surg 2020;4:60.
http://dx.doi.org/10.20517/2574-1225.2020.52

Received: 26 May 2020 First Decision: 16 Jun 2020 Revised: 28 Jun 2020 Accepted: 8 Jul 2020 Published: 1 Sep 2020

Academic Editor: Oreste de Divitiis Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Cavernous sinus (CS) meningiomas represent a formidable neurosurgical pathology. The desired treatment
depends on tumor size and extensions apart from the presenting clinical symptoms of the patient. The last few
decades have shown a paradigm shift in the management towards a multimodal treatment. For patients with
tumors presenting with a medial extension or when the meningioma occupies the antero-inferior portion of the
CS, an endoscopic biopsy can be safely performed through the endonasal route. The boundaries of endoscopic
endonasal approaches have been pushed during the last decade, and a direct access to the CS may now be
performed. At the same time, an extensive bony decompression to decompress the optic canal and the pituitary
gland may be performed. Autologous fat may be interposed between the residual tumor and radiosensitive
structures to safely perform adjuvant radiation therapy. The aim of this manuscript is to describe the role
of endoscopic surgery in the management of cavernous sinus meningiomas along with the complementary
role of radiotherapy. We describe the endoscopic anatomy and the surgical technique to safely perform the
procedure and we review the surgical series reported in the literature dealing with the endoscopic approach for
CS meningiomas with or without complementary radiation therapy. Endoscopic endonasal approaches have
shown promising results in terms of improvement or stabilization of cranial neuropathy and hypopituitarism.
Furthermore, the endoscopic approach may enhance the efficacy and safety of stereotactic radiosurgery through
the performance of an hypophysopexy and/or chiasmopexy.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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