Commentary

The article retrospectively reviews the Barcelona experience treating patients with cavernous sinus meningiomas using the fractionated stereotactic radiotherapy technique. It is a reasonably large series for this subgroup of patients, and the follow-up is intermediate in length. The authors report a progression-free survival of 93% and improvement of neurologic symptoms in 50% of patients. Two cases of treatment-related morbidity occurred, both of which appeared to be due to radiation injury to the mesial temporal lobe.

These results are consistent with the literature for stereotactic radiotherapy treatment of cavernous sinus meningiomas reported from the Joint Center in Boston, the Mayfield Clinic, and our institutional experience. With modern techniques such as micro-leaf collimation which achieve both high conformality and target dose homogeneity, morbidity should diminish further while simultaneously optimizing the likelihood of improving pretreatment cranial neuropathies arising from tumor invasion of the cavernous sinus. For tumors which abut the optic apparatus, stereotactic radiotherapy should also minimize the risk of radiation-induced optic neuropathies.