2026 Poster Presentations
P052: SURGICAL OUTCOMES AND PROGNOSTIC FACTORS IN MEDIAL SPHENOID WING MENINGIOMAS WITH CAVERNOUS SINUS INVOLVEMENT: A SINGLE-ARM META-ANALYSIS
Khushal A Gupta, MBBS1; Michael Karsy2; 1Bharat Ratna Late Shri Atal Bihari Vajpayee Memorial Medical College; 2University of Michigan Health
Introduction: Medial sphenoid wing meningiomas that extend into the cavernous sinus remain among the most challenging skull base tumors to manage. These lesions are often intertwined with critical neurovascular structures, making complete removal risky and functional preservation difficult. Involvement was variably defined across studies, most often as radiographic or intraoperative evidence of tumor extension into or along the cavernous sinus wall, with or without frank invasion. While surgeons strive for aggressive resection, the true benefit must always be weighed against the risk of long-term neurological compromise. To better understand outcomes and guide decision-making, we performed a single-arm meta-analysis focusing on surgical results and prognostic factors in this population.
Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane were searched through June 2025. Eligible studies included ≥5 patients with medial sphenoid wing meningiomas involving the cavernous sinus. Extracted variables included extent of resection, adjuvant radiation therapy, recurrence, visual outcomes, new postoperative cranial nerve morbidity (distinct from preoperative baseline deficits), complications, mortality, and prognostic factors. Pooled proportions were calculated using a DerSimonian–Laird random-effects model with 95% confidence intervals (CI). Heterogeneity was assessed with the I² statistic, and prediction intervals were reported to estimate real-world variability. Risk of bias was evaluated with the Newcastle–Ottawa Scale.
Results: Across 14 studies with 1,065 patients, the pooled gross total resection (GTR) rate was 61% (95% CI: 53%–69%). Surgery achieved meaningful disease control, with a recurrence rate of 16% (95% CI: 12%–21%) over a mean follow-up of 3–8 years. Adjuvant radiosurgery was reported in 15–30% of patients following subtotal resection and was associated with durable local control in several series. Among patients with preoperative visual deficits, 50% experienced postoperative improvement (95% CI: 29%–72%), though outcomes varied widely across studies. Mortality was consistently low (<2%), but new postoperative cranial nerve deficits occurred in 20–25% of patients, most commonly affecting CN III and VI. While many improved over time, approximately 5–10% had persistent long-term deficits. Prognostic factors linked to poorer outcomes included large tumor size, ICA encasement, optic canal invasion, and higher WHO grade.
Conclusions: Surgery for medial sphenoid wing meningiomas with cavernous sinus invasion remains a delicate balance between oncologic control and functional preservation. While complete resection is often limited, careful surgical planning can achieve disease control with low mortality and meaningful functional gains, particularly visual improvement in nearly half of patients. The recurrence risk after subtotal resection highlights the importance of adjuvant radiosurgery as part of a multimodal strategy. Management should be individualized, incorporating prognostic features and balancing tumor control with neurological function.
