Korreliert die Beteiligung der A. carotis interna mit dem Schlaganfallrisiko bei Sinus-cavernosus Meningiomen?

Cavernous sinus meningiomas (CSMs) are among the most challenging skull base tumors to treat due to their tendency to involve the internal carotid artery (ICA), which, in rare cases, can lead to ischemic symptoms. However, data on the long-term risk of ischemic stroke remain limited. This study aims to analyze the long-term risk of ischemic stroke in patients with previously treated CSMs.

We reviewed the database of our skull base center for cases of histologically confirmed primary CSMs treated between 2006 and 2022. Included patients underwent tailored microsurgical resection of the extracavernous tumor portion followed by fractionated stereotactic radiation therapy (FSRT) as a standard departmental procedure for symptomatic CSM. Medical records and neuroimaging were analyzed to collect clinical information and identify symptoms or radiological evidence of ischemic strokes during follow-up. Cavernous carotid artery involvement was classified according to the Hirsch grading system as partially encased, completely encased (with or without narrowing), or completely encased with obliteration.

A total of 33 patients were identified, with a mean age of 55 years (range 22–77). The median clinical and radiological follow-up after FSRT was 102 months (range 12–212) and 88 months (range 12–209) respectively. At initial imaging, narrowing of the ICA was observed in 20 patients (60.6%), while occlusion was evident in 3 cases (9.1%). 14/33 patients (42.4%) exhibited subcortical arteriosclerotic leucencephalopathy, which did not progress during follow-up. None of the patients received prophylactic antiplatelet or anticoagulation therapy specifically for tumoral ICA involvement. In one case in which a benign CSM occluded the ipsilateral ICA, protective stent implantation on the contralateral side was performed prior salvage irradiation. Only one patient experienced an acute ischemic thalamic stroke ipsilateral to the CSM 8 years after FSRT, but this event was unrelated to the CSM.

Our study demonstrates that despite the high prevalence of ICA stenosis in patients with CSMs, the long-term risk of ischemic stroke is not increased, even after FSRT. Importantly, the absence of ischemic events directly attributable to tumoral ICA involvement suggests that prophylactic antiplatelet or anticoagulation therapies may not be necessary in this patient population.