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Introduction Cavernous sinus meningiomas (CSMs) are challenging given their proximity to neurovascular structures. Treatments include surgery, radiation, or observation. There are little data comparing outcomes based on treatment. This study presents the radiographic and functional outcomes of patients with CSMs treated with either radiation, surgical resection ± radiation, or radiographic surveillance. Methods This is a retrospective review of adults diagnosed with CSMs between 2009 and 2016. Patient and tumor characteristics and outcomes were obtained from chart review. Categorical and continuous variables were compared via nonparametric tests. Results Sixty-four patients were diagnosed with CSMs between 2009 and 2016. Thirty-four had radiation. Thirteen had surgical resection with adjuvant radiation and 14 underwent observation. Fifty-four patients had a pretreatment deficit (84.4%). Radiographic control rates were 100% in the surgery group, 97.1% in the radiation group, 69.2% in the surgery + adjuvant radiation, and 90.9% in the observation group (p = 0.035). The radiotherapy group had complete improvement of symptoms in 32.4% and partial improvement in 23.1% (p = 0.022). In the surgery group, one patient had complete resolution of symptoms (6.3%), eight had partial improvement (50.0%), and seven patients had no improvement (p = 0.002). Surgery was more likely to lead to progression of symptoms posttreatment (odds ratio: 5.16, confidence interval: 1.309–20.34) (p = 0.019). Conclusion Radiation has an excellent rate of radiographic control. Surgery is an option for large or symptomatic lesions. The role of surgery is primarily for vision preservation, decompression of cranial nerves, and tumor debulking and patients should be counseled extensively regarding treatment goals and expectations prior to surgery. [ABSTRACT FROM AUTHOR]

Objective  Cystic vestibular schwannomas (CVSs) are anecdotally believed to have worse clinical and tumor-control outcomes than solid vestibular schwannomas (SVSs); however, no data have been reported to support this belief. In this study, we characterize the clinical outcomes of patients with CVSs versus those with SVSs. Design  This is a retrospective review of prospectively collected data. Setting  This study is set at single high-volume neurosurgical institute. Participants  We queried a database for details on all patients diagnosed with vestibular schwannomas between January 2009 and January 2014. Main Outcome Measures  Records were retrospectively reviewed and analyzed using univariate and multivariate analyses to study the differences in clinical outcomes and tumor progression or recurrence. Results  Of a total of 112 tumors, 24% (n  = 27) were CVSs and 76% (n  = 85) were SVSs. Univariate analysis identified the extent of resection, Koos grade, and tumor diameter as significant predictors of recurrence (p  ≤ 0.005). However, tumor diameter was the only significant predictor of recurrence in the multivariate analysis (p  = 0.007). Cystic change was not a predictor of recurrence in the univariate or multivariate analysis (p  ≥ 0.40). Postoperative facial nerve and hearing outcomes were similar for both CVSs and SVSs (p  ≥ 0.47). Conclusion  Postoperative facial nerve outcome, hearing, tumor progression, and recurrence are similar for patients with CVSs and SVSs. As CVS growth patterns and responses to radiation are unpredictable, we favor microsurgical resection over radiosurgery as the initial treatment. Our data do not support the commonly held belief that cystic tumors behave more aggressively than solid tumors or are associated with increased postoperative facial nerve deficits. [ABSTRACT FROM AUTHOR]