STA-MCA Bypass in Carotid Stenosis after Radiosurgery for Cavernous Sinus Meningioma

SIMPLE SUMMARY: We present the case of a patient with a radiation-induced internal carotid artery stenosis after stereotactic radiosurgery for cavernous sinus meningioma. Our case presented with symptomatic vascular insufficiency two years after treatment. We carried out a review of the literature searching for vascular and non-vascular complications following the treatment of cavernous sinus meningiomas with radiosurgery or radiotherapy. As a result, two cases of stroke and one case of asymptomatic stenosis of the internal carotid artery were described, aside from non-vascular complications. We were able to conclude that radiosurgery and radiotherapy carry fewer complications than open surgery, with similar rates of tumor control. Altogether, our case and the associated review emphasize the importance of a multidisciplinary, extended follow-up of irradiated cavernous sinus meningiomas. ABSTRACT: Background: Cavernous sinus meningiomas (CSM) are mostly non-surgical tumors. Stereotactic radiosurgery (SRS) or radiotherapy (SRT) allow tumor control and improvement of pre-existing cranial nerve (CN) deficits. We report the case of a patient with radiation-induced internal carotid artery (ICA) stenosis. We complete the picture with a review of the literature of vascular and non-vascular complications following the treatment of CSMs with SRS or SRT. Methods: After a case description, a systematic literature review is presented, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2015 guidelines. Results: 115 abstracts were screened and 70 titles were retained for full-paper screening. A total of 58 articles did not meet the inclusion criteria. There were 12 articles included in our review, with a follow-up ranging from 33 to 120 months. Two cases of post-SRT ischemic stroke and one case of asymptomatic ICA stenosis were described. Non-vascular complications were reported in all articles. Conclusion: SRS and SRT carry fewer complications than open surgery, with similar rates of tumor control. Our case shows the importance of a follow-up of irradiated CSMs not only by a radio-oncologist, but also by a neurosurgeon, illustrating the importance of multidisciplinary management of CSMs.