Early outcomes of conformal radiotherapy in the treatment of cavernous sinus meningioma

2018 ◽  
Vol 18 (02) ◽  
pp. 150-154
Author(s):  
R. Moujahed ◽  
K. Ghedira ◽  
C. Drissi ◽  
A. Kallel ◽  
L. Kochbati
Keyword(s):  
Cavernous Sinus ◽  
Tumour Progression ◽  
Therapeutic Option ◽  
Tumour Size ◽  
Signs And Symptoms ◽  
Conformal Radiotherapy ◽  
Lesion Size ◽  
Conservative Strategy ◽  
Cavernous Sinus Meningioma

Abstract Aim: Cavernous sinus tumours represent 1% of all intracranial neoplasms, and 41% of them are cavernous sinus meningiomas (CSM). The disappointing results of the microsurgical approach in the treatment of CSM have led to the evaluation of a more conservative strategy, such as conformal radiotherapy (CR) and stereotactic radiosurgery (SRS). Here we report our experience with CR in the treatment of CSM, aiming to evaluate local control, clinical response and radiation-induced toxicity. Methods: A total of 18 patients with CSM, treated from 2011 to 2017, were retrospectively reviewed. Results: Patient median age was 59 years [31–74]. Clinical presentation included impaired vision, cranial nerve deficit, headache, ocular signs. Median tumour size was 35 mm [13–56]. Six patients were operated before the radiation. Twelve patients were treated with definitive radiotherapy. Dose of radiation varied from 50.4 Gy in 28 fractions, to 54 Gy in 30 fractions. Median follow-up was 33 months [6–84]. Among the 18 patients, patient’s signs and symptoms of disease remained unchanged in three cases (16.66%), 12 (66.66%) were improved and 1 patient (5.55%) exhibited tumour progression (exophthalmia). Two patients (11.11%) were lost to follow-up after the end of the treatment with radiotherapy. Findings: Based on our study findings, CR has proved to be a relatively safe and effective therapeutic option in the treatment of CSM, whether used as first-line or as an adjuvant treatment. CR may be particularly effective for tumours that are not amenable to SRS, owing to lesion size (> 30-35 mm) and/or proximity to the optic apparatus (<3 mm).

scholarly journals Outcomes after surgical treatment of meningioma-associated proptosis

2016 ◽  
Vol 125 (3) ◽  
pp. 544-550 ◽  
Author(s):  
Christian A. Bowers ◽  
Mohammed Sorour ◽  
Bhupendra C. Patel ◽  
William T. Couldwell
Keyword(s):  
Cavernous Sinus ◽  
Surgical Approach ◽  
Residual Tumor ◽  
Senior Author ◽  
Adjuvant Radiation ◽  
Limited Information ◽  
Visual Symptoms ◽  
Cavernous Sinus Meningioma ◽  
Study Results

OBJECTIVE Meningioma-associated proptosis (MAP) can be cosmetically and functionally debilitating for patients with sphenoorbital and other skull base meningiomas, and there is limited information on the quantitative improvement in proptosis after surgery. Because less extensive removals of tumor involving the orbit fail to reduce proptosis, the senior author has adopted an aggressive surgical approach to the removal of tumor involving the periorbita and orbit. The authors of this study retrospectively reviewed outcomes of this surgical approach. METHODS All surgeries for MAP performed by a single surgeon between January 1, 2002, and May 1, 2015, were reviewed. Age, sex, visual symptoms, number and types of surgical treatments, cavernous sinus involvement, complications, duration of follow-up, residual tumor, use of adjuvant radiation therapy, and extent of proptosis resolution as measured by the exophthalmos index (EI) pre- and postoperatively and at the final follow-up were recorded. RESULTS Thirty-three patients (24 female [73%]) with an average age of 51.6 years were treated for MAP. Of the 22 patients with additional visual symptoms (for example, loss of visual acuity, field cut, or diplopia), 15 had improved vision and 7 had stable vision. No patients had worse proptosis after treatment. The average preoperative EI was 1.39, the average immediate postoperative EI was 1.23, and the average final EI at the most recent follow-up was 1.13. Thus, average overall EI improvement was 0.26, but the average immediate EI reduction was 0.16, demonstrating that proptosis progressively improved during the postoperative period. Residual cavernous sinus involvement was present in 17 of 18 patients who had had preoperative cavernous sinus meningioma involvement. Only 2 patients in the series had recurrent tumor at the orbital region, and their proptosis improved again after reoperation. One case of delayed vasospasm and 2 cases of postoperative trigeminal numbness (V2) were recorded. The average follow-up was 4.5 years (53.8 months). CONCLUSIONS In this series, all patients experienced proptosis improvement and none had worse visual symptoms at the final follow-up, although proptosis resolution occurred over time. Only 2 patients had tumor recurrence at the orbit that required surgery. Surgical complications were uncommon. Study results suggest that aggressive resection of MAP is well tolerated and offers superior proptosis elimination with infrequent recurrence at the orbit. Importantly, no cases of enophthalmos were noted despite the lack of formal reconstruction of the orbit.

scholarly journals Functional Outcome After Resection of Von Hippel-Lindau Disease-Associated Cauda Equina Hemangioblastomas: An Observational Cohort Study

2017 ◽  
Vol 13 (4) ◽  
pp. 435-440 ◽  
Author(s):  
Gautam U. Mehta ◽  
Blake K. Montgomery ◽  
Dominic M. Maggio ◽  
Prashant Chittiboina ◽  
Edward H. Oldfield ◽  
...  
Keyword(s):  
Nerve Root ◽  
Motor Nerve ◽  
Therapeutic Option ◽  
Cauda Equina ◽  
Signs And Symptoms ◽  
Vascular Supply ◽  
Complete Resection ◽  
Von Hippel Lindau ◽  
Nerve Fascicle

Abstract BACKGROUND: Cauda equina hemangioblastomas in von Hippel-Lindau (VHL) disease can cause significant neurological signs and symptoms. Despite their associated morbidity, the management of these tumors remains incompletely defined. OBJECTIVE: To determine optimal management, we analyzed the functional outcomes after resection of these tumors. METHODS: VHL patients who underwent surgical resection of cauda equina hemangioblastomas at the National Institutes of Health and the University of Virginia were included. Clinical and radiological follow-up was performed at 6- to 12-month intervals after surgery. RESULTS: Fifteen patients underwent 18 operations for 21 cauda equina hemangioblastomas (median follow-up 5.9 years). Patients often presented with multiple symptoms, including pain (67%), numbness (50%), urinary complaints (33%), and weakness (11%). Median preoperative tumor volume was 1.2 cm3. Four tumors at 3 operations were not resected due to a motor nerve root origin. Gross total resection was achieved in 14 surgeries (93% of operations when resection was attempted). New mild (non-function limiting) neurological symptoms were noted after 11 operations (61%), which most often (64%) resolved within 2 weeks of surgery. At 6-month follow-up, 15 patients (83%) were stable, 2 (11%) were improved, and 1 (6%) was worse. Histological analysis revealed that all tumors originated from within the involved nerve fascicle. CONCLUSIONS: VHL-associated cauda equina hemangioblastomas have an intrafascicular origin and require interruption of the rootlet of origin for complete resection. Motor nerve root involvement may preclude complete resection but strategies including bony decompression and/or interruption of vascular supply may provide a therapeutic option. Nevertheless, most VHL patients with symptom-producing lesions improve with resection.

scholarly journals Abducens nerve palsy on a patient with sphenoid fungal rhinosinusitis and cavernous sinus meningioma – Case report

2018 ◽  
Vol 8 (31) ◽  
pp. 193-196
Author(s):  
Andreea Marza ◽  
Claudiu Manea
Keyword(s):  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Complete Removal ◽  
Abducens Nerve Palsy ◽  
Cavernous Sinus Meningioma ◽  
Fungal Rhinosinusitis ◽  
Wait And See ◽  
The Brain

Abstract We report a case of a 47-year-old patient recently diagnosed with left abducens nerve palsy, who was admitted in our clinic with diplopia. The cranio-facial CT scan revealed left sphenoid fungal rhinosinusitis and the patient underwent endoscopic surgery with complete removal of the fungal material. The immediate postoperative evolution of the patient was favourable, with partial improvement of diplopia. The first month follow-up visit revealed the recurrence of the diplopia, so the patient performed an MRI scan of the brain that showed a cavernous sinus meningioma. The patient was referred to a neurosurgeon who choose a “wait-and-see” strategy instead of surgery. The paper presents the limits of computed tomography versus magnetic resonance imaging in the radiologic diagnosis of intracranial tumors.

scholarly journals Gamma Knife stereotactic radiosurgery for cavernous sinus meningioma: long-term follow-up in 200 patients

2019 ◽  
Vol 130 (6) ◽  
pp. 1799-1808 ◽  
Author(s):  
Kyung-Jae Park ◽  
Hideyuki Kano ◽  
Aditya Iyer ◽  
Xiaomin Liu ◽  
Daniel A. Tonetti ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Cavernous Sinus Meningioma ◽  
Long Term Study

OBJECTIVEThe authors of this study evaluate the long-term outcomes of stereotactic radiosurgery (SRS) for cavernous sinus meningioma (CSM).METHODSThe authors retrospectively assessed treatment outcomes 5–18 years after SRS in 200 patients with CSM. The median patient age was 57 years (range 22–83 years). In total, 120 (60%) patients underwent Gamma Knife SRS as primary management, 46 (23%) for residual tumors, and 34 (17%) for recurrent tumors after one or more surgical procedures. The median tumor target volume was 7.5 cm3 (range 0.1–37.3 cm3), and the median margin dose was 13.0 Gy (range 10–20 Gy).RESULTSTumor volume regressed in 121 (61%) patients, was unchanged in 49 (25%), and increased over time in 30 (15%) during a median imaging follow-up of 101 months. Actuarial tumor control rates at the 5-, 10-, and 15-year follow-ups were 92%, 84%, and 75%, respectively. Of the 120 patients who had undergone SRS as a primary treatment (primary SRS), tumor progression was observed in 14 (11.7%) patients at a median of 48.9 months (range 4.8–120.0 months) after SRS, and actuarial tumor control rates were 98%, 93%, 85%, and 85% at the 1-, 5-, 10-, and 15-year follow-ups post-SRS. A history of tumor progression after microsurgery was an independent predictor of an unfavorable response to radiosurgery (p = 0.009, HR = 4.161, 95% CI 1.438–12.045). Forty-four (26%) of 170 patients who had presented with at least one cranial nerve (CN) deficit improved after SRS. Development of new CN deficits after initial microsurgical resection was an unfavorable factor for improvement after SRS (p = 0.014, HR = 0.169, 95% CI 0.041–0.702). Fifteen (7.5%) patients experienced permanent CN deficits without evidence of tumor progression at a median onset of 9 months (range 2.3–85 months) after SRS. Patients with larger tumor volumes (≥ 10 cm3) were more likely to develop permanent CN complications (p = 0.046, HR = 3.629, 95% CI 1.026–12.838). Three patients (1.5%) developed delayed pituitary dysfunction after SRS.CONCLUSIONSThis long-term study showed that Gamma Knife radiosurgery provided long-term tumor control for most patients with CSM. Patients who underwent SRS for progressive tumors after prior microsurgery had a greater chance of tumor growth than the patients without prior surgery or those with residual tumor treated after microsurgery.

scholarly journals Multimodal therapy of cavernous sinus meningioma: impact of surgery and 68Ga-DOTATATE PET-guided radiation therapy on tumor control and functional outcome

2021 ◽  
Author(s):  
Indrawati Hadi ◽  
Annamaria Biczok ◽  
Nicole Terpolilli ◽  
Jun Thorsteinsdottir ◽  
Robert Forbrig ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Cavernous Sinus ◽  
Treatment Strategies ◽  
Progression Free Survival ◽  
Rank Test ◽  
Tumor Control ◽  
Who Grade ◽  
Cavernous Sinus Meningioma ◽  
Group B

Abstract Background Functional preservation in patients with WHO grade I meningioma involving the cavernous sinus (CSM) is crucial for long-term tumor control. Concise data on the functional outcome of an interdisciplinary, multimodal treatment are scarce. We analyzed functional outcome and tumor control in CSM patients following maximal safe resection (MSR), fractionated stereotactic radiotherapy (FSRT) or combination of them, retrospectively. Methods Patients with WHO°I CSM treated between 2003 and 2017 were included. Prior to FSRT, a 68Ga-DOTATATE PET/CT was performed for radiation planning. Progression-free survival (PFS) was analyzed using Kaplan-Meier method and log-rank test was performed to test differences between groups. Visual function were analyzed at baseline and follow-up. Results Eighty-five patients were included. MSR alone was performed in 48 patients (group A), MSR followed by FSRT in 25 patients (group B), and FSRT alone in 12 patients (group C). Intracranial tumor volumes were higher in A and B compared to C (median 9.2/10.8/4.3ccm for A/B/C, p=0.023). Median follow-up was 47/46/45 months and PFS at 5-years 55.7%, 100%, and 100% in A/B/C, respectively (p<0.001). Optic nerve compression was more common in A (91.7%) and B (84.0%) than C (16.7%), p<0.001. Post-therapeutic new onset or deterioration of double vision was observed in 29%(A), 17%(B) and 0%(C). Conclusion Personalized treatment strategies for CSM are essential to control space-occupying or functionally compromising lesions. The additional potential side effect of radiotherapy seems to be justified under the aspect of longer tumor control with low functional risk. Without space-occupying effect of CSM, FSRT alone is reasonably possible.

Management of meningiomas en plaque of the sphenoid wing

2006 ◽  
Vol 104 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Uta Schick ◽  
Joris Bleyen ◽  
Alan Bani ◽  
Werner Hassler
Keyword(s):  
Cavernous Sinus ◽  
Three Dimensional ◽  
Conformal Radiotherapy ◽  
Growth Patterns ◽  
Retrospective Case ◽  
Superior Orbital Fissure ◽  
Anterior Clinoid Process ◽  
Orbital Roof ◽  
Orbital Wall

Object The authors present their findings on growth patterns in a large series of surgically treated meningiomas en plaque of the sphenoid wing. Methods A retrospective case analysis was performed in 67 patients (53 of whom were female) harboring meningiomas en plaque originating from the sphenoid wing, who underwent surgery between 1991 and 2002. The standard surgical approach consisted of pterional craniotomy and extradural resection of any infiltrated bone. The intracranial tumor was removed, and the dura mater and bone were reconstructed. The follow-up period ranged from 6 to 118 months (mean 45.7 months). Total macroscopic resection was achieved in 40 patients. Forty-eight meningiomas extended to the orbital roof and/or the lateral orbital wall, 34 involved the extraconal space, and eight the intraconal space. Fifty-four tumors involved the superior orbital fissure, 46 the optic canal, and 21 the inferior orbital fissure. Twelve tumors infiltrated the cavernous sinus and 27 involved the anterior clinoid process. There were no deaths in this group of patients; the rate of minor morbidity was 11.9% and the rate of major morbidity was 3%. Subtotal resections were performed in 27 patients because there was intraorbital tumor (eight patients), tumor in the cavernous sinus (nine patients), tumor beyond the tentorial notch (three patients), tumor invading the superior orbital fissure (four patients), and tumor of the skull base (three patients). Five patients underwent postoperative three-dimensional conformal radiotherapy, which resulted in stable tumor volume at follow up. Tumor recurrence was identified in seven patients (10.4%) postoperatively (range of follow up 13–47 months). Conclusions The goal of surgery is complete tumor removal without morbidity. An exact analysis of tumor growth and its involvement of different structures is mandatory before performing surgery.

Glomus Jugulare Tumors

Neurosurgery ◽  
2006 ◽  
Vol 59 (3) ◽  
pp. 561-569 ◽  
Author(s):  
Massimo Gerosa ◽  
Anna Visca ◽  
Paolo Rizzo ◽  
Roberto Foroni ◽  
Antonio Nicolato ◽  
...  
Keyword(s):  
Tumor Volume ◽  
Therapeutic Option ◽  
Gamma Knife Radiosurgery ◽  
Growth Control ◽  
Signs And Symptoms ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Glomus Jugulare

Abstract OBJECTIVE: Glomus jugulare tumors are generally considered slow-growing, benign lesions. However, their pronounced local aggressiveness frequently results in severe neurological deficits. Surgical removal is rarely radical and is usually associated with morbidity. There is increasing evidence that stereotactic radiosurgery, particularly gamma knife radiosurgery (GKR), may play a relevant role as a therapeutic option in these tumors. METHODS: Between 1996 and 2005, we used GKR to treat 20 patients bearing growing glomus jugulare tumors, mostly classified as Glasscock-Jackson Grade IV or Fisch Stage D1. Follow-up (mean, 50.85 mo) data was available for 20 patients (four men, 16 women; mean age, 56 yr): eight out of 20 tumors were surgical recurrences, three out of 20 patients had GKR as the primary treatment, and 11 out of 20 patients previously underwent endovascular embolization. Regarding the radiosurgical dose planning, the average tumor volume was 7.03 cm3 (range, 1.5–13.4 cm3) and the mean marginal dose was 17.3 Gy (range, 13–24 Gy). RESULTS: Neurological signs and symptoms were unchanged in 13 out of 20 patients. An improvement of cranial nerve function was observed in five patients and hearing deterioration was observed in two patients. Tumor volume was unchanged in 11 out of 20 patients and was slightly (≤ 20%) decreased in eight out of 20 patients. In one unusual case of a bulky cavernous sinus recurrence, neoplastic regression was particularly pronounced. CONCLUSION: Despite the constraints of the limited case material, considering the estimated doubling time of these rare tumors (4.2 yr), our preliminary results with GKR at a mid-term follow-up examination suggest an effective tumor growth control with negligible incidence of untoward sequelae.

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

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2420
Author(s):  
Marco Vincenzo Corniola ◽  
Marton König ◽  
Torstein Ragnar Meling
Keyword(s):  
Cavernous Sinus ◽  
Internal Carotid ◽  
Vascular Complications ◽  
Tumor Control ◽  
Inclusion Criteria ◽  
Cavernous Sinus Meningioma ◽  
Radiation Induced ◽  
Meta Analyses ◽  
Ica Stenosis

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.

Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

2014 ◽  
Vol 17 (3) ◽  
pp. 146
Author(s):  
Osman Tansel Darcin ◽  
Mehmet Kalender ◽  
Ayse Gul Kunt ◽  
Okay Guven Karaca ◽  
Ata Niyazi Ecevit ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Therapeutic Option ◽  
Complete Recovery ◽  
Aortic Aneurysms ◽  
Thoracoabdominal Aorta ◽  
Mortality And Morbidity ◽  
Early Results ◽  
The Mean ◽  
Procedural Success

<p><b>Background:</b> Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.</p><p><b>Methods:</b> From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.</p><p><b>Results:</b> All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.</p><p><b>Conclusion:</b> Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.</p>

Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

2013 ◽  
Vol 154 (33) ◽  
pp. 1291-1296 ◽  
Author(s):  
László Romics Jr. ◽  
Sophie Barrett ◽  
Sheila Stallard ◽  
Eva Weiler-Mithoff
Keyword(s):  
Recurrence Rate ◽  
Tumour Size ◽  
Breast Conservation ◽  
Malignant Lesion ◽  
Surgical Techniques ◽  
Incomplete Resection ◽  
Immediate Reconstruction ◽  
Oncological Safety

Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296.

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