Association of Morbidity with Extent of Resection and Cavernous Sinus Invasion in Sphenoid Wing Meningiomas

Abstract Background Despite the recent advances in skull base surgery, microsurgical techniques, and neuroimaging, yet surgical resection of clinoidal meningiomas is still a major challenge. In this study, we present our institution experience in the surgical treatment of anterior clinoidal meningiomas highlighting the role of extradural anterior clinoidectomy in improving the visual outcome and the extent of tumor resection. This is a prospective observational study conducted on 33 consecutive patients with clinoidal meningiomas. The surgical approach utilized consisted of extradural anterior clinoidectomy, optic canal deroofing with falciform ligament opening in all patients. The primary outcome assessment was visual improvement and secondary outcomes were extent of tumor resection, recurrence, and postoperative complications. Results The study included 5 males and 28 females with mean age 49.48 ± 11.41 years. Preoperative visual deficit was present in 30 (90.9%) patients. Optic canal involvement was present in 24 (72.7%) patients, ICA encasement was in 16 (48.5%), and cavernous sinus invasion in 8 (24.2%). Vision improved in 21 patients (70%), while 6 patients (20%) had stationary course and 1 patient (3%) suffered postoperative new visual deterioration. Gross total resection was achieved in 24 patients (72.7%). The main factors precluding total removal were cavernous sinus involvement and ICA encasement. Mortality rate was 6.1%; mean follow-up period was 27 ± 13 months. Conclusions In this series, the use of extradural anterior clinoidectomy provided a favorable visual outcome and improved the extent of resection in clinoidal meningioma patients.

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Endoscopic endonasal management of non-functioning pituitary adenomas with cavernous sinus invasion: a 10- year experience

Rhinology Journal ◽

10.4193/rhino14.309 ◽

2015 ◽

Vol 53 (4) ◽

pp. 308-316

Author(s):

F. Ferreli ◽

M. Turri-Zanoni ◽

F.R. Canevari ◽

P. Battaglia ◽

M. Bignami ◽

...

Keyword(s):

Cavernous Sinus ◽

Tumor Resection ◽

Mass Effect ◽

Extent Of Resection ◽

Tumor Control ◽

Endoscopic Endonasal ◽

Cavernous Sinus Invasion ◽

Visual Outcomes ◽

Contrast Enhanced ◽

Wait And See

Background: The management of Non-Functioning Pituitary Adenoma (NFPA) invading the cavernous sinus (CS) is currently a balancing act between the surgical decompression of neural structures, radiotherapy and a wait-and-see policy. Methods: We undertook a retrospective review of 56 cases of NFPA with CS invasion treated through an endoscopic endonasal approach (EEA) between 2000 and 2010. The Knosp classification was adopted to describe CS involvement using information from preoperative MRI and intraoperative findings. Extent of resection and surgical outcomes were evaluated on the basis of postoperative contrast-enhanced MRI. Endocrinological improvement and visual outcomes were assessed according to the most recent consensus criteria. Results: EEA was performed using direct para-septal, trans-ethmoidal-sphenoidal or trans-ethmoidal-pterygoidal-sphenoidal approach. Visual outcomes improved in 30 (81%) patients. Normalization or at least improvement of previous hypopituitarism was obtained in 55% of cases. A gross total resection was achieved in 30.3% of cases. The recurrence-free survival was 87.5%, with a mean follow-up of 61 months (range, 36-166 months). No major intraoperative or postoperative complications occurred. Discussion: EEA is a minimally-invasive, safe and effective procedure for the management of NFPA invading the CS. The extent of CS involvement was the main factor limiting the degree of tumor resection. The EEA was able to resolve the mass effect, preserving or restoring visual function, and obtaining adequate long-term tumor control.

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Radiographic and clinical outcomes using intraoperative magnetic resonance imaging for transsphenoidal resection of pituitary adenomas

Journal of Neurosurgery ◽

10.3171/2020.4.jns20178 ◽

2020 ◽

pp. 1-12

Author(s):

Rupa G. Juthani ◽

Anne S. Reiner ◽

Ankur R. Patel ◽

Aimee Cowan ◽

Marie Roguski ◽

...

Keyword(s):

Clinical Outcomes ◽

Cavernous Sinus ◽

Pituitary Adenomas ◽

Progression Free Survival ◽

Extent Of Resection ◽

Gross Total Resection ◽

Total Resection ◽

Cavernous Sinus Invasion ◽

Treatment Groups ◽

Postoperative Mri

OBJECTIVEThe utility and safety of intraoperative MRI (iMRI) for resection of pituitary adenomas is not clearly established in the context of advances in endoscopic approaches. The goal in this study was to evaluate the safety and efficacy of iMRI for pituitary adenoma resection, with endoscopic transsphenoidal (ETS) versus microscopic transsphenoidal (MTS) approaches.METHODSRadiographic and clinical outcomes of all pituitary adenomas resected using iMRI between 2008 and 2017 at a single institution were retrospectively evaluated.RESULTSOf 212 tumors treated, 131 (62%) underwent further resection based on iMRI findings, resulting in a significant increase in gross-total resection on postoperative MRI compared with iMRI (p = 0.0001) in both ETS and MTS groups. iMRI increased rates of gross-total resection for cavernous sinus invasion Knosp grades 1 and 2, but not in Knosp ≥ 3 across treatment groups (p < 0.0001). The extent of resection on postoperative MRI was significantly correlated with increased progression-free survival (p < 0.0001). Initial hormone remission off medical therapy was achieved in 64%, with a significantly higher rate of remission in tumors resected via the ETS approach (81%) compared with the MTS approach (55%) (p = 0.02). The rate of persistent new hormone deficit was low at 8%, including a 2.8% rate of permanent diabetes insipidus, and 45% of patients had improvement in preoperative hormone deficit following surgery. Serious postoperative complications including CSF leaks requiring reoperation were rare at 1%, with no postoperative infections.CONCLUSIONSThese results suggest that iMRI is a safe and effective method of increasing the extent of resection for pituitary adenomas while preserving hormone function. When paired with the endoscope, iMRI may offer the ability to tailor more aggressive removal of tumors while optimizing pituitary function, resulting in high rates of secretory hormone remission. Secretory tumors and adenomas with Knosp grade < 3 cavernous sinus invasion may benefit most from the use of iMRI.

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Association of Morbidity with Extent of Resection and Cavernous Sinus Invasion in Sphenoid Wing Meningiomas

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0032-1304562 ◽

2012 ◽

Vol 73 (01) ◽

pp. 076-083 ◽

Cited By ~ 7

Author(s):

Michael Ivan ◽

Jason Cheng ◽

Gurvinder Kaur ◽

Michael Sughrue ◽

Aaron Clark ◽

...

Keyword(s):

Cavernous Sinus ◽

Extent Of Resection ◽

Cavernous Sinus Invasion

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Robotic Radiosurgery for Persistent Postoperative Acromegaly in Patients with Cavernous Sinus-Invading Pituitary Adenomas—A Multicenter Experience

Cancers ◽

10.3390/cancers13030537 ◽

2021 ◽

Vol 13 (3) ◽

pp. 537

Author(s):

Felix Ehret ◽

Markus Kufeld ◽

Christoph Fürweger ◽

Alfred Haidenberger ◽

Paul Windisch ◽

...

Keyword(s):

Disease Control ◽

Effective Treatment ◽

Cavernous Sinus ◽

Treatment Options ◽

Cavernous Sinus Invasion ◽

Robotic Radiosurgery ◽

Patient Morbidity ◽

Biochemical Remission ◽

Patients Experience

Background: The rates of incomplete surgical resection for pituitary macroadenomas with cavernous sinus invasion are high. In growth hormone-producing adenomas, there is a considerable risk for persistent acromegaly. Thus, effective treatment options are needed to limit patient morbidity and mortality. This multicenter study assesses the efficacy and safety of robotic radiosurgery (RRS) for patients with cavernous sinus-invading adenomas with persistent acromegaly. Methods: Patients who underwent RRS with CyberKnife for postoperative acromegaly were eligible. Results: Fifty patients were included. At a median follow-up of 57 months, the local control was 100%. The pretreatment insulin-like growth factor 1 (IGF-1) levels and indexes were 381 ng/mL and 1.49, respectively. The median dose and prescription isodose were 18 Gy and 70%, respectively. Six months after RRS, and at the last follow-up, the IGF-1 levels and indexes were 277 ng/mL and 1.14, as well as 196 ng/mL and 0.83, respectively (p = 0.0001 and p = 0.0002). The IGF-1 index was a predictor for biochemical remission (p = 0.04). Nine patients achieved biochemical remission and 24 patients showed biochemical disease control. Three patients developed a new hypopituitarism. Conclusions: RRS is an effective treatment for this challenging patient population. IGF-1 levels are decreasing after treatment and most patients experience biochemical disease control or remission.

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