scholarly journals Spheno-Orbital Meningioma with Cavernous Sinus Extension

2021 ◽  
Author(s):  
Rodolfo Figueiredo de Carvalho ◽  
Artur Nóbrega Lima de Morais ◽  
Leonardo Desessards Olijnyk ◽  
Adriana Azeredo Coutinho Abrao ◽  
Claudia Zanatta ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Nerve Preservation ◽  
Secondary Invasion ◽  
Foramen Rotundum ◽  
And Function ◽  
Orbital Meningioma ◽  
Cranial Nerve Preservation ◽  
First Time

AbstractWe present a case of a 37-year-old female, with progressive left eye proptosis and an extensive ipsilateral en plaque spheno-orbital meningioma, with diffuse involvement of the lateral wall of the cavernous sinus and the orbit.A cranio-orbital zygomatic approach was performed to reach all extension of the lesion. We made an extradural clinoidectomy and an extensive bone removal of the orbit, exposition of the superior and lateral walls of the cavernous sinus, unroofing of the optic canal, superior orbital fissure, foramen rotundum, and foramen ovale. We performed the peeling of the lateral wall of cavernous sinus with total removal and preservation of the cranial nerves anatomy and function.In this video, we illustrate the importance of the first time aggressive removal of such tumors. We also demonstrate the concept that secondary invasion of the cavernous sinus are suitable for removal with cranial nerve preservation.The link to the video can be found at https://youtu.be/GJmkqVa6jSs.

Isolated Trigeminal Nerve Sarcoid Granuloma Mimicking Trigeminal Schwannoma: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 52 (3) ◽  
pp. 700-705 ◽  
Author(s):  
Alfredo Quinones-Hinojosa ◽  
Edward F. Chang ◽  
Saad A. Khan ◽  
Michael W. McDermott
Keyword(s):  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Frozen Section ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Neurophysiological Monitoring ◽  
Pathology Report ◽  
Trigeminal Schwannoma ◽  
Sarcoid Granuloma

Abstract OBJECTIVE AND IMPORTANCE Sarcoidosis most commonly presents as a systemic disorder. Infrequently, sarcoidosis can manifest itself in the central nervous system, with granulomas involving the leptomeninges and presenting with facial nerve weakness. Sarcoid of the trigeminal nerve is exceedingly rare and can mimic trigeminal schwannoma. We review the literature on sarcoid granulomas of the trigeminal nerve and compare their radiological features with the more common schwannoma. CLINICAL PRESENTATION A 33-year-old woman presented with a history of left-sided facial pain and numbness for 11 months, which was presumed to be trigeminal neuralgia. A trial of carbamazepine had been unsuccessful in relieving the facial pain. Her neurological examination revealed decreased facial sensation in the V1–V2 distribution. Preoperative magnetic resonance imaging demonstrated a contrast-enhancing mass centered in the left cavernous sinus with extension along the cisternal portion of the left trigeminal nerve. INTERVENTION The patient underwent a left frontotemporal orbitozygomatic craniotomy with intraoperative neurophysiological monitoring of Cranial Nerves III, V, and VI and image guidance for subtotal microsurgical resection of what appeared, grossly and on frozen section, to be a neurofibroma. The final pathology report, however, revealed a sarcoid granuloma of the trigeminal nerve. CONCLUSION The differential diagnosis of contrast-enhancing lesions in the lateral wall of the cavernous sinus should include inflammatory conditions such as sarcoidosis. We recommend that surgery for biopsy or decompression be used only for those patients in whom a diagnosis cannot be confirmed with noninvasive testing. If surgery is performed, intraoperative frozen pathology is very useful in guiding the extent of resection.

Development of Artificial Cranial Base Model With Soft Tissues for Practical Education

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. onsE339-onsE341 ◽  
Author(s):  
Kentaro Mori ◽  
Takuji Yamamoto ◽  
Yasuaki Nakao ◽  
Takanori Esaki
Keyword(s):  
Cavernous Sinus ◽  
Dura Mater ◽  
Soft Tissues ◽  
Surgical Simulation ◽  
Cranial Nerves ◽  
Single Layer ◽  
Lateral Wall ◽  
Cranial Base ◽  
Superior Orbital Fissure ◽  
3 Dimensional

Abstract OBJECTIVE Improved educational tools for anatomic understanding and surgical simulation of the cranial base are needed because of the limited opportunities for cadaver dissection. A 3-dimensional cranial base model with retractable artificial dura mater is essential to simulate the epidural cranial base approach. METHODS We developed our 3-dimensional cranial base model with artificial dura mater, venous sinuses, cavernous sinus, internal carotid artery, and cranial nerves, and the extradural temporopolar approach was simulated using this new model. INSTRUMENTATION This model can be dissected with a surgical drill because of the artificial bone material. The periosteal dura was reconstructed in the medial wall of the cavernous sinus, periorbita, and periosteal bridge in the superior orbital fissure with yellow silicone. The meningeal dura was made with brown silicone. The single-layer dura mater could be dissected from the bone surface and retracted with a surgical spatula. RESULTS Extradural drilling of the superior orbital fissure and opening of the optic canal were similar to actual surgery. Extradural anterior clinoidectomy was performed via the extradural space by retracting the artificial dura mater. The artificial dura propria of the lateral wall in the cavernous sinus was successfully peeled from the artificial cranial nerves to complete the extradural temporopolar approach. CONCLUSION The improved 3-dimensional cranial base model provides a useful educational tool for the anatomic understanding and surgical simulation of extradural cranial base surgery.

scholarly journals Neuroendocrine Carcinoma of the Jugular Foramen

2008 ◽  
Vol 87 (2) ◽  
pp. 86-91 ◽  
Author(s):  
John P. Leonetti ◽  
Mobeen A. Shirazi ◽  
Sam Marzo ◽  
Douglas Anderson
Keyword(s):  
Neuroendocrine Carcinoma ◽  
Vocal Fold ◽  
Cranial Nerves ◽  
Intensity Modulated Radiation Therapy ◽  
Jugular Foramen ◽  
Concurrent Chemotherapy ◽  
Lower Cranial Nerve ◽  
Nerve Preservation ◽  
Pathologic Features ◽  
Cranial Nerve Preservation

We describe what might have been the first reported case of a neuroendocrine carcinoma of the jugular foramen. A 50-year-old woman presented with progressive left-sided sensorineural hearing loss, vertigo, pulsatile tinnitus, headaches, and ataxia. Magnetic resonance imaging revealed a 4-cm left-sided jugular foramen tumor. The patient underwent near-total resection of the tumor. Despite lower cranial nerve preservation, postoperative paralysis of cranial nerves IX and X occurred, and vocal fold medialization was performed 5 days later. The final pathologic diagnosis was neuroendocrine carcinoma. The patient was treated with concurrent chemotherapy and intensity-modulated radiation therapy. This article will discuss the pathologic features and the management of jugular foramen tumors, along with the differential diagnosis of these rare tumors.

scholarly journals The extradural temporopolar approach: a review of indications and operative technique

2008 ◽  
Vol 25 (6) ◽  
pp. E3 ◽  
Author(s):  
Gabriel Zada ◽  
J. Diaz Day ◽  
Steven L. Giannotta
Keyword(s):  
Cavernous Sinus ◽  
Basilar Artery ◽  
Operative Technique ◽  
Cranial Nerves ◽  
Artery Aneurysm ◽  
Lateral Wall ◽  
Superior Cerebellar Artery ◽  
Trigeminal Schwannoma ◽  
Cerebellar Artery ◽  
Brain Retraction

Object The extradural temporopolar approach is used for enhanced exposure of the cavernous sinus and petroclival regions in the treatment of complex lesions not amenable to sole treatment via radiosurgical or endovascular methods. The authors' objective was to review the indications, surgical experience, and operative technique in a series of patients who underwent surgery with this approach. Methods The authors conducted a retrospective review to identify patients who underwent a temporopolar approach from 1992 to 2008. An orbitozygomatic craniotomy was frequently used, followed by extradural retraction of the temporal lobe. A sequential progression of bone removal at the anterior and middle skull base, followed by opening the layers of the lateral wall of the cavernous sinus was next performed to safely retract the brain and widen the exposure to the cavernous sinus, interpeduncular fossa, and upper petroclival regions. Results Sixty-six patients were identified and included in the study. The mean patient age was 49 years. The main indications for surgery were as follows: meningioma (25 patients, 38%), basilar artery aneurysm (11 patients, 17%), trigeminal schwannoma (7 patients, 11%), chordoma (5 patients, 7%), hemangioma (3 patients, 5%), pituitary adenoma (3 patients, 5%), superior cerebellar artery aneurysm (3 patients, 5%), and other lesions (9 patients, 14%). Complications included hemiparesis in 4 patients (6%), infarcts in 4 patients (6%), transient aphasia in 1 patient (1.5%), and cranial nerve paresis in 20 patients (30%). Conclusions The extradural temporopolar approach offers a relatively safe and wide exposure of the sphenocavernous and petroclival regions. Mobilization of the cranial nerves and internal carotid artery allow gentle brain retraction and maximal preservation of venous outflow. This is an advantageous approach to large tumors in these regions and for complex upper basilar artery or superior cerebellar artery aneurysms.

scholarly journals Surgical Approach to the Cavernous Sinus for a Trigeminal Schwannoma Resection: Technical Note and Case Report

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Riccardo Caruso ◽  
Alessandro Pesce ◽  
Venceslao Wierzbicki ◽  
Luigi Marrocco ◽  
Emanuele Piccione
Keyword(s):  
Cavernous Sinus ◽  
Surgical Approach ◽  
Rare Case ◽  
Postoperative Morbidity ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Technical Note ◽  
Trigeminal Schwannoma ◽  
Rare Lesion

We report a rare case of schwannoma of the lateral wall of the cavernous sinus, an exceedingly rare lesion affecting this anatomical district, and discuss salient aspects of the surgical approach to the cavernous sinus, which are traditionally considered technically challenging due to the high risk of postoperative morbidity and mortality related to the presence of the cranial nerves and internal carotid artery.

Tumors of the lateral wall of the cavernous sinus

1992 ◽  
Vol 77 (4) ◽  
pp. 508-514 ◽  
Author(s):  
Magdy El-Kalliny ◽  
Harry van Loveren ◽  
Jeffrey T. Keller ◽  
John M. Tew
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Tumor Resection ◽  
Lateral Wall ◽  
Content Type ◽  
Nerve Preservation ◽  
Membranous Layer ◽  
Microsurgical Approach ◽  
Dural Wall ◽  
Fine Print

✓ The lateral dural wall of the cavernous sinus is composed of two layers, the outer dural layer (dura propria) and the inner membranous layer. Tumors arising from the contents of the lateral dural wall are located between these two layers and are classified as interdural. They are in essence extradural/extracavernous. The inner membranous layer separates these tumors from the venous channels of the cavernous sinus. Preoperative recognition of tumors in this location is critical for selecting an appropriate microsurgical approach. Characteristics displayed by magnetic resonance imaging show an oval-shaped, smooth-bordered mass with medial displacement but not encasement of the cavernous internal carotid artery. Tumors in this location can be resected safely without entering the cavernous sinus proper by using techniques that permit reflection of the dura propria of the lateral wall (methods of Hakuba or Dolenc). During the last 5 years, the authors have identified and treated five patients with interdural cavernous sinus tumors, which included two trigeminal neurinomas arising from the first division of the fifth cranial nerve, two epidermoid tumors, and one malignant melanoma presumed to be primary. The pathoanatomical features that make this group of tumors unique are discussed, as well as the clinical and radiological findings, and selection of the microsurgical approach. A more favorable prognosis for tumor resection and cranial nerve preservation is predicted for interdural tumors when compared with other cavernous sinus tumors.

Waterjet dissection of the vestibulocochlear nerve: an experimental study

2009 ◽  
Vol 110 (4) ◽  
pp. 656-661 ◽  
Author(s):  
Christoph Tschan ◽  
Michael Robert Gaab ◽  
Joachim Kurt Krauss ◽  
Joachim Oertel
Keyword(s):  
Time Course ◽  
Cranial Nerves ◽  
Auditory Brainstem ◽  
Contralateral Side ◽  
Auditory Brainstem Responses ◽  
Vestibulocochlear Nerve ◽  
Nerve Preservation ◽  
Suboccipital Craniectomy ◽  
And Function ◽  
Waterjet Dissection

Object Waterjet dissection has been shown to protect intracerebral vessels, but no experience exists in applying this modality to the cranial nerves. To evaluate its potential, the authors examined waterjet dissection of the vestibulocochlear nerve in rats. Methods Lateral suboccipital craniectomy and microsurgical preparation of the vestibulocochlear nerve were performed in 42 rats. Water pressures of 2–10 bar were applied, and the effect was microscopically evaluated. Auditory brainstem responses (ABRs) were used to define nerve function compared with preoperative values and the healthy contralateral side. The final anatomical preparation documented the morphological and histological effects of waterjet pressure on the nerve. Results In using up to 6 bar, the cochlear nerve was preserved in all cases. Eight bar moderately damaged the nerve surface. A 10-bar jet markedly damaged or even completely dissected the nerve. Time course analysis of the ABR demonstrated complete functional nerve preservation up to 6 bar after 6 weeks in all rats. Waterjet dissection with 8 bar was associated with a 60% recovery of ABR. In the 10-bar group, no recovery was seen. Conclusions Microsurgical dissection of cranial nerves is possible using waterjet dissection while preserving both morphology and function. The aforementioned jet pressures are known to be effective in neurosurgical treatment of tumors. Thus, waterjet dissection may be useful in skull base surgery including dissection of cranial nerves from tumors. Further studies on this subject are encouraged.

Endoscopic Endonasal Approach to the Lateral Wall of the Cavernous Sinus: A Cadaveric Feasibility Study

2018 ◽  
Vol 127 (12) ◽  
pp. 903-911 ◽  
Author(s):  
Sameh M. Amin ◽  
Hesham Fathy ◽  
Ahmed Hussein ◽  
Mohamed Kamel ◽  
Ahmed Hegazy ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Maxillary Nerve ◽  
Bony Landmarks ◽  
Extradural Approach

Objective: A transcranial extradural approach to the middle cranial fossa (MCF) requires separation of the dural layers of the lateral wall of the cavernous sinus. The authors tested the feasibility of an endonasal approach for this separation. Methods: A cadaveric feasibility study was conducted on the sides of 14 dry skulls and 10 fresh cadaveric heads. An endonasal, transsphenoidal, transpterygoid approach was taken to the MCF. The maxillary struts and medial greater wing of the sphenoid below the superior orbital fissure were drilled with transposition of the maxillary nerve. The lateral cavernous dural layers were split at the maxillary nerve with separation of the temporal lobe dura and exposure of the MCF bony base. The integrity of the cranial nerves and inner and outer dural layers of the lateral cavernous wall was checked. Different measurements of bony landmarks were obtained. Results: The integrity of the dural layers of the lateral cavernous wall and the cranial nerves were preserved in 10 heads. The mean area of the bony corridor was 4.68 ± 0.97 cm2, the V2-to-V3 distance was 15.21 ± 3.36 mm medially and 18.21 ± 3.45 mm laterally, and the vidian canal length was 13.01 ± 3.06 mm. Conclusions: Endonasal endoscopic separation of the lateral cavernous dural layers is feasible without crossing the motor cranial nerves, allowing better exposure of the MCF.

EXTRADURAL TRANSCAVERNOUS APPROACH TO CAVERNOUS SINUS HEMANGIOMAS

Neurosurgery ◽  
2007 ◽  
Vol 60 (3) ◽  
pp. 483-489 ◽  
Author(s):  
Ashish Suri ◽  
Faiz U. Ahmad ◽  
Ashok K. Mahapatra
Keyword(s):  
Cavernous Sinus ◽  
Surgical Complication ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Middle Meningeal Artery ◽  
Anterior Clinoid Process ◽  
Complete Excision ◽  
Computed Tomographic ◽  
Rapid Decompression

Abstract OBJECTIVE Cavernous sinus hemangiomas (CSHs) are uncommon lesions and comprise fewer than 1% of all parasellar masses. Because of their location, propensity for profuse bleeding during surgery, and relationship to complex neurovascular structures, they are notoriously difficult to excise. CLINICAL PRESENTATION The authors describe their experience with seven cases of CSHs. Headache and visual impairment were the most common presenting complaints, followed by facial hypesthesia and diplopia. Computed tomographic scans revealed iso- to hyperdense expansile lesions in the region of the cavernous sinus and middle cranial fossa. Magnetic resonance imaging scans revealed hypo- to isointense lesions on T1-weighted images and markedly hyperintense lesions on T2-weighted images, with marked homogeneous enhancement after contrast administration. INTERVENTION All CSHs were treated by a purely extradural transcavernous approach. This involved reduction of sphenoid ridge, exposure of the superior orbital fissure, drilling of the anterior clinoid process, coagulation and division of the middle meningeal artery, and peeling of the meningeal layer of the lateral wall of the cavernous sinus from the inner membranous layer. The cranial nerves in the lateral wall of the cavernous sinus were exposed (Cranial Nerves III and IV, as well as V1, V2, and V3). The tumor was accessed through its maximum bulge through either the lateral or anterolateral triangle. The tumor was removed via rapid decompression, coagulation of the feeder from the meningohypophyseal trunk, and dissection along the cranial nerves. All but one patient had complete tumor excision. Transient ophthalmoparesis (complete resolution in 6–8 wk) was the most common surgical complication. CONCLUSION To our knowledge, we describe one of the largest series of pure extradural transcavernous approaches to CSHs. CSHs are uncommon but challenging cranial base lesions. The extradural transcavernous approach allows complete excision with minimal mortality or long-term morbidity.

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