scholarly journals Clinoidal Meningioma with Cavernous Sinus Invasion

2021 ◽  
Author(s):  
Adriana Azeredo Coutinho Abrao ◽  
Carlos Eduardo da Silva
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Neurophysiological Monitoring ◽  
Anterior Clinoid Process ◽  
Cavernous Sinus Invasion ◽  
Optic Strut ◽  
Cranial Nerve Injury ◽  
Sharp Dissection ◽  
The Right ◽  
Surgical Manipulation

AbstractWe present a-49-year old female presenting headache and progressive right eye visual loss in the last 6 months. Magnetic resonance imaging showed a large clinoidal meningioma on the right side, invading the superior, lateral and medial aspects of the cavernous sinus, the optic canal, and the clinoidal segment of the internal carotid artery (ICA).A cranio-orbital approach was performed. The anterior clinoid process was removed extradurally to achieve devascularization of the anterior clinoidal meningioma, followed by the peeling of the middle fossa to decompress V2 and open the superior orbital fissure. We open the dura in a standard fronto-temporal flap to access the lower portion of the skull base allowing retractorless dissection. We complete the removal of the anterior clinoid process and optic strut through an intradural approach. It allows safer dissection of the clinoidal segment of the ICA and avoids its injury by adherent and hard consistency tumor.Intraoperative neurophysiological monitoring, sharp dissection, and avoiding the use of bipolar coagulation when dissecting the cavernous sinus are essential to minimize the risk of cranial nerve injury. We also like to point that cranial nerve deficit caused by surgical manipulation without primary lesion of the nerve can be recovered postoperatively.The link to the video can be found at: https://youtu.be/ozUCsnUGxyM.

scholarly journals A Rare Case of Tolosa-Hunt-Like Syndrome in a Poorly Controlled Diabetes Mellitus

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Glenmore Lasam ◽  
Sakshi Kapur
Keyword(s):  
Diabetes Mellitus ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Rare Case ◽  
Tight Glycemic Control ◽  
Eighth Cranial Nerve ◽  
Diagnostic Investigation ◽  
Hunt Syndrome ◽  
Cranial Nerve Palsies ◽  
The Right

We report a case of a 50-year-old female with diabetes mellitus who presented with progressive second, third, fifth, sixth, and eighth cranial nerve palsy. Diagnostic investigation revealed hyperglycemic state, and brain imaging showed a right cavernous sinus enhancement suggestive of and consistent with Tolosa-Hunt syndrome. The patient was started on steroids with tight glycemic control for eight weeks; subsequently, the cranial nerve palsies resolved as well as documented resolution of the right cavernous sinus enhancement.

scholarly journals Endoscopic endonasal transcavernous approach for invasive corticotroph pituitary adenoma

2020 ◽  
Vol 2 (2) ◽  
pp. V2
Author(s):  
Ming-Ying Lan ◽  
Wei-Hsin Wang
Keyword(s):  
Cavernous Sinus ◽  
Diagnostic Tests ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Surgical Anatomy ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Cavernous Sinus Invasion ◽  
The Right

This is a 37-year-old woman who presented with weight gain, a moon-shaped face, and muscle weakness for 4 months. Cushing’s disease was confirmed after a series of diagnostic tests. MRI demonstrated a pituitary macroadenoma with right cavernous sinus invasion and encasement of the right ICA. An endoscopic endonasal approach was performed, and gross-total resection could be achieved without injury of the cranial nerves. The Cushing’s syndrome improved gradually after the surgery. Histopathology revealed a corticotroph adenoma. In this surgical video, we demonstrate the strategies of tumor resection according to a surgical anatomy-based classification of the cavernous sinus from an endonasal perspective.The video can be found here: https://youtu.be/aNXFRdGfjpI.

Pituitary adenoma presenting as acute onset isolated complete third cranial nerve palsy without vision changes

2020 ◽  
Vol 13 (6) ◽  
pp. e232490
Author(s):  
Divya Natarajan ◽  
Suresh Tatineni ◽  
Srinivasa Perraju Ponnapalli ◽  
Virender Sachdeva
Keyword(s):  
Pituitary Adenoma ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Cranial Nerves ◽  
Lateral Spread ◽  
Automated Perimetry ◽  
Third Cranial Nerve Palsy ◽  
The Right

We report a case of isolated unilateral complete pupil involving third cranial nerve palsy due to pituitary adenoma with parasellar extension into the right cavernous sinus. The patient was referred to us from neurosurgery with sudden onset binocular vertical diplopia with complete ptosis, and mild right-sided headache of 5-day duration. Ocular examination revealed pupil involving third cranial nerve palsy in right eye while rest of the examination including automated perimetry was normal. MRI brain with contrast revealed a mass lesion with heterogenous enhancement in the sella suggestive of a pituitary macroadenoma with possible internal haemorrhage (apoplexy). In addition, the MRI showed lateral spread to the right cavernous sinus which was causing compression of the right third cranial nerve. The patient was systemically stable. This report highlights a unique case as the lesion showed a lateral spread of pituitary adenoma without compression of the optic chiasm or other cranial nerves.

scholarly journals Interdural cavernous sinus dermoid cyst in a child: case report

2017 ◽  
Vol 19 (3) ◽  
pp. 354-360 ◽  
Author(s):  
Flavio Giordano ◽  
Giacomo Peri ◽  
Giacomo M. Bacci ◽  
Massimo Basile ◽  
Azzurra Guerra ◽  
...  
Keyword(s):  
Case Report ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Lateral Wall ◽  
Total Removal ◽  
Pediatric Case ◽  
Third Cranial Nerve Palsy ◽  
The Right

Interdural dermoid cysts (DCs) of the cavernous sinus (CS), located between the outer (dural) and inner layer (membranous) of the CS lateral wall, are rare lesions in children. The authors report on a 5-year-old boy with third cranial nerve palsy and exophthalmos who underwent gross-total removal of an interdural DC of the right CS via a frontotemporal approach. The patient had a good outcome and no recurrence at the 12-month follow-up. To the best of the authors' knowledge this is the second pediatric case of interdural DC described in the literature.

scholarly journals Epithelioid Hemangioendothelioma of Cavernous Sinus

2017 ◽  
Vol 06 (03) ◽  
pp. 206-209
Author(s):  
Raj Chandran ◽  
Jyotsna Nair ◽  
Krishna Balachandran ◽  
Bhanu Rajmohan
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Epithelioid Hemangioendothelioma ◽  
Rare Tumor ◽  
Cranial Nerve Involvement ◽  
Sixth Cranial Nerve ◽  
Vascular Neoplasm ◽  
Headache Pain ◽  
The Right ◽  
Uncommon Location

AbstractEpithelioid hemangioendothelioma is an uncommon vascular neoplasm. It is rare in the intracranial location. Its occurrence in the region of cavernous sinus is reported only once. Here, we report a case of 49-year-old man who presented with a headache, pain in the right eye, diplopia, and ptosis due to third and sixth cranial nerve involvement. Imaging showed an enhancing lesion in the region of cavernous sinus on the right side. Pterional craniotomy, combined extradural and intradural approach, and subtotal excision of the tumor was done. Histopathology and immunohistochemistry were suggestive of epithelioid hemangioendothelioma which is a rare tumor in this location. We report this case because of its rarity and uncommon location.

Management of Cranial Nerve Injury Following Surgery of the Skull Base

1984 ◽  
Vol 17 (3) ◽  
pp. 577-589 ◽  
Author(s):  
Robert Thayer Sataloff ◽  
Donald L. Myers ◽  
Frederic B. Krenter
Keyword(s):  
Skull Base ◽  
Nerve Injury ◽  
Cranial Nerve ◽  
Cranial Nerve Injury

The Anteromedial Triangle: The Risk for Cranial Nerve Ischemia at the Cavernous Sinus Lateral Wall. Anatomic Cadaveric Study

Skull Base ◽  
2009 ◽  
Vol 19 (01) ◽  
Author(s):  
Michele Conti ◽  
Daniel Prevedello ◽  
Andreas Schwarz ◽  
Roger Robert ◽  
Amin Kassam
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Lateral Wall ◽  
Cadaveric Study

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

Cancers ◽  
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.

scholarly journals Non-Pathological Opacification of the Cavernous Sinus on Brain CT Angiography: Comparison with Flow-Related Signal Intensity on Time-of-Flight MR Angiography

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 94
Author(s):  
Sun Ah Heo ◽  
Eun Soo Kim ◽  
Yul Lee ◽  
Sang Min Lee ◽  
Kwanseop Lee ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Signal Intensity ◽  
Time Of Flight ◽  
Weighted Kappa ◽  
Wilcoxon Test ◽  
Tof Mra ◽  
Superior Petrosal Sinus ◽  
Grade Difference ◽  
Diagnostic Modalities ◽  
The Right

Purpose: To investigate the non-pathological opacification of the cavernous sinus (CS) on brain computed tomography angiography (CTA) and compare it with flow-related signal intensity (FRSI) on time-of-flight magnetic resonance angiography (TOF-MRA). Methods: Opacification of the CS was observed in 355 participants who underwent CTA and an additional 77 participants who underwent examination with three diagnostic modalities: CTA, TOF-MRA, and digital subtraction angiography (DSA). Opacification of the CS, superior petrosal sinus (SPS), inferior petrosal sinus (IPS), and pterygoid plexus (PP) were also analyzed using a five-point scale. The Wilcoxon test was used to determine the frequencies of the findings on each side. Additionally, the findings on CTA images were compared with those on TOF-MRA images in an additional 77 participants without dural arteriovenous fistula (DAVF) using weighted kappa (κ) statistics. Results: Neuroradiologists identified non-pathological opacification of the CS (n = 100, 28.2%) on brain CTA in 355 participants. Asymmetry of opacification in the CS was significantly correlated with the grade difference between the right and left CS, SPS, IPS, and PP (p < 0.0001 for CS, p < 0.0001 for SPS, p < 0.0001 for IPS, and p < 0.05 for PP). Asymmetry of the opacification and FRSI in the CS was observed in 77 participants (CTA: n = 21, 27.3%; TOF-MRA: n = 22, 28.6%). However, there was almost no agreement between CTA and TOF-MRA (κ = 0.10, 95% confidence interval: −0.12–0.32). Conclusion: Asymmetry of non-pathological opacification and FRSI in the CS may be seen to some extent on CTA and TOF-MRA due to anatomical variance. However, it shows minimal reliable association with the FRSI on TOF-MRA.

Sign in / Sign up

Export Citation Format

Share Document