Radiosurgical Management of Benign Cavernous Sinus Tumors: Dose Profiles and Acute Complications

Neurosurgery ◽  
2001 ◽  
Vol 48 (5) ◽  
pp. 1022-1032 ◽  
Author(s):  
Joseph C.T. Chen ◽  
Steven L. Giannotta ◽  
Cheng Yu ◽  
Zbigniew Petrovich ◽  
Michael L. Levy ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pituitary Adenoma ◽  
Radiation Dose ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Tumor Volume ◽  
Grade Iii

Abstract OBJECTIVE Radiosurgery has emerged as an alternative treatment modality for cranial base tumors in patients deemed not suited for primary surgical extirpation, patients with recurrent or residual tumor after open surgery, or patients who refuse surgical treatment. We review our short-term experience with radiosurgical management of cavernous sinus region tumors with the Leksell gamma knife. METHODS From August 1994 to February 1999, 69 patients with cavernous sinus lesions were treated in 72 separate treatment sessions. The tumor type distribution was 29 pituitary adenomas, 35 meningiomas, 4 schwannomas, and 1 paraganglioma. The median follow-up was 122 weeks. Lesions were stratified according to a five-level surgical grade. The grade distribution of the tumors was as follows: Grade I, 13; Grade II, 21; Grade III, 19; Grade IV, 12; Grade V, 4. Median tumor volume was 4.7 cm3. The median radiation dose was 15 Gy to the 50% isodose line. Median maximal radiation dose was 30 Gy. RESULTS Analysis of tumor characteristics and radiation dose to optic nerve and pontine structures revealed a significant correlation between distance and dose. Much lower correlation coefficients were found between tumor volume and dose. One lesion in this series had evidence of transient progression and later regression on follow-up radiographic studies. No other lesions in this series were demonstrated to have exhibited progression. Complications after radiosurgical treatment were uncommon. Two patients had cranial nerve deficits after treatment. One patient with a surgical Grade III pituitary adenoma had VIth cranial nerve palsy 25 months after radiosurgical treatment that spontaneously resolved 10 months later. A patient with a bilateral pituitary adenoma experienced bilateral VIth cranial nerve palsy 3 months after treatment that had not resolved at 35 months after treatment. Six patients with preoperative cranial nerve deficits experienced resolution or improvement of their deficits after treatment. One patient with a prolactin-secreting adenoma experienced normalization of endocrine function with return of menses. CONCLUSION Radiosurgical treatment represents an important advance in the management of cavernous sinus tumors, with low risk of neurological deficit in comparison with open surgical treatment, even in patients with high surgical grades.

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.

Newly occurring cranial nerve palsy after endovascular treatment of cavernous sinus dural arteriovenous fistulas

2019 ◽  
Vol 11 (11) ◽  
pp. 1168-1172
Author(s):  
Su Hwan Lee ◽  
Won-Sang Cho ◽  
Hyun-Seung Kang ◽  
Jeong Eun Kim ◽  
Young Dae Cho ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Endovascular Intervention ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

ObjectiveCranial nerve palsy (CNP) is rarely reported after endovascular intervention for cavernous sinus dural arteriovenous fistulas (CS DAVFs). Our aim was to evaluate the treatment outcomes of CS DAVFs, and the clinical course and risk factors of newly occurring CNPs, with a review of the literature.Methods121 patients with 134 lesions treated in our institution were selected. They were retrospectively analyzed in terms of baseline characteristics, radiologic results, clinical outcome, and newly occurring CNPs after treatment. Angiographic and clinical follow-up data were available for 104 lesions (77.6%) and 130 lesions (97.0%), respectively.ResultsThe angiographic results showed partial:complete obliterations in 13:91 (87.5%) at the final follow-up. Clinical outcomes were deteriorated or no change:improved or completely recovered (3:126 (96.9%)) at the final follow-up. New CNPs occurred in 24 patients (19.8%), including the sixth CNP alone or mixed in 23 patients (95.8%). 23 cases were completely recovered or improved (21 and 2 cases, respectively), and 19 (90.4%) of 21 were completely recovered within 6 months after treatment. In the multivariate analysis, pretreatment cranial nerve symptoms (OR=0.33; 95% CI 0.14 to 0.76; P=0.010) and complete obliteration immediately after treatment (OR=0.32; 95% CI 0.12 to 0.85; P=0.021) were significant preventive factors for new CNPs. Embolization in the posterior compartments of the CS (OR=5.15; 95% CI 1.71 to 15.47; P=0.004) was a significant risk factor.ConclusionsEndovascular intervention was satisfactory in patients with CS DAVFs. The prognosis of newly occurring CNPs was favorable.

scholarly journals Isolated sixth cranial nerve palsy as the presenting symptom of a rapidly expanding ACTH positive pituitary adenoma: a case report

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Norman Saffra ◽  
Elizabeth Kaplow ◽  
Irina Mikolaenko ◽  
Alice Kim ◽  
Benjamin Rubin ◽  
...  
Keyword(s):  
Case Report ◽  
Pituitary Adenoma ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Sixth Cranial Nerve ◽  
Sixth Cranial Nerve Palsy

Unusual cranial nerve palsy caused by cavernous sinus aneurysms

1999 ◽  
Vol 52 (2) ◽  
pp. 143-149 ◽  
Author(s):  
Marcelo Nery Silva ◽  
Naokatsu Saeki ◽  
Shinji Hirai ◽  
Akira Yamaura
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy

scholarly journals Surgical Treatment of Fourth Cranial Nerve Palsy

2011 ◽  
Vol 41 (2) ◽  
pp. 84-89
Author(s):  
Doğan Ceyhan ◽  
Tarık Bozca ◽  
Reyhan Konca ◽  
Sıddık Keskin
Keyword(s):  
Surgical Treatment ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Fourth Cranial Nerve

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 Internuclear ophthalmoplegia as a presenting feature in a COVID-19-positive patient

2021 ◽  
Vol 14 (4) ◽  
pp. e241873
Author(s):  
Varshita Hemanth Vasanthapuram ◽  
Akshay Badakere
Keyword(s):  
Diabetes Mellitus ◽  
Cerebrovascular Accident ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Internuclear Ophthalmoplegia ◽  
Reverse Transcription Pcr ◽  
Ophthalmic Manifestations ◽  
The World

A 58-year-old man presented with vertical diplopia for 10 days which was sudden in onset. Extraocular movement examination revealed findings suggestive of internuclear ophthalmoplegia. Investigations were suggestive of diabetes mellitus, and reverse transcription-PCR for SARS-CoV-2 was positive. At 3 weeks of follow-up, his diplopia had resolved. Neuro-ophthalmic manifestations in COVID-19 are increasingly being recognised around the world. Ophthalmoplegia due to cranial nerve palsy and cerebrovascular accident in COVID-19 has been reported. We report a case of internuclear ophthalmoplegia in a patient with COVID-19.

Gamma Knife Radiosurgery for Pituitary Adenoma: Early Results

Neurosurgery ◽  
2003 ◽  
Vol 53 (1) ◽  
pp. 51-61 ◽  
Author(s):  
Zbigniew Petrovich ◽  
Cheng Yu ◽  
Steven L. Giannotta ◽  
Chi-Shing Zee ◽  
Michael L.J. Apuzzo
Keyword(s):  
Growth Hormone ◽  
Radiation Dose ◽  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Cranial Nerve ◽  
Adrenocorticotropic Hormone ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Late Toxicity

Abstract OBJECTIVE In recent years, gamma knife radiosurgery (GKRS) has emerged as an important treatment modality in the management of pituitary adenomas. Treatment results after performing GKRS and the complications of this procedure are reviewed. METHODS Between 1994 and 2002, a total of 78 patients with pituitary adenomas underwent a total of 84 GKRS procedures in our medical center. This patient group comprised 46 men (59%) and 32 women (41%). All patients were treated for recurrent or residual disease after surgery or radiotherapy, with 83% presenting with extensive tumor involvement. The cavernous sinus was involved in 75 patients (96%), and 22 patients (28%) had hormone-secreting adenomas. This latter subset of patients included 12 prolactinomas (15%), 6 growth-hormone secreting tumors (8%), and 4 adrenocorticotropic hormone-secreting tumors (5%). The median tumor volume was 2.3 cm3, and the median radiation dose was 15 Gy defined to the 50% isodose line. The mean and median follow-up periods were 41 and 36 months, respectively. RESULTS GKRS was tolerated well in these patients; acute toxicity was uncommon and of no clinical significance. Late toxicity was noted in three patients (4%) and consisted of VIth cranial nerve palsy. In two patients, there was spontaneous resolution of this palsy, and in one patient, it persisted for the entire 3-year duration of follow-up. Of the 15 patients who presented with cranial nerve dysfunction, 8 (53%) experienced complete recovery and 3 (20%) showed major improvement within 12 months of therapy. Tumor volume reduction was slow, with 30% of patients showing decreased tumor volume more than 3 years after undergoing GKRS. None of the 56 patients with nonfunctioning tumors showed progression in the treated volume, and 4 (18%) of the 22 hormone-secreting tumors relapsed (P = 0.008). Of the four patients with adrenocorticotropic hormone-secreting adenomas, therapy failed in two of them. All six patients with growth hormone-producing tumors responded well to therapy. Of the 12 patients with prolactinomas 10 (83%) had normalization of hormone level and 2 patients experienced increasing prolactin level. Two patients with prolactinomas had three normal pregnancies after undergoing GKRS. CONCLUSION GKRS is a safe and effective therapy in selected patients with pituitary adenomas. None of the patients in our study experienced injury to the optic apparatus. A radiation dose higher than 15 Gy is probably needed to improve control of hormone-secreting adenomas. Longer follow-up is required for a more complete assessment of late toxicity and treatment efficacy.

Gamma Knife Radiosurgery as a Primary Treatment for Nonfunctioning Pituitary Adenoma Invading the Cavernous Sinus

2020 ◽  
Vol 98 (6) ◽  
pp. 371-377
Author(s):  
Won Jae Lee ◽  
Kyung-Rae Cho ◽  
Jung-Won Choi ◽  
Doo-Sik Kong ◽  
Ho Jun Seol ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Primary Treatment ◽  
Tumor Control ◽  
Nonfunctioning Pituitary Adenoma ◽  
Maximal Diameter

<b><i>Objectives:</i></b> Surgical resection of nonfunctioning pituitary adenoma (NFPA) invading the cavernous sinus (CS) remains a challenging and significant factor associated with incomplete resection. The residual tumor in CS is usually treated with adjuvant stereotactic radiosurgery (SRS), but there is little information concerning SRS as an initial treatment for CS-invading NFPA. In this study, we investigated the tumor control rate and clinical outcomes of the patients who received primary gamma knife radiosurgery (GKRS) for CS-invading NFPA. <b><i>Methods:</i></b> This was a single-institute retrospective analysis of 11 patients. CS invasion of tumor was categorized using the modified Knosp grading system. The median tumor volume and maximal diameter were 1.6 cm<sup>3</sup> (range 0.4–6.5) and 17.2 mm (range 11.6–23.3), respectively. The median clinical follow-up period was 48.5 months (range 16.4–177.8). The median prescription dose at tumor margin was 15 Gy (range 11–25) and median prescription isodose was 50% (range 45–50). The maximum radiation dose to optic chiasm and optic nerve were 7.2 Gy (range 3.4–9.2) and 7.5 Gy (range 4.5–11.5), respectively. <b><i>Results:</i></b> Tumor control was achieved in all patients. The median tumor volume and maximal diameter at last follow-up were 0.4 cm<sup>3</sup> (range 0.1–2.3) and 11.4 mm (range 4.7–19.5), respectively. The median volume reduction rate was 52% (range 33–88). Six patients showed downgrading of modified Knosp grade after GKRS. No patients developed GKRS-related complications such as hypopituitarism or visual disturbance. <b><i>Conclusions:</i></b> SRS may be an alternative primary treatment option for CS-invading NFPA if there is no urgent and absolute indication for surgery such as optic apparatus compression.

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