Outcome of aggressive removal of cavernous sinus meningiomas

1994 ◽  
Vol 81 (2) ◽  
pp. 245-251 ◽  
Author(s):  
Franco DeMonte ◽  
Harold K. Smith ◽  
Ossama Al-Mefty
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
The Other ◽  
Surgical Removal ◽  
Content Type ◽  
Formidable Challenge ◽  
Acute Hypothyroidism ◽  
Total Tumor Removal ◽  
Subtotal Removal ◽  
Fine Print

✓ Despite recent advances in surgery of the cavernous sinus, meningiomas in that area offer a formidable challenge. The rationale for aggressive surgical removal of cavernous sinus meningiomas is based on the presumption that the extent of removal is inversely related to the rate of recurrence. Over the past 10 years, 41 patients with histologically benign meningiomas involving the cavernous sinus underwent aggressive surgery. Total removal, as confirmed by intraoperative inspection and postoperative radiological studies, was achieved in 31 patients (76%). Twelve patients have been followed for more than 5 years; 10 underwent total tumor removal and only one of these experienced recurrence (5 years after surgery). The other two patients underwent subtotal removal and had symptomatic and radiological evidence of regrowth 3 and 4 years after surgery. Pre-existing cranial nerve deficits improved in only 14% of the patients, remained unchanged in 80%, and worsened permanently in 6%. Seven patients experienced a total of 10 new cranial nerve deficits, four of which involved the nerves subserving ocular motor function. Extraocular muscle function did not worsen in the 25 patients with a seeing eye ipsilateral to the tumor, and no instance of visual worsening occurred. Two patients died 4 months after surgery, one from severe delayed vasospasm and hypothalamic infarction and the other because of a myocardial infarction. Another patient died from a pulmonary embolus on the 9th postoperative day. There were three instances of cerebral ischemia; one was transient, lasting less than 24 hours, while two were related to injury of the middle cerebral artery and resulted in residual hemiplegia. Other complications included three cases of nonfatal pulmonary emboli, two cerebrospinal fluid leaks, and one instance each of exposure keratitis, acute hypothyroidism, and cerebral edema.

The abducens nerve

1974 ◽  
Vol 41 (5) ◽  
pp. 561-566 ◽  
Author(s):  
Hilel Nathan ◽  
Georges Ouaknine ◽  
Isaac Z. Kosary
Keyword(s):  
Cavernous Sinus ◽  
Subarachnoid Space ◽  
Cranial Nerve ◽  
Rectus Muscle ◽  
Abducens Nerve ◽  
The Other ◽  
Sixth Cranial Nerve ◽  
Content Type ◽  
Lateral Rectus Muscle ◽  
Fine Print

✓ The authors describe the origins and course of the sixth cranial nerve in 62 cadaver or autopsy cases and describe three patterns. In Pattern 1 the nerve originates and runs all its way as a single trunk. In Pattern 2 it originates as a single trunk, but splits into two branches in the subarachnoid space, while in Pattern 3 it originates as two separate trunks. In both Patterns 2 and 3 the trunks perforate the dura mater independently and enter the cavernous sinus by passing one above and the other below the petrosphenoidal ligament. In the sinus the two trunks fuse into a single trunk which then continues to the lateral rectus muscle. The practical neurological importance of these variations is discussed.

Gamma knife radiosurgery in the management of cavernous sinus meningiomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 68-73 ◽  
Author(s):  
Pierre-Hugues Roche ◽  
Jean Régis ◽  
Henry Dufour ◽  
Henri-Dominique Fournier ◽  
Christine Delsanti ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Tumor Growth ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Surgical Removal ◽  
Content Type ◽  
Cavernous Sinus Meningioma ◽  
The Mean ◽  
Fine Print

Object. The authors sought to assess the functional tolerance and tumor control rate of cavernous sinus meningiomas treated by gamma knife radiosurgery (GKS). Methods. Between July 1992 and October 1998, 92 patients harboring benign cavernous sinus meningiomas underwent GKS. The present study is concerned with the first 80 consecutive patients (63 women and 17 men). Gamma knife radiosurgery was performed as an alternative to surgical removal in 50 cases and as an adjuvant to microsurgery in 30 cases. The mean patient age was 49 years (range 6–71 years). The mean tumor volume was 5.8 cm3 (range 0.9–18.6 cm3). On magnetic resonance (MR) imaging the tumor was confined in 66 cases and extensive in 14 cases. The mean prescription dose was 28 Gy (range 12–50 Gy), delivered with an average of eight isocenters (range two–18). The median peripheral isodose was 50% (range 30–70%). Patients were evaluated at 6 months, and at 1, 2, 3, 5, and 7 years after GKS. The median follow-up period was 30.5 months (range 12–79 months). Tumor stabilization after GKS was noted in 51 patients, tumor shrinkage in 25 patients, and enlargement in four patients requiring surgical removal in two cases. The 5-year actuarial progression-free survival was 92.8%. No new oculomotor deficit was observed. Among the 54 patients with oculomotor nerve deficits, 15 improved, eight recovered, and one worsened. Among the 13 patients with trigeminal neuralgia, one worsened (contemporary of tumor growing), five remained unchanged, four improved, and three recovered. In a patient with a remnant surrounding the optic nerve and preoperative low vision (3/10) the decision was to treat the lesion and deliberately sacrifice the residual visual acuity. Only one transient unexpected optic neuropathy has been observed. One case of delayed intracavernous carotid artery occlusion occurred 3 months after GKS, without permanent deficit. Another patient presented with partial complex seizures 18 months after GKS. All cases of tumor growth and neurological deficits observed after GKS occurred before the use of GammaPlan. Since the initiation of systematic use of stereotactic MR imaging and computer-assisted modern dose planning, no more side effects or cases of tumor growth have occurred. Conclusions. Gamma knife radiosurgery was found to be an effective low morbidity—related tool for the treatment of cavernous sinus meningioma. In a significant number of patients, oculomotor functional restoration was observed. The treatment appears to be an alternative to surgical removal of confined enclosed cavernous sinus meningioma and should be proposed as an adjuvant to surgery in case of extensive meningiomas.

Transsphenoidal approach to infrasellar tumors involving the cavernous sinus

1990 ◽  
Vol 73 (4) ◽  
pp. 513-517 ◽  
Author(s):  
Nobuo Hashimoto ◽  
Haruhiko Kikuchi
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Transsphenoidal Approach ◽  
Skull Base Tumors ◽  
Content Type ◽  
Operating Field ◽  
Cranial Nerve Palsies ◽  
Operative Complications ◽  
Fine Print

✓ The authors review their 2-year experience with a rhinoseptal transsphenoidal approach to skull-base tumors of various pathologies involving both the sphenoid and cavernous sinuses. Eight patients with cranial nerve palsies attributable to compression of the contents of the cavernous sinus and/or optic canal are included in this report. Among these patients, a total of 17 cranial nerves were affected. Postoperative normalization was achieved in eight nerves, significant improvement in seven nerves, and no improvement in two nerves. There were no operative complications of aggravation of cranial nerve palsies in this series. In spite of the limited operating field, the results demonstrate the effectiveness and safety of this approach. The authors recommend that this approach be considered before more aggressive surgery is undertaken.

A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus

1989 ◽  
Vol 71 (5) ◽  
pp. 699-704 ◽  
Author(s):  
Akira Hakuba ◽  
Kiyoaki Tanaka ◽  
Toshihisa Suzuki ◽  
Shuro Nishimura
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
The Other ◽  
Vascular Lesions ◽  
Content Type ◽  
Fine Print

✓ The authors present four cases of vascular lesions and 10 cases of tumors involving the cavernous sinus. They were operated on via a combined orbitozygomatic infratemporal epidural and subdural approach. With this approach, multisided exposure of the cavernous sinus can be achieved via the shortest possible distance with minimal retraction of the neural structures in and around the cavernous sinus. In one patient the carotid artery had been occluded previously, but in the other 13 patients it was preserved. There was no mortality, and all patients except one returned to work within 6 months after surgery.

Intracranial sympathetic pathways associated with the sixth cranial nerve

1974 ◽  
Vol 40 (2) ◽  
pp. 236-243 ◽  
Author(s):  
J. A. Johnston ◽  
Dwight Parkinson
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Abducens Nerve ◽  
Sixth Cranial Nerve ◽  
Content Type ◽  
Photographic Documentation ◽  
Parasellar Region ◽  
Fine Print

✓ During a continuing study of the anatomy of the parasellar region, a macroscopically identifiable nerve has been observed to leave the foramen lacerum and join the abducens nerve within the cavernous sinus. A description and photographic documentation of this sympathetic branch to the fifth cranial nerve by way of the sixth cranial nerve are presented.

A cavernous sinus cavernous hemangioma

1986 ◽  
Vol 65 (5) ◽  
pp. 716-718 ◽  
Author(s):  
Bruce Rosenblum ◽  
Allen S. Rothman ◽  
Charles Lanzieri ◽  
Sun Song
Keyword(s):  
Cavernous Sinus ◽  
Cavernous Hemangioma ◽  
Surgical Removal ◽  
Syndrome Patient ◽  
Turner’S Syndrome ◽  
Radiological Findings ◽  
Content Type ◽  
Fine Print ◽  
Postoperative Deficit

✓ The case of a Turner's syndrome patient with an intracavernous cavernous hemangioma is presented. The rarity of this lesion is stressed, as is surgical removal without postoperative deficit, the role of estrogens in the pathogenesis, and the clinical and radiological findings.

Extrasellar extension of a pituitary adenoma in a patient with a normal-sized sella turcica and impaired vision from an atheromatous carotid artery

1973 ◽  
Vol 39 (3) ◽  
pp. 398-401 ◽  
Author(s):  
John R. Clifford ◽  
Dean H. Echols
Keyword(s):  
Carotid Artery ◽  
Surgical Intervention ◽  
Sella Turcica ◽  
Complete Recovery ◽  
The Other ◽  
Surgical Removal ◽  
Impaired Vision ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ Chromophobe adenomas rarely invade the brain without causing enlargement of the sella turcica and without compressing the optic nerves or chiasm. Such a case is reported, in which the patient made a complete recovery after surgical removal of the tumor. Five years later impaired vision in the other eye suggested recurrence of the adenoma. This time surgical intervention disclosed compression of the optic nerve by an atheromatous 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.

Operative management of tumors involving the cavernous sinus

1986 ◽  
Vol 64 (6) ◽  
pp. 879-889 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Aage R. Møller
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Preoperative Evaluation ◽  
Operative Procedure ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Petrous Apex ◽  
Content Type ◽  
The Third ◽  
Fine Print

✓ In the past, neurosurgeons have been reluctant to operate on tumors involving the cavernous sinus because of the possibility of bleeding from the venous plexus or injury to the internal carotid artery (ICA) or the third, fourth, or sixth cranial nerves. The authors describe techniques for a more aggressive surgical approach to neoplasms in this area that are either benign or locally confined malignant lesions. During the last 2 years, seven tumors involving the cavernous sinus have been resected: six totally and one subtotally. The preoperative evaluation included axial and coronal computerized tomography, cerebral angiography, and a balloon-occlusion test of the ICA. Intraoperative monitoring of the third, fourth, sixth, and seventh cranial nerves was used to assist in locating the nerves and in avoiding injury to them. The first major step in the operative procedure was to obtain proximal control of the ICA at the petrous apex and distal control in the supraclinoid segment. The cavernous sinus was then opened by a lateral, superior, or inferior approach for tumor resection. Temporary clipping and suture of the ICA was necessary in one patient. None of the patients died or suffered a stroke postoperatively. Permanent trigeminal nerve injury occurred in three patients; in two, this was the result of tumor invasion. One patient suffered temporary paralysis of the third, fourth, and sixth cranial nerves, and in another the sixth cranial nerve was temporarily paralyzed. Preoperative cranial nerve deficits were improved postoperatively in three patients. Radiation therapy was administered postoperatively to four patients. These seven patients have been followed for 6 to 18 months to date and none has shown evidence of recurrence of the intracavernous tumor.

Multiple dural arteriovenous malformations

1989 ◽  
Vol 71 (6) ◽  
pp. 932-934 ◽  
Author(s):  
Naoya Kuwayama ◽  
Akira Takaku ◽  
Michiharu Nishijima ◽  
Shunro Endo ◽  
Masato Hirao
Keyword(s):  
Cavernous Sinus ◽  
Arteriovenous Malformations ◽  
Sigmoid Sinus ◽  
The Other ◽  
Lateral Sinus ◽  
Content Type ◽  
Multiple Occurrence ◽  
The Right ◽  
Dural Avm ◽  
Fine Print

✓ Two cases of multiple dural arteriovenous malformations (AVM's) in different locations are reported. One patient was diagnosed as having a dural AVM involving the right cavernous sinus that disappeared spontaneously 4 months after onset of symptoms. After an interval of 4 months, another dural AVM appeared involving the right lateral sinuses (transverse and sigmoid sinuses) with occlusion of the right sigmoid sinus. In the other patient, multiple dural AVM's were demonstrated on angiography, one involving the cavernous sinus and the other the left lateral sinus. The frequency of multiple occurrence and possible mechanisms of sinus occlusion are discussed.

Sign in / Sign up

Export Citation Format

Share Document