Radiosurgery of Cavernous Sinus Tumors

Salles, Antonio Af De; Bajada, C L; Goetsch, Steven J.; Selch, Michael T.; Holly, F. Eugene; Solberg, T.D.; Becker, Denise

doi:10.1007/978-3-7091-9297-9_23

Cited by 6 publications

(8 citation statements)

References 19 publications

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“…Small tumors confined to the cavernous sinus (smaller than 3.5 cm in largest diameter) are controlled with a rate of 90 to 100% [2,7,8,16]. This control rate has been achieved with a very favorable complication rate, less than 6% new cranial nerve deficits, including visual deficits.…”

Section: Radiosurgery Resultsmentioning

confidence: 95%

“…Conservative resection followed by conventional radiation therapy was previously suggested [35]. Surgical efforts should be concentrated in turning a high-grade cavernous sinus meningioma into a lower grade tumor which may be controlled by stereotactic radiation [2,7,8,16].…”

Section: Surgery Combined With Radiosurgerymentioning

confidence: 99%

“…Radiosurgery has emerged as an adjuvant and frequently as an option for primary treatment of cavernous sinus meningiomas (CSM) [7][8][9]. The management of these tumors remains complex despite developments in microsurgical and radiosurgical techniques [6].…”

Section: Introductionmentioning

confidence: 99%

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Radiosurgery and Stereotactic Radiation Therapy of Skull Base Meningiomas: Proposal of a Grading System

Salles

Frighetto

Grande

et al. 2001

Stereotact Funct Neurosurg

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Objective: The development of a grading system to guide treatment selection, and predict treatment difficulty and outcome of skull base meningiomas infiltrating the cavernous sinus which are managed by stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT), based on an 8-year experience with stereotactic radiation of skull base meningiomas. Methods: T1 gadoliniun-enhanced magnetic resonance imaging (MRI) of 40 patients with skull base meningiomas, with or without prior surgery, who underwent radiosurgery or stereotactic radiation therapy from 1991 to 1998 at the UCLA Medical Center were reviewed, and the result of treatment was related to the tumor grade. Grade was based on tumor infiltration of the cavernous sinus and extension into adjacent structures. Treatment was performed with a linac-based system. The dose prescribed to the periphery of the tumor for SRS patients (n = 34) ranged from 12 to 22 Gy, and the maximum dose delivered to the tumor ranged from 24 to 46 Gy. SRT (n = 6). Treatment was planned using a single isocenter, usually prescribed to the 90% isodose volume, bringing the fractionation scheme to the maximal tolerance of the optic apparatus. The periphery dose ranged from 24 to 46 Gy with a maximum dose of 45 to 51 Gy. Clinical and MRI follow-up was performed every six months for the first 3 years and every year thereafter. Results: Grade I meningiomas were restricted to the cavernous sinus (n = 12). Grade II cavernous sinus meningiomas extended to the clivus and/or the petrous bone, without compression of the brainstem (n = 9). Grade III meningiomas had superior and/or anterior extension with compression of the optic nerve or tract (n = 9). Grade IV tumors compressed the brain stem (n = 8), and Grade V were bilateral lesions (n = 2). Tumor control rates were 90% for Grade I, 86% for Grade II, 86% for Grade III, 42% for Grade IV and no control for tumors Grade V. Complications were not related to tumor grade. Conclusion: This grading system correlated with outcome and difficulty in planning radiosurgery. Failure of treatment was more likely to occur in patients with higher Grade tumors.

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Section: Radiosurgery Resultsmentioning

confidence: 95%

Section: Surgery Combined With Radiosurgerymentioning

confidence: 99%

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Radiosurgery and Stereotactic Radiation Therapy of Skull Base Meningiomas: Proposal of a Grading System

Salles

Frighetto

Grande

et al. 2001

Stereotact Funct Neurosurg

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“…[2,4,6,11,15,19,46] These often require neurosurgical interventions, [33][34][35][36] treatment using invasive radiological techniques, [1,5,29,40] or radiotherapy. [7,9] All manipulations within this narrow space require an exact knowledge of the particular parasellar topography in infants. [33] However, all detailed descriptions of cavernous sinus anatomy, [3,27,31,41,42] measurements of important distances, [14,[20][21][22] and analyses of surgical approaches [8,10,18,32,37,38] have been based on adult specimens.…”

mentioning

confidence: 99%

The parasellar region of human infants: cavernous sinus topography and surgical approaches

Weninger¹,

Mülle²

1999

FOC

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Object In this study the authors analyze the peculiarities of the parasellar anatomy and the topography of surgical approaches to the parasellar region (PSR) in human infants. Methods Forty-nine specimens of the PSR obtained at autopsy were studied using microdissection and histological analysis. Important distances between anatomical landmarks were measured with the aid of a dissecting microscope. One serially sectioned specimen was three-dimensionally reconstructed and analyzed on the computer screen by using the authors' new episcopic reconstruction technique. The anatomy of the infant PSR differs distinctly from that of the adult. The parasellar portion of the internal carotid artery (ICA) does not form a siphon, but takes a straight course, and the venous pathways as well as the cranial and sympathetic nerves have different topographical relationships. Analyses of surgical approaches demonstrate that, in young children, the anterolateral approach can be used to reach the pterygopalatine compartment, the superior ophthalmic vein, and those pathological processes that extend from the orbit into the PSR. The approach via Parkinson's triangle can be used in 45% of cases to access the pathological processes that occur in the voluminous space above and behind the posterior flexure of the parasellar ICA. Taking this route, sympathetic nerve fibers passing through the PSR are not at risk, but some arterial branches that run within the lateral wall of the sinus can complicate this approach. Conclusions This study presents a guideline that can assist radiologists and neurosurgeons in the planning and performance of interventions within the PSR of neonates and young children.

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“…18 Patients with widespread metastatic disease have limited prognosis and may represent higher surgical risk because of poor medical condition. In these cases, the noninvasiveness of stereotactic radiosurgery is attractive.…”

Section: Discussionmentioning

confidence: 99%