Skull base approaches for meningiomas invading the cavernous sinus

Kawase, Takeshi; Toya, Shigeo; Shiobara, Ryuzo; Kimura, Chojiro; Nakajima, Hideo

doi:10.1007/978-3-7091-6982-7_31

Cited by 21 publications

(4 citation statements)

References 9 publications

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“…When the combined epi-and subdural approach is carried out, the anteromedial triangle and the superolateral (Parkinson's) triangle are useful; however, their structures are sometimes distorted by pathology. The transpetrosal-transtentorial approach was described for the treatment of sphenopetroclival meningiomas (Kawase et al, 1985(Kawase et al, , 1987(Kawase et al, , 1991. This study confirmed that the anterior transpetrosal-transtentorial approach was the optimum operative approach from the middle cranial fossa to the posterior cranial fossa through the largest triangle compared to the other approaches.…”

Section: Operative Approachsupporting

confidence: 77%

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Anatomical variations of the ten triangles around the cavernous sinus

Watanabe

Nagaseki²,

Ohkubo

et al. 2002

Clinical Anatomy

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The dimensions of the 10 triangles around the cavernous sinus were measured to define the anatomical characteristics of the triangles and to compare their consistency in shape and area. Twelve tissue blocks containing the bilateral cavernous sinuses and medial two-thirds of the middle cranial fossae were obtained from Japanese adults at autopsy, fixed to a stereotactic frame, and examined with an operative microscope. The dimensions of each triangle were measured with calipers and compared, based on the same point and border. The anteromedial triangle and the superolateral (Parkinson's) triangle were more consistent in shape than the paramedial and oculomotor triangles, but the oculomotor triangle was larger in area than these other triangles. The posteromedial (Kawase's) triangle was more consistent in shape and larger than the anterolateral, lateral, and the posterolateral (Glasscock's) triangles. The anteromedial and superolateral (Parkinson's) triangles are important for the combined epi- and subdural approach to cavernous sinus lesions. The posteromedial (Kawase's) triangle is important for gaining access to the posterior cranial fossa from the middle cranial fossa.

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Section: Operative Approachsupporting

confidence: 77%

“…There are four commonly used approaches to the cavernous sinus: the anteromedial approach (Hakuba et al, 1982); a combined epi-and subdural approach (Dolenc, 1985); a transpetrosal-transtentorial approach (Kawase et al, 1985(Kawase et al, , 1987(Kawase et al, , 1991; and a transnasal or transoral approach.…”

Section: Operative Approachmentioning

confidence: 99%

Anatomical variations of the ten triangles around the cavernous sinus

Watanabe

Nagaseki²,

Ohkubo

et al. 2002

Clinical Anatomy

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“…1 and 2 upper), as thoroughly described previously. 1,5,11,16,18,41 An obvious advantage from exposure with an FTOZ craniotomy was noted for the central skull base tumors that had a more superior extension and/or occupied the floor of the MF. Furthermore, for some skull base meningiomas, a cranial base approach allowed identification and interruption of the anastomotic connection of ECA-ICA from which they derive their blood supply, as explained by Yamaki et al 49 and Day.…”

Section: Surgical Approachesmentioning

confidence: 99%

Microsurgical resectability, outcomes, and tumor control in meningiomas occupying the cavernous sinus

Nanda

Thakur

Sonig

et al. 2016

JNS

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Cavernous sinus meningiomas (CSMs) represent a subset of intracranial tumors that continue to pose a formidable challenge to neurosurgeons. The various factors contributing to the challenging management of CSMs include not only their location, which limits their resectability and increases the risk of injuring critical neurovascular structures, but also achieving long-term tumor control and maintaining or improving patient quality-of-life outcomes. 1,5,6,9,10,13,20,21,27,30,32,38,41,44 Initially, CSMs were deemed inoperable due to the considerable mortality and morbidity related to removal of the tumor from what was deemed a surgically inaccessible area. With the introduction of the operating microscope and advances in neuroimaging, resection of these tumors became a realistic goal. The advances in microneurosurgical techniques in the 1980s and early 1990s allowed attempts at aggressive resection of these tumors. In the last 2 decades, the enthusiasm for aggressive resection has been tempered and the pendulum has swung toward a more conservative surgical strategy for treating the tumors of the parasellar compartment. Major factors that seem to be responsible for this paradigm shift include the efficacy and abbreviatioNs CN = cranial nerve; CND = CN dysfunction; CS = cavernous sinus; CSM = CS meningioma; ECA = external carotid artery; FT = frontotemporal; FTO = FT craniotomy with orbital osteotomy; FTOZ = FT orbitozygomatic; ICA = internal carotid artery; KPS = Karnofsky Performance Scale; MF = middle fossa; RT = radiotherapy; SRS = stereotactic radiosurgery. obJective Cavernous sinus meningiomas (CSMs) represent a cohort of challenging skull base tumors. Proper management requires achieving a balance between optimal resection, restoration of cranial nerve (CN) function, and maintaining or improving quality of life. The objective of this study was to assess the pre-, intra-, and postoperative factors related to clinical and neurological outcomes, morbidity, mortality, and tumor control in patients with CSM. methods A retrospective review of a single surgeon's experience with microsurgical removal of CSM in 65 patients between January 1996 and August 2013 was done. Sekhar's classification, modified Kobayashi grading, and the Karnofsky Performance Scale were used to define tumor extension, tumor removal, and clinical outcomes, respectively. results Preoperative CN dysfunction was evident in 64.6% of patients. CN II deficits were most common. The greatest improvement was seen for CN V deficits, whereas CN II and CN IV deficits showed the smallest degree of recovery. Complete resection was achieved in 41.5% of cases and was not significantly associated with functional CN recovery. Internal carotid artery encasement significantly limited the complete microscopic resection of CSM (p < 0.0001). Overall, 18.5% of patients showed symptomatic recurrence after their initial surgery (mean follow-up 60.8 months [range 3-199 months]). The use of adjuvant stereotactic radiosurgery (SRS) after microsurgery independently decreas...

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“…After this surgical success, Kawase started applying the anterior transpetrosal approach to treat skull base tumors. He reported two successful resections of petroclival meningioma using this approach 12 at the first Cavernous Sinus Symposium in Ljubljana, Yugoslavia, organized by Vinko Dolenc in 1986 (Fig. 5A).…”

Section: The First Successful "Kawase Approach" At Ashikaga Red Cross...mentioning

confidence: 99%

The historical adventures of Takeshi Kawase: the mountaineer who explored the "no man’s land" with love for art, nature, and humankind

Ganaha,

Shibao

2024

Journal of Neurosurgery

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The anterior petrosal approach, or Kawase’s approach, is a commonly used technique in skull base surgery to access the brainstem in the posterior fossa from the middle fossa, and has the advantages of minimizing brain retraction and preserving hearing. It was first successfully performed by the legendary Japanese neurosurgeon, Takeshi Kawase, for the clipping of a basilar artery aneurysm in 1981. To date, no historical article has shed light on Kawase’s intriguing personal history. In this historical vignette, the authors depict Kawase’s unique background, talent, passion, as well as struggles that ultimately shaped his career. By sharing Kawase’s personal story from the hospital where he first successfully performed his original approach, the authors hope to pass on to future generations Kawase’s spirit and philosophy that have impacted the global neurosurgical community.

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Skull base approaches for meningiomas invading the cavernous sinus

Cited by 21 publications

References 9 publications

Anatomical variations of the ten triangles around the cavernous sinus

Anatomical variations of the ten triangles around the cavernous sinus

Microsurgical resectability, outcomes, and tumor control in meningiomas occupying the cavernous sinus

The historical adventures of Takeshi Kawase: the mountaineer who explored the "no man’s land" with love for art, nature, and humankind

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