Treatment of tumors invading the cavernous sinus

Dolenc, Vinko V.; Kregar, T; Ferluga, M.; Fettich, M.; Morina, Arsim

doi:10.1007/978-3-7091-6982-7_33

Cited by 43 publications

(15 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent reports document a 6% mortality rate and morbidity rates of approximately 30% [17]. Meanwhile, total gross tumor excision is achieved in only 60-70% of patients [17,18].…”

Section: Discussionmentioning

confidence: 99%

LINAC Radiosurgery for Cavernous Sinus Meningiomas

Chang

Adler²,

Martin³

1998

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

Radiosurgery is increasingly used to treat unresectable cavernous sinus tumors. Since 1989, 24 patients with cavernous sinus meningiomas have been treated at Stanford University Medical Center with linear accelerator (LINAC) radiosurgery. The mean age of the patients was 47.8 years (range 28–78). The mean volume treated was 6.83 cm³ (range 0.45–22.45 cm³), covered with an average of 2.3 isocenters (range 1–5).Radiation dose averaged 17.7 Gy (range 14–20 Gy). This group of patients was retrospectively studied by sending clinical questionnaires to both the patient/family and referring physicians, and reviewing clinic charts. In addition, follow-up imaging studies were obtained to measure residual tumor volume. Follow-up averaged 45.6 months (range 19–80). Tumor control (stabilization) following radiosurgery was noted in 15 (63%) and tumor shrinkage in 9 (37%). Seven meningiomas (29%) showed evidence of central tumor necrosis on MRI imaging 1–3 years after radiosurgery. Neurologic status was improved in 10 patients (42%) and unchanged in 12 patients (50%). There was 1 case of symptomatic brain necrosis and 1 case of radiation edema (asymptomatic). All other complications were transient, including 4 cases of trigeminal hypesthesia and 1 case of worsening diplopia. The 2-year actuarial tumor control rate was 100%. Although follow-up is still short, this experience corroborates prior reports that radiosurgery can be used to treat selected small cavernous sinus meningiomas with good to excellent clinical results and minimal morbidity.

show abstract

“…Recent reports document a 6% mortality rate and morbidity rates of approximately 30% [17]. Meanwhile, total gross tumor excision is achieved in only 60-70% of patients [17,18].…”

Section: Discussionmentioning

confidence: 99%

LINAC Radiosurgery for Cavernous Sinus Meningiomas

Chang

Adler²,

Martin³

1998

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

show abstract

“…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%

“…Over the last 3 decades, as data have accumulated for long-term follow-up of patients treated with conservative approaches with or without adjuvant SRS, the paradigm of the extent of resection needed to achieve optimal tumor control has shifted from aggressive maximal resection to safe maximal resection. 1,6,9,11,27,31,32,37,41,48 Recent studies with long-term follow-up suggest no definite correlation of aggressive resection with better long-term tumor control.…”

Section: Tumor Control and Temporal Patterns Of Recurrence Among Patimentioning

confidence: 99%

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

Nanda

Thakur

Sonig

et al. 2016

JNS

View full text Add to dashboard Cite

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...

show abstract

“…Large series of meningiomas affecting the cavernous sinus and petroclival areas demonstrate between 19% and 86% cranial nerve morbidity [3][4][5] following surgery. The handling and complications of Nn.…”

Section: Introductionmentioning

confidence: 99%

Trigeminal complications arising after surgery of cranial base meningiomas

2011

View full text Add to dashboard Cite

Chronic severe facial pain is a feared sequel of cranial base surgery. This study explores the symptomatology, incidence and impact on the individual of postoperative de novo trigeminal nerve affection as well as the recovery potential. Out of 231 patients operated for cranial base meningiomas at the Karolinska University Hospital during 7 years, 25 complained of de novo trigeminal symptoms at clinical follow-up 3 months after surgery. Six were later lost to follow-up leaving 19 participants in the study, which was conducted using a questionnaire and a structured telephone interview. All patients complained of facial numbness, affecting the V1 branch in 10/19 patients (53%), the V2 branch in 18/19 (95%) and the V3 branch in 9/19 (47%). Surprisingly, only three (16%) suffered from trigeminal pain, which could be adequately managed by pharmacotherapy. However, five patients (26%) demonstrated ocular dysaesthetic problems. Twelve (63%) described their handicap to be mild, while seven (37%) had daily or severe symptoms. Five patients (26%) reported no improvement over time, while nine (47%) showed improvement and four (21%) stated good recovery. Only one patient (5%) claimed complete symptom remission. In the present study, 11% of the patients presented with a de novo postoperative affection of the trigeminal nerve after removal of a cranial base meningioma; 37% of these reported daily/severe symptoms. Only 26% showed good recovery, observed in patients without tumour infiltration of the nerve or intraoperative nerve damage. In spite of frequent complaints of numbness, pain was uncommon (16%) and often manageable by pharmacotherapy, while ocular symptoms turned out to be more frequent and more disabling than expected.

show abstract

Treatment of tumors invading the cavernous sinus

Cited by 43 publications

References 18 publications

LINAC Radiosurgery for Cavernous Sinus Meningiomas

LINAC Radiosurgery for Cavernous Sinus Meningiomas

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

Trigeminal complications arising after surgery of cranial base meningiomas

Contact Info

Product

Resources

About