In a recent study, tumor progression after gamma knife surgery was high in patients treated with incomplete coverage, with cavernous sinus or with meningiomatosis, despite benign tumor histology. Cavernous sinus trombosis dr munish kumar g b pant delhi 2. Cavernous sinus dissection and bleeding in meningiomas full. Within this compact space run the carotid artery and the ocular motor nerves, and. Cavernous sinus meningioma nancy huynh ophthalmic medical technology uams, college of health professions little rock, ar the cavernous venous sinus is a small bloodfilled space on both sides of the base of the skull located behind the eyes. Clival meningiomas are located on the underside of the cerebrum within the posterior cranial fossa. Until 1965, when parkinsons landmark article describing the direct surgical approach to carotidcavernous fistulas was published, little reference was made in the neurosurgical literature to direct operative attack on lesions of the cavernous sinus.
Outcome of aggressive removal of cavernous sinus meningiomas. Today, meningiomas with primary or, more commonly, secondary involvement of the cavernous sinus remain a surgical challenge. These types of meningiomas often grow as part of a larger lesion within the sphenoid bone. Cavernous sinus is constituted of paired venous structures located in the middle cranial fossa. At the posterior aspect of the roof of the cavernous sinus, the free and attached edges of tentorium cerebelli forms a space through which cn iii enters the lateral wall of the sinus. Cavernous sinus meningiomas can cause double vision, dizziness and facial pain. The cavernous sinus has many vital structures passing through it, including the carotid artery and the third, fourth, fifth, and sixth cranial nerves. Cavernous meningioma 3d virtual tour ucla neurosurgery. Major radiosurgery rs series report progressionfree survival rates at 5.
The medial border of the cavernous sinus is the bony floor and lateral wall of the sella. Attempted resection of this lesion without preoperative planning carries a high risk for significant blood loss and cranial neuropathies. Santacroce a, walier m, regis j, liscak r, motti e, lindquist c, kemeny a, et al. Winslow, however, was the first to use the term cavernous sinus in 1734, as an analogy to the corpus cavernosum of the penis. Jul 31, 20 resection of cavernous sinus meningiomas. The most common are neurogenic tumors and cavernoma. Risks are rooted primarily in tumor location, particularly.
Management of parasellar and cavernous sinus meningiomas neil r. Such is the case with meningiomas involving the cavernous sinus csm. Recent studies 11 26 have shown progression free survival rates of 94% after 5 years and 86% at 8 years, with a median followup of 62 months. Conclusions the treatment of cavernous sinus meningiomas using surgical decompression with or without adjuvant radiation is an effective oncological strategy, achieving excellent tumor control. In the present study, pfs was 95% at 5 years and 84% at 10 years with a median followup of 100. The tumor is often histologically benign, slow growing, and seldom. They exclude meningiomas that invade the cavernous sinus from an adjacent area. Types of meningiomas meningioma types mount sinai new york.
Meningiomas involving the cavernous sinus may start in the sinus or grow into it as an extension from a larger tumour involving the medial sphenoid wing, orbit, clivus, or petrous bones. Cavernous sinus chs are usually misdiagnosed as a meningioma because meningioma. Cavernous sinus meningioma cavernous sinus cs meningiomas are by definition those supratentorial skull base meningiomas which originate from the parasellar region. Jan 17, 2014 in those patients with typical meningioma, the control rate was 93. Mar, 2020 a cavernous sinus meningioma is a benign tumor arising from the cells that form the internal lining membrane of the brain, called the pia mater, which expands to fill the cavernous sinus. Meningiomas confined to the cavernous sinus mcss are benign tumors. In the patients who had srs as the primary treatment, the fiveyear local control rate was 96. The coronal projection provided imaging of cranial nerves within the cavernous sinus. It is located at the central base of the skull, on either side of the sella turcica. Stereotactic radiosurgery for benign international stereotactic. Meningiomas also differ in the extent of their cavernous sinus. The authors describe a series of meningiomas of the cavernous sinus. The veins that communicate with the cavernous sinus are. Cavernous sinus developments and future perspectives.
Meningiomas are the most common tumor arising from the lateral wall of the cavernous sinus. As note below, radiosurgery is particularly well suited for treating cavernous sinus meningioma, but if the tumor is too close to the optic tract it may be better to use fractionated radiation go here and here. It takes an anterior, inferomedial course relative to the other nerves in the lateral wall towards the anterior extremity of the sinus. Cavernous sinus meningioma the neurosurgical atlas, by. At the skull base caudally, the cavernous sinus extends from the inferior edge of the superior orbital fissure to the superior end of the petroclival fissure. Cavernous sinus meningiomas were once considered unresectable. Cavernous hemangiomas can be misdiagnosed as a meningioma, especially when localized in the cavernous sinus. Baltimore, md objectives at the conclusion of this program, the attendee will be able to. These tumors may be more difficult to remove surgically than brain meningiomas because they may be on or near the bones of the skull. On the other hand, the improvement of the anatomical knowledge and the microsurgical techniques together with diffusion of radiosurgery are currently changing the treatment strategy, opening new perspectives to the. Meningiomas occupying the cs represent a heterogeneous group of tumors originating and extending over different anatomical skull base surfaces. Cavernous sinus dissection and bleeding in meningi omas ocs the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Objective microsurgical resection of cavernous sinus meningiomas csm is associated with a high rate of incomplete resection, recurrence. Meningioma extending into the cavernous sinus image. The paired cavernous sinuses are thinwalled venous pockets below and behind the orbits or eye sockets that collect blood draining from the face, eye, and anterior brain. 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. The meningioma involving the cavernous sinus remains one of the most challenging types of lesion in neurosurgery. Cavernous sinus dissection and bleeding in meningiomas. Recognize the major presenting signs and symptoms of parasellar and cavernous sinus meningiomas. Evaluation of over 255 patients with sellar and parasellar lesions allowed study of the computed tomographic ct appearance of the cavernous sinus.
Fiftysix patients undergoing 57 cavernous sinus surgical procedures performed by a single senior neurosurgeon were. Owing to the fact that there are no valves in the sinus and its connected veins, the direction of blood flow is dependent on venous pressure. These may be metastatic from lung, breast, prostate, etc, result from local spread nasopharyngeal, pituitary, craniopharyngioma, or be primary tumours meningioma, neurofibroma. Evidencebased treatment of cavernous sinus meningioma. Potential causes of cavernous sinus syndrome include metastatic tumors, direct extension of nasopharyngeal tumours, meningioma, pituitary tumors or pituitary apoplexy, aneurysms of the intracavernous carotid artery, carotid cavernous fistula, bacterial infection causing cavernous sinus thrombosis, aseptic cavernous sinus thrombosis, idiopathic. Cavernous sinus meningiomas are rare tumors that affect the cavernous sinus, an area that controls eye movement and allows your face to feel sensations. Management of parasellar and cavernous sinus meningiomas. In this report, we evaluate the recurrenceand progressionfree survival of patients with meningiomas involving the cavernous sinus. We speculated that meningiomas adherent to the dural sinuses may be more inclined to distant organ metastasis, and they might use dural sinuses for seeding.
A cavernous sinus meningioma is a benign tumor arising from the cells that form the internal lining membrane of the brain, called the pia mater, which expands to fill the cavernous sinus. Despite the advances in techniques and technologies, the management of cavernous sinus cs meningiomas still remains a challenge for both neurosurgeons and radiation oncologists. Apr 12, 2019 the maxillary nerve cranial nerve v2 courses just inferior to the junction of the lateral and medial walls of the cavernous sinus. Longterm followup of 82 cavernous sinus meningiomas treated.
Cavernous sinus meningiomas may grow within the plane of the intradural space, between the layers of cavernous sinus dura, without invading the cavernous sinus proper. Diagnosis, treatment, and outcome pdf free download. Meningiomas involving the cavernous sinus may start in the sinus or grow into it as part of a larger tumor involving the medial sphenoid wing, orbit. Review stereotactic radiosurgery for benign world health organization grade i cavernous sinus meningiomas international stereotactic radiosurgery society isrs practice guideline. Recognize the major presenting signs and symptoms of parasellar and cavernous sinus meningiomas 2. Cavernous sinus meningioma nancy huynh ophthalmic medical technology uams, college of health professions little rock, ar the cavernous venous sinus is a small bloodfilled space on both sides of the base of the. The reported incidences of permanently impaired extraocular muscle function developing after resection of cavernous sinus meningioma is 14% to 58%. Tumors involving the cavernous sinus clinical gate. Part of the tumor was removed without entering deep into the cavernous sinus, and she received postoperative radiation treatment.
Cavernous sinus meningiomas csms are challenging lesions for the skull base neurosurgeon to. At operation, the tumor was a part of the cavernous sinus, hard in consistency, and unlike pituitary tumors, it was very solid. Cavernous sinus meningioma nancy huynh ophthalmic medical. Details of the image meningioma extending into the cavernous sinus modality. Syndromes of the orbital fissure, cavernous sinus, cerebello pontine angle, and skull base. Cavernous sinus meningioma represent a scenario where srs is particularly useful given the potential morbidity of surgical resection in that region. Cavernous sinus meningiomas neurosurgery oxford academic. Imaging lesions of the cavernous sinus american journal of. Cavernous sinus meningioma radiosurgery request pdf. Gamma knife surgery of meningiomas involving the cavernous.
Gamma knife surgery of meningiomas involving the cavernous sinus article pdf available in neurosurgery 664. Tumors of the nasopharynx, skull base, and sphenoid sinus. The development of microsurgical and skull base techniques as well as advances in anesthesia and neuroradiology have allowed safe and systematic treatment of these lesions. Optimal visualization of the cavernous sinus was obtained with continuous contrast enhancement of both axial and coronal tomograms. Meningiomas of the cavernous sinus cs are extremely difficult to treat surgically with acceptable morbidity and mortality. Conclusions the treatment of cavernous sinus meningiomas using surgical decompression with or without adjuvant radiation is an effective oncological strategy, achieving excellent. A collection of core cranial procedures for the neurosurgeon 2015 prose award first prize winner. A meningioma is a tumor that arises from a layer of tissue the meninges that covers the brain and spine. In this report, we evaluate the recurrenceand progression free survival of patients with meningiomas involving the cavernous sinus. Pathologic conditions of the cavernous sinus can have various clinical consequences, ranging from subtle to devastating, and including headache, ophthalmoplegia, exophthalmos proptosis, chemosis, vision loss, trigeminal neuralgia, and, rarely, cerebral. American journal of roentgenology, 160 5, 10831088. The mass is t1 isotense and t2 hyperintense with vivid contrast enhancement. Gamma knife surgery of meningiomas involving the cavernous sinus.
Surgically proven as venous channel matter of debatea pair of cavernous sinus, on either side of sella turcica. Stereotactic radiosurgery of cavernous sinus meningiomas. We presented a rare case has been treated for cavernous sinus meningioma and then diagnosed with malign meningioma metastasis to the lung. I am in the beginning stages of being diagnosed with meningioma. Tumors of the nasopharynx, skull base, and sphenoid sinus may extend to the cs as can perineural and hematogenous metastases. Pdf cavernous sinus meningiomas antonio santoro and. In 1685 vieussens described the relation of cranial nerves to the outer wall of the sinus. The mass also compresses the left temporal lobe and left pons. They offer a classification of their tumors and present their strategy and experiences. These initial references were followed by ridleys first detailed description of the cs in 1695. Postero lateral part of cavernous sinus has diverticulum of meninges of post.
Anatomic research on cadaver specimens, together with the advances made in cranial base and microvascular surgery over the past 2 decades, have made it possible to completely resect lesions within the cavernous sinus. Cavernous sinus dissection and bleeding in meningiomas ocs the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Understand the advantages and disadvantages of the. Anteriorly, the tumor extends for 1 centimeter into the apex of the right orbit, medially into the upper right sphenoid sinus. Median dose was 52 gy with standard fractionation and median follow up was 6. A large right paraselllar mass is noted measuring up to 18 mm thick, filling the cavernous sinus and moderately narrowing in the transverse portion of the cavernous carotid artery. The cavernous sinus is, at least from the angiographic perspective, a metaphysical entity. Over the past 10 years, 41 patients with histologically benign meningiomas involving the cavernous sinus.
Patients with apparent meningiomas of the cavernous sinus, although their tumors are benign, are considered for surgery only in select circumstances. Facial pain or hypoesthesia associated with ophthalmoplegia should raise suspicion for a cavernous sinus lesion. Risks are rooted primarily in tumor location, particularly with respect to the proximity of important neurovascular structures. Venous relationships cavernous sinus venous plexus or venous channel. Diagnosing cavernous sinus ch preoperatively is very important, but its radiological differential diagnosis is quite difficult. Value of imaging for predicting surgical complications. Cavernous sinus anatomy large venous space situated in the middle cranial fossa, on either side of body of the sphenoid bone. Evidencebased treatment of cavernous sinus meningioma ncbi. Radiation oncologycnsmeningioma wikibooks, open books for. Background cavernous sinus meningioma csm causes gradual ophthalmoplegia and may eventually cause compression of the chiasma. Cavernous sinus meningiomas arise from the dura of the cavernous sinus more specifically, the lateral wall dura or arise from the adjacent dura in the petroclival region, the sphenoid ridge, or the clinoid process with extension to the cavernous sinus. Winslow clearly described the anatomy including the placement of the internal carotid artery and the iiird, ivth, vth, and vith cranial nerves within the sinus.
The cavernous sinus is an unconventional venous system in the sense that it does not have a unidirectional flow of blood. Cavernous sinus, meningioma, surgery, radiosurgery. And are a typical adult female tumors with peak incidence of 4060 y. The cavernous sinus cs is a venous plexus that lies between the periosteal and dural layers of the dura mater. Meningiomas of the cavernous sinus make up a very small percentage of all cranial meningiomas, but their location within the cavernous sinus makes their surgical. Longterm followup of patients with meningiomas involving the. These features are suggestive of a cavernous sinus meningioma. Meningioma near the cavernous sinus brain tumors inspire. Imaging lesions of the cavernous sinus american journal. The term cavernous sinus meningioma is generically used to indicate 3 anatomic presentations. Meningiomas account for % to 26% of all intracranial neoplasms. The tumor removal of cavernous sinus meningiomas usually results in.
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