scholarly journals Aggressive Radiation-Induced Cavernous Sinus Meningioma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Antonio Aversa ◽  
Ossama Al-Mefty
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Radical Resection ◽  
Science Museum ◽  
Common Finding ◽  
Cushing Disease ◽  
Cavernous Sinus Meningioma ◽  
Radiation Induced ◽  
And Control ◽  
Neurovascular Structures

Abstract Radiation-induced meningiomas are the most common radiation-induced neoplasms. They exhibit a distinct aggressive clinical behavior as rapid growth, recurrences, multiplicity, and malignant progression are common features.1-4 Atypical histological findings and aberrant cytogenetics are increasingly identified.5-7 Radical resection of aggressive radiation-induced meningiomas is the best treatment option and would offer the best chance for control of the disease. Wide bone and dural margins should be pursued in the resection. Parasellar extension creates significant surgical challenges. Cavernous sinus exploration through the multidirectional axis provided by the cranioorbital zygomatic approach allows radical resection of the tumor, cranial nerve decompression, and carotid artery preservation and control.8-11 This article describes a cavernous sinus radiation-induced meningioma after radiation for Cushing disease. It demonstrates the details of the extra- and intradural exploration and dissection of the neurovascular structures in the cavernous sinus, with proximal and distal control of the carotid artery. However, even after radical resection, recurrence is a common finding in this malignant behavioral radiation-induced tumor. Patient consented for surgery. Image at 9:41 comes from the Science Museum Group, United Kingdom. Refer to the Wellcome blog post (archive). This image is licensed under the CC-BY 4.0 International license.

Zygomatic Approach to Cavernous Sinus Chordoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Antonio Aversa ◽  
Ossama Al-Mefty
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Radical Resection ◽  
High Rate ◽  
Petrous Apex ◽  
High Dose ◽  
Middle Fossa ◽  
Cavernous Carotid Artery

Abstract Chordoma is not a benign disease. It grows invasively, has a high rate of local recurrence, metastasizes, and seeds in the surgical field.1 Thus, chordoma should be treated aggressively with radical resection that includes the soft tissue mass and the involved surrounding bone that contains islands of chordoma.2–5 High-dose radiation, commonly by proton beam therapy, is administered after gross total resection for long-term control. About half of chordoma cases occupy the cavernous sinus space and resecting this extension is crucial to obtain radical resection. Fortunately, the cavernous sinus proper extension is the easier part to remove and pre-existing cranial nerves deficit has good chance of recovery. As chordomas originate and are always present extradurally (prior to invading the dura), an extradural access to chordomas is the natural way for radical resection without brain manipulation. The zygomatic approach is key to the middle fossa, cavernous sinus, petrous apex, and infratemporal fossa; it minimizes the depth of field and is highly advantageous in chordoma located mainly lateral to the cavernous carotid artery.6–12 This article demonstrates the advantages of this approach, including the mobilization of the zygomatic arch alleviating temporal lobe retraction, the peeling of the middle fossa dura for exposure of the cavernous sinus, the safe dissection of the trigeminal and oculomotor nerves, and total control of the petrous and cavernous carotid artery. Tumor extensions to the sphenoid sinus, sella, petrous apex, and clivus can be removed. The patient is a 30-yr-old who consented for surgery.

Management of Cavernous Sinus Meningioma Presenting With Cerebrovascular Insufficiency Secondary to Cavernous Carotid Artery Occlusion: Report of 2 Cases

2018 ◽  
Vol 16 (4) ◽  
pp. 503-513 ◽  
Author(s):  
Gmaan Alzhrani ◽  
Nicholas Derrico ◽  
Hussam Abou-Al-Shaar ◽  
William T Couldwell
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Surgical Removal ◽  
Cerebrovascular Insufficiency ◽  
Cavernous Sinus Meningioma ◽  
Cavernous Carotid Artery

Abstract BACKGROUND Surgical removal of cavernous sinus meningiomas is challenging and associated with high morbidities as a result of the anatomic location and the surrounding neurovascular structures that are often invaded or encased by the tumor. Advances in radiotherapy techniques have led to the adoption of more conservative approaches in the management of cavernous sinus meningioma. Internal carotid artery encasement and invasion has been documented in these cases; however, ischemic presentation secondary to internal carotid artery stenosis or occlusion by meningioma in the region of the cavernous sinus is rare, with only few cases reported in the literature. OBJECTIVE To report our surgical technique and experience with bypass grafting for cavernous sinus meningiomas that invade or narrow the internal carotid artery. METHODS We report 2 patients who presented with signs and symptoms attributed to cavernous carotid artery occlusion secondary to cavernous sinus meningioma in the last 5 yr. Both patients were treated with flow augmentation without surgical intervention for the cavernous sinus meningioma. RESULTS In both cases, the clinical and radiological signs of cerebrovascular insufficiency improved markedly, and the patients’ tumors are currently being monitored. CONCLUSION Although the cerebrovascular insufficiency in this subset of patients is attributed to the occlusion of the cavernous carotid artery caused by the tumor, we propose treating those patients with flow augmentation first with or without radiation therapy when there is a clear imaging feature suggestive of meningioma in the absence of significant cranial nerve deficit.

scholarly journals Cavernous Sinus Meningioma with Orbital Involvement: Algorithmic Decision-Making and Treatment Strategy

2020 ◽  
Vol 81 (04) ◽  
pp. 348-356
Author(s):  
Amol Raheja ◽  
William T. Couldwell
Keyword(s):  
Decision Making ◽  
Cavernous Sinus ◽  
Interdisciplinary Collaboration ◽  
Radical Resection ◽  
Screening Tools ◽  
Unique Challenge ◽  
Orbital Involvement ◽  
Cavernous Sinus Meningioma ◽  
Close Proximity ◽  
Clinical Dilemma

AbstractCavernous sinus meningioma (CSM) with orbital involvement presents a unique challenge to modern-day neurosurgeons. In the modern era of preventive medicine with enhanced screening tools, physicians encounter CSM more frequently. An indolent natural history, late clinical presentation, close proximity to vital neurovascular structures, poor tumor-to-normal tissue interface, and high risk of iatrogenic morbidity and mortality with aggressive resection add to the complexity of decision-making and optimal management of these lesions. The clinical dilemma of deciding whether to observe or intervene first for asymptomatic lesions remains an enigma in current practice. The concepts of management for CSM with orbital involvement have gradually evolved from radical resection to a more conservative surgical approach with maximal safe resection, with the specific goals of preserving function and reducing proptosis. This change in surgical attitude has enabled better long-term functional outcomes with conservative approaches as compared with functionally disabled outcomes resulting from the pursuit of anatomical cure from disease with radical resection. The advent of stereotactic radiosurgery as an adjunct tool to treat residual CSM has greatly shaped our resection principles and planning. Interdisciplinary collaboration for multimodality management is key to successful management of these difficult to treat lesions and tailor management as per individual's requirement.

scholarly journals The caroticoclinoid foramen in fetal and infantile orbitosphenoid, presphenoid, and sphenoid bones: developmental and neurosurgical considerations

2019 ◽  
Vol 23 (3) ◽  
pp. 390-396 ◽  
Author(s):  
Matthew J. Zdilla
Keyword(s):  
Carotid Artery ◽  
Early Life ◽  
Internal Carotid ◽  
Clinical Importance ◽  
Common Finding ◽  
Anterior Clinoid Process ◽  
Black And White ◽  
Risk Of Injury ◽  
Caroticoclinoid Foramen ◽  
Neurovascular Structures

OBJECTIVEThe presence of a caroticoclinoid foramen may increase the likelihood of adverse neurosurgical events. Despite the clinical importance of the caroticoclinoid foramen, its study has been mostly limited to adult populations. Therefore, the object of this study was to describe the prevalence, morphology, and development of the caroticoclinoid foramen among varied sexes and races in early life.METHODSThe study analyzed caroticoclinoid foramina in dry orbitosphenoid, presphenoid, and sphenoid bones from a population of 101 fetal and infantile crania of varied sex and race.RESULTSA caroticoclinoid foramen, whether complete, near complete, or partial, was found in 36 of 199 sides (18.1%). Of the 98 crania with bilaterally intact sides, 21 (21.4%) had the presence of at least one caroticoclinoid foramen. Caroticoclinoid foramina were found unilaterally and bilaterally, in both female and male crania (9/41, 22.0%; 12/57, 21.1%, respectively) and, likewise, in crania of both black and white races (9/54, 16.7%; 12/44, 27.3%, respectively). Caroticoclinoid foramina were formed from cornuate bony projections from the anterior clinoid process, middle clinoid process, or both anterior and middle clinoid processes. Caroticoclinoid foramina were also found in isolated orbitosphenoid bones from individuals as young as 4 months’ fetal age.CONCLUSIONSThe caroticoclinoid foramen occurs in approximately one of every 5 sides and in one in every 5 individuals of perinatal age and should, therefore, be considered a common finding in both fetuses and infants. It is common in both females and males as well as in both black and white races, alike. Furthermore, the caroticoclinoid foramen can be found in individuals as young as 4 months of fetal age. Failure to anticipate the presence of a caroticoclinoid foramen will place important neurovascular structures, including the internal carotid artery, at risk of injury. Neurosurgeons should, therefore, anticipate the caroticoclinoid foramen even in their youngest patients.

Agenesis of the internal carotid artery and cavernous sinus hypoplasia with contralateral cavernous sinus meningioma

1993 ◽  
Vol 35 (8) ◽  
pp. 588-590 ◽  
Author(s):  
C. M. Grand ◽  
S. Louryan ◽  
W. O. Bank ◽  
D. Bal�riaux ◽  
J. Brotchi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Cavernous Sinus Meningioma

scholarly journals Gross Total Resection of a Recurrent in-and-around Cavernous Sinus Meningioma through a Combined Transcavernous Anterior and Middle Infratemporal Fossa Approach with Extracranial-Intracranial Bypass

2021 ◽  
Author(s):  
Yoichi Nonaka ◽  
Naokazu Hayashi ◽  
Takanori Fukushima
Keyword(s):  
Carotid Artery ◽  
Skull Base ◽  
Cavernous Sinus ◽  
Bypass Surgery ◽  
Internal Carotid ◽  
Infratemporal Fossa ◽  
Cavernous Sinus Meningioma ◽  
Skull Base Meningioma ◽  
Cerebral Bypass ◽  
Vessel Reconstruction

Abstract Objectives The study aims to describe surgical management of an invasive cavernous sinus meningioma with a combination of several skull base approaches and bypass surgery. Design This study is an operative video. Results Resection of the recurrent skull base meningioma is still challenging, especially if the tumor involves or encases the carotid artery. Cerebral bypass surgery is an essential adjunct in the armamentarium of skull base surgery when vessel reconstruction is required. In this paper, we describe our experience of successful treatment of an invasive recurrent skull base meningioma, which involved the entire cavernous sinus and the internal carotid artery. A 46-year-old woman presented with a 2-year history of gradually worsening left-sided exophthalmos and visual impairment. The patient had previously undergone two craniotomies for resection of the left-sided spheno-orbital meningioma. Pathological diagnosis was chordoid meningioma, which is classified as an intermediate-grade meningioma. The second surgery had been performed for a rapid tumor regrowth 6 months after the first surgery. The patient lost her left-side vision after the second surgery. Aggressive tumor regrowth was confirmed with extension into the left orbit, infratemporal fossa, and cavernous sinus with engulfment of the carotid artery. A balloon occlusion test revealed intolerance of the left internal carotid artery occlusion. Considering the patient's age, tumor behavior, and intolerance of the carotid artery of the lesion side, we scheduled gross total resection of the tumor with vessel reconstruction. Conclusion Although cerebral bypass surgery is a technically challenging procedure, it plays an important role in the surgical management of the complex vessel-engulfing tumor.The link to the video can be found at https://youtu.be/GCmpxK3hW18.

scholarly journals Gross Total Resection of a Recurrent Cavernous Sinus Meningioma through a Combined Transzygomatic Transcavernous and Extended Middle Fossa Approach with Cavernous Carotid Denudation

2021 ◽  
Author(s):  
Yoichi Nonaka ◽  
Naokazu Hayashi ◽  
Takanori Fukushima
Keyword(s):  
Carotid Artery ◽  
Skull Base ◽  
Posterior Fossa ◽  
Cavernous Sinus ◽  
Middle Fossa ◽  
Total Resection ◽  
Middle Fossa Approach ◽  
Cavernous Sinus Meningioma ◽  
Skull Base Meningioma ◽  
The Right

Abstract Objective The aim of this study is to describe surgical management of invasive cavernous sinus meningioma with a combination of skull base approaches. Design This study is an operative video. Results Resection of the recurrent skull base meningioma is still challenging, especially if the tumor involves or encases the carotid artery. In this video, we describe our experience with the successful treatment of a recurrent skull base meningioma, which involved the entire cavernous sinus and the internal carotid artery. A 53-year-old male presented with a 1-year history of progressing right-side complete oculomotor palsy and facial dysesthesia. The patient had previously undergone craniotomy for the right-side petroclival cavernous meningioma (Fig. 1A and B). Total 8 years after the first surgery, the remaining portion of the cavernous sinus grew up and extended into the posterior fossa (Fig. 1C). Then the second surgery was performed to resect only the posterior fossa component (Fig. 1D). However, the follow-up magnetic resonance imaging revealed an aggressive tumor regrowth in 2 years. The tumor occupied the right middle fossa with an extension to the posterior fossa and infratemporal fossa (Fig. 1E and F). We scheduled to perform gross total resection of the tumor through a combined transzygomatic transcavernous and extended middle fossa approach with preparation for vessel reconstruction. Mild adhesion between the tumor and the cavernous carotid artery facilitated complete resection of the intracavernous component of the tumor (Fig. 2A–C). Conclusion A combination of skull base approaches provides multidirectional operative corridors and wide exposure of the skull base lesions.The link to the video can be found at https://youtu.be/DB_WXFeyBvo.

Infiltration of the carotid artery by cavernous sinus meningioma

1994 ◽  
Vol 81 (2) ◽  
pp. 252-255 ◽  
Author(s):  
Mark J. Kotapka ◽  
Kamal K. Kalia ◽  
A. Julio Martinez ◽  
Laligam N. Sekhar
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Clinical Importance ◽  
Complete Removal ◽  
Artery Wall ◽  
Carotid Artery Wall ◽  
Content Type ◽  
Cavernous Sinus Meningioma ◽  
Tunica Muscularis ◽  
Fine Print

✓ Intracranial meningiomas are known to infiltrate surrounding structures such as the calvaria and dural sinuses, and the brain itself. The issue of whether meningiomas invade major intracranial arteries is of clinical importance, particularly in the case of meningiomas of the cavernous sinus. If a meningioma has not invaded the carotid artery wall, complete tumor removal may be accomplished with careful dissection from the carotid artery; however, if the tumor has infiltrated the wall of the carotid artery, complete removal may require sacrifice of the artery. To determine whether cavernous sinus meningiomas invade the carotid artery, the authors retrospectively reviewed the histopathology of 19 consecutively treated individuals whose carotid artery was sacrificed during removal of a meningioma involving the cavernous sinus. Patients were selected for carotid artery resection based on preoperative magnetic resonance imaging studies demonstrating complete encasement of the artery. Reconstruction of the carotid artery was planned depending on the results of preoperative balloon test occlusion with blood flow determinations. None of the 19 patients had pathological evidence of malignant tumor. Eight individuals (42%) were found to have infiltration of the carotid artery by meningioma. In five cases, focal involvement of the adventitia of the carotid artery wall was noted and, in three, the vessel was infiltrated up to the tunica muscularis. In no case was the tunica muscularis invaded by tumor. Thus, meningiomas of the cavernous sinus do infiltrate the internal carotid artery and, in order to completely resect these lesions and effect a surgical cure, it may be necessary to sacrifice the carotid artery with or without reconstruction.

scholarly journals Radiation-induced cavernous malformation after stereotactic radiosurgery for cavernous sinus meningioma: a case report

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Zuan Yu ◽  
Bin Huang ◽  
Risheng Liang
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Surgical Intervention ◽  
Cavernous Malformation ◽  
Surgical Removal ◽  
Case Presentation ◽  
Cavernous Sinus Meningioma ◽  
Radiation Induced ◽  
The Relationship

Abstract Background Radiation-induced cavernous malformation (RICM) is a rare sequela of stereotactic radiosurgery (SRS) treatment of intracranial tumors. To date, no study reported on RICM after SRS for meningiomas originating from the skull base. The relationship between locus of initial meningioma and RICM has not been studied. Case presentation A 57-year-old woman presented with persistent headaches and blepharoptosis at initial episode. MRI disclosed a right parasellar lesion, diagnosed as a cavernous sinus meningioma (CSM). After receiving a single-fractionated SRS, headache relieved, but blepharoptosis did not significantly improve. Three years and three months later, she returned with headaches and dizziness. MRI showed an enlarged CSM. Moreover, a new mass-like lesion, suspected hemangioma, appeared in the nearby right temporal lobe. After surgical removal of the new lesion and the CSM, the patient’s neurological symptoms significantly improved. Pathology confirmed CSM and temporal RICM. Conclusions We report the first rare case of RICM occurring after SRS for CSM. The RICM may be in the same region as the initial tumor. Surgical intervention was preferred for symptomatic RICM and initial meningioma. We recommend long-term regular followup MRIs for patients with meningioma after SRS treatment.

scholarly journals STA-MCA Bypass in Carotid Stenosis after Radiosurgery for Cavernous Sinus Meningioma

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2420
Author(s):  
Marco Vincenzo Corniola ◽  
Marton König ◽  
Torstein Ragnar Meling
Keyword(s):  
Cavernous Sinus ◽  
Internal Carotid ◽  
Vascular Complications ◽  
Tumor Control ◽  
Inclusion Criteria ◽  
Cavernous Sinus Meningioma ◽  
Radiation Induced ◽  
Meta Analyses ◽  
Ica Stenosis

Background: Cavernous sinus meningiomas (CSM) are mostly non-surgical tumors. Stereotactic radiosurgery (SRS) or radiotherapy (SRT) allow tumor control and improvement of pre-existing cranial nerve (CN) deficits. We report the case of a patient with radiation-induced internal carotid artery (ICA) stenosis. We complete the picture with a review of the literature of vascular and non-vascular complications following the treatment of CSMs with SRS or SRT. Methods: After a case description, a systematic literature review is presented, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2015 guidelines. Results: 115 abstracts were screened and 70 titles were retained for full-paper screening. A total of 58 articles did not meet the inclusion criteria. There were 12 articles included in our review, with a follow-up ranging from 33 to 120 months. Two cases of post-SRT ischemic stroke and one case of asymptomatic ICA stenosis were described. Non-vascular complications were reported in all articles. Conclusion: SRS and SRT carry fewer complications than open surgery, with similar rates of tumor control. Our case shows the importance of a follow-up of irradiated CSMs not only by a radio-oncologist, but also by a neurosurgeon, illustrating the importance of multidisciplinary management of CSMs.

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