Abstract
Cavernous sinus (CS) meningiomas which are by definition those meningiomas which originate from the parasellar region are difficult skull base tumors to deal with. For deciding the most appropriate surgical strategy, surgeons need detailed preoperative neuroimaging. The vicinity of the tumor with the vital and highly functional neurovascular structures, tumor extensions into the basal cisterns and skull base structures, and the arterial vascularization and venous drainage pathways, as they shape operative strategy, are important preoperative data to take into account. Thin section CT scan with bone windows, 3D spiral CT reconstruction, MRI, MR angiography, and DSA performed with selective arteriography including late venous phases give those required detailed informations about the tumor and its relation with neurovascular and bony structures. The type of craniotomy and complementary osteotomy and the usefulness of an extradural anterior clinoidectomy with unroofing the optic canal can be decided from preoperative neuroimaging. Data collected also help in determining whether extensive exposure of the middle cranial fossa is necessary to ensure substantial devascularization of the tumor and whether proximal control of the internal carotid artery (ICA) at its intrapetrosal portion might be useful. Study of the capacity of blood supply of the Willis circle is wise for deciding the need and way of performing an extra–intracranial bypass together with tumor removal. Currently the concept of operating only the tumors with extracavernous extensions and to limit resection to only their extracavernous portions is the most accepted way of treating these tumors. It was that strategy that was adopted in the senior author’s 220-patient series.
Radiosurgery or stereotactic fractionated radiotherapy may complement surgery or can be only reserved for growing remnants.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- CS:
-
Cavernous sinus
- CT:
-
Computed tomography
- DSA:
-
Digital subtraction angiography
- ICA:
-
Internal carotid artery
- MRI:
-
Magnetic resonance imaging
References
Alaywan M, Sindou M (1990) Fronto-temporal approach with orbito-zygomatic removal. Surgical anatomy. Acta Neurochir (Wien) 104:79–83
Alexiou GA, Gogou P, Markoula S, Kyritsis AP (2010) Management of meningiomas. Clin Neurol Neurosurg 112:177–182
Al-Mefty O, Smith RR (1988) Surgery of tumors invading the cavernous sinus. Surg Neurol 30:370–381
Alvernia JE, Sindou MP (2004) Preoperative neuroimaging findings as a predictor of the surgical plane of cleavage: prospective study of 100 consecutive cases of intracranial meningioma. J Neurosurg 100:422–430
Bouthillier A, van Loveren HR, Keller JT (1996) Segments of the internal carotid artery: a new classification. Neurosurgery 38:425–433
Bulsara KR, Patel T, Fukushima T (2008) Cerebral bypass surgery for skull base lesions: technical notes incorporating lessons learned over two decades. Neurosurg Focus 24:E11
Cusimano MD, Sekhar LN, Sen CN, Pomonis S, Wright DC, Biglan AW, Jannetta PJ (1995) The results of surgery for benign tumors of the cavernous sinus. Neurosurgery 37:1–10
De Jesús O, Sekhar LN, Parikh HK, Wright DC, Wagner DP (1996) Long-term follow-up of patients with meningiomas involving the cavernous sinus: recurrence, progression, and quality of life. Neurosurgery 39:915–920
DeMonte F, Smith HK, Al-Mefty O (1994) Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 81:245–251
Dolenc VV (1985) A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 62:667–672
Dolenc VV (2003) Microsurgical anatomy and surgery of the central skull base. Springer, Wien/New York
Dolenc VV (2008) Introduction: surgery of the central skull base. Neurosurg Focus 25:E1
Emery E, Alaywan M, Sindou M (1994) Respective indications of orbital and/or zygomatic arch removal combined with fronto-pteriono-temporal approaches. 58 cases (French). Neurochirurgie 40:337–347
Fukushima T (2009) Management of cavernous sinus lesions. In: Practical handbook of neurosurgery from leading neurosurgeons, vol 2. Springer, Wien/New York, pp 129–154
Guclu B, Sindou M (2010) Reconstruction of vein of Labbé in temporo-occipital meningioma invading transverse sinus: technical report. Acta Neurochir (Wien) 152:941–945
Jacob M, Wydh E, Vighetto A, Sindou M (2008) Visual outcome after surgery for cavernous sinus meningioma. Acta Neurochir (Wien) 150:421–429
Liu AL, Wang C, Sun S, Wang M, Liu P (2005) Gamma knife radiosurgery for tumors involving the cavernous sinus. Stereotact Funct Neurosurg 83:45–51
Maguire PD, Clough R, Friedman AH, Halperin EC (1999) Fractionated external-beam radiation therapy for meningiomas of the cavernous sinus. Int J Radiat Oncol Biol Phys 44:75–79
Maruyama K, Shin M, Kurita H, Kawahara N, Morita A, Kirino T (2004) Proposed treatment strategy for cavernous sinus meningiomas: a prospective study. Neurosurgery 55:1068–1075
Mathiesen T, Kihlström L (2006) Visual outcome of tuberculum sellae meningiomas after extradural optic nerve decompression. Neurosurgery 59:570–576
Nebbal M, Sindou M (2008) Imaging for the management of cavernous sinus meningiomas (French). Neurochirurgie 54:739–749
Otani N, Muroi C, Yano H, Khan N, Pangalu A, Yonekawa Y (2006) Surgical management of tuberculum sellae meningioma: role of selective extradural anterior clinoidectomy. Br J Neurosurg 20:129–138
Pamir MN, Kiliç T, Bayrakli F, Peker S (2005) Changing treatment strategy of cavernous sinus meningiomas: experience of a single institution. Surg Neurol 64:58–66
Pieper DR, Al-Mefty O, Hanada Y, Buechner D (1999) Hyperostosis associated with meningioma of the cranial base: secondary changes or tumor invasion. Neurosurgery 44:742–747
Regli L, Piepgras DG, Hansen KK (1995) Late patency of long saphenous vein bypass grafts to the anterior and posterior cerebral circulation. J Neurosurg 83:806–811
Samii M (1994) Skull base surgery. Karger, Basel
Sekhar LN, Altschuler E (1991) Meningiomas of the cavernous sinus. In: Al Mefti O (ed) Meningiomas. Raven Press Ltd, New York, pp 445–460
Shaffrey ME, Dolenc VV, Lanzino G, Wolcott WP, Shaffrey CI (1999) Invasion of the internal carotid artery by cavernous sinus meningiomas. Surg Neurol 52:167–171
Sindou M (1996) Cavernous sinus tumors: general introduction and presentation (French). Neurochirurgie 41:145–151
Sindou M (1996) Cavernous sinus tumors: general introduction and presentation (French). Neurochirurgie 41:208–236
Sindou M, Alaywan M (1990) Orbital and/or zygomatic removal in an approach to lesions near the cranial base. Surgical technic, anatomic study and analysis of a series of 24 cases (French). Neurochirurgie 36:225–233
Sindou M, Auque J (2000) The intracranial venous system as a neurosurgeon’s perspective. Adv Tech Stand Neurosurg 26:131–216
Sindou M, Auque J, Jouanneau E (2005) Neurosurgery and the intracranial venous system. Acta Neurochir Suppl 94:167–175
Sindou M, Emery E, Acevedo G, Ben-David U (2001) Respective indications for orbital rim, zygomatic arch and orbito-zygomatic osteotomies in the surgical approach to central skull base lesions. Critical, retrospective review in 146 cases. Acta Neurochir (Wien) 143:967–975
Sindou M, Messerer M, Alvernia J, Saint-Pierre G (2012) Percutaneous biopsy through the foramen ovale for parasellar lesions: surgical anatomy, method, and indications. Adv Tech Stand Neurosurg 38:57–73
Sindou M, Wydh E, Jouanneau E, Nebbal M, Lieutaud T (2007) Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone. J Neurosurg 107:937–944
Tulleken CA, van der Zwan A, Kappelle LJ (1999) High-flow transcranial bypass for prevention of brain ischemia (Dutch). Ned Tijdschr Geneeskd 143:2281–2285
Yonekawa Y, Ogata N, Imhof HG, Olivecrona M, Strommer K, Kwak TE, Roth P, Groscurth P (1997) Selective extradural anterior clinoidectomy for supra- and parasellar processes. Technical note. J Neurosurg 87:636–642
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Sindou, M., Nebbal, M., Guclu, B. (2015). Cavernous Sinus Meningiomas: Imaging and Surgical Strategy. In: Schramm, J. (eds) Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 42. Springer, Cham. https://doi.org/10.1007/978-3-319-09066-5_6
Download citation
DOI: https://doi.org/10.1007/978-3-319-09066-5_6
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-09065-8
Online ISBN: 978-3-319-09066-5
eBook Packages: MedicineMedicine (R0)