Cavernous Sinus Meningioma Resection Through Orbitozygomatic Craniotomy.

Meningiomas of the cavernous sinus (CS) present a neurosurgical challenge. The anatomic complexity of the area can create a potential for injury to neurovascular structures. This has traditionally limited total tumor removal. A thorough understanding of the cavernous sinus surgical anatomy can help overcome this problem. Patients with CS meningiomas generally present with cranial nerve deficits (III-VI), proptosis, and visual disturbances. Management of CS tumors is controversial and includes observation, stereotactic radiosurgery, and surgical resection. We present the case of a 43-year-old right-handed male who presented with right facial numbness. A magnetic resonance imaging scan of the brain showed a right cavernous sinus tumor. He underwent stereotactic radiosurgery at an outside hospital. His facial numbness gradually improved. Four years later he had recurrence of the right facial numbness in the V3 distribution associated with right eyelid ptosis and diplopia. On neurologic examination he had decreased sensation to light touch in the 3 branches of the trigeminal nerve. He had a right eyelid ptosis and a 6-VI cranial nerve palsy. A new magnetic resonance imaging scan of the brain showed radiologic progression of the tumor. An orbitozygomatic craniotomy was performed and gross total tumor resection was achieved through lateral wall of the cavernous sinus working mainly between V2 and V3. The facial numbness he had preoperatively gradually improved, and his extraocular movements and eyelid ptosis recovered completely. Histopathology showed a clear cell grade 2 meningioma. The patient received adjuvant radiosurgery. At 3-year follow-up, the patient was free of disease recurrence. CS surgery for meningioma is feasible with low morbidity and can provide benefits in improving preexisting cranial nerve dysfunction (Video 1).1-4 Complete resection of the CS meningiomas is possible in most cases. CS tumors remain a surgical challenge, but accurate knowledge of surgical neuroanatomy and surgical approaches facilitates their safe and effective treatment. The patient gave informed consent for surgery, use of images, and video publication.

Najera E ，Muhsen BA ，Borghei-Razavi H ，Adada B ... -  《-》

Resection of Invasive Sphenoorbital and Cavernous Sinus Meningioma via Frontotemporal Craniotomy.

Sphenoorbital meningiomas require extensive bone removal around the superior and lateral orbital walls, superior orbital fissure, and anterior middle fossa floor. Incomplete resection can lead to recurrence or growth into the cavernous sinus (CS). A 46-year-old woman with a history of childhood leukemia treated with chemotherapy and whole-body radiotherapy had presented to an outside institution in 2004 with headache and vision changes and undergone subtotal resection for right sphenoorbital meningioma. Residual tumor growth caused progressive optic neuropathy, and she underwent multiple orbital decompressions and fractionated radiotherapy. In 2017, she underwent another craniotomy for repeat resection. Additional tumor growth causing neuropathic facial pain syndrome and progressive ophthalmoplegia was treated with orbital enucleation. On referral to our institution, magnetic resonance imaging demonstrated right sphenoorbital and CS meningioma extending into the sella and nearly to the medial border of the contralateral CS. Given her complete ophthalmoplegia and recent orbital enucleation, she underwent revision right frontotemporal craniotomy for radical resection of invasive meningioma, including right internal carotid artery occlusion and CS resection (Video 1). The skull-base defect was repaired with autologous fascia and a free muscle flap. Postoperative transient aphasia and left hemiparesis resolved over several days. At the 1-month follow-up examination, she was neurologically intact, with moderate improvement of facial pain syndrome (preoperative pain score, 9 of 10; postoperative pain score, 6 of 10). Magnetic resonance imaging demonstrated gross total resection. Pathological tissue analysis was consistent with grade 1 meningioma with an increased MIB-1 proliferative index, although, clinically, the tumor behaved more malignantly. The patient provided consent.

Cohen MA ，Cannon RB ，Couldwell WT 《-》

Outcomes of decompressive surgery for cavernous sinus meningiomas: long-term follow-up in 50 patients.

Gozal YM ，Alzhrani G ，Abou-Al-Shaar H ，Azab MA ，Walsh MT ，Couldwell WT ... -  《-》

Safe maximal resection of primary cavernous sinus meningiomas via a minimal anterior and posterior combined transpetrosal approach.

Morisako H ，Goto T ，Ohata H ，Goudihalli SR ，Shirosaka K ，Ohata K ... -  《Neurosurgical Focus》

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

Nanda A ，Thakur JD ，Sonig A ，Missios S ... -  《-》