scholarly journals Cavernous Sinus Chondromas

2018 ◽  
Vol 26 (3) ◽  
pp. 211-217
Author(s):  
Jonathan Polo Valdez ◽  
Ricardo Ramina ◽  
Luis Fernando Moura Da Silva Jr ◽  
Mauricio Coelho Neto
Keyword(s):  
Cavernous Sinus ◽  
Clinical Symptoms ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
The Body ◽  
Neurological Deficits ◽  
Surgical Approaches ◽  
Benign Tumors ◽  
Surgical Removal ◽  
Adequate Knowledge

Background: Chondromas are benign tumors with slow growth pattern that may develop along the body. Intracranial chondromas are rare, 0.1 to 0.3% of all intracranial tumors, usually in parasellar region. Few papers reported cavernous sinus chordomas. Case Description: We reported two cases of cavernous sinus chondromas. Two patients presented diplopia, one facial hypoesthesia and one presented extension to the petroclival region. Surgical approaches were frontotemporal combining presigmoid/middle fossa. Literature was reviewed concerning incidence, clinical symptoms, treatment and outcome. Both cases achieved complete tumor resection without postoperative complication. Preoperative deficits improved. Literature review confirms their rarity, clinical symptoms are related to deficits of cranial nerves passing through the cavernous sinus and cure can be achieved through radical surgical removal. Conclusion: Cavernous sinus chondromas are rare benign lesions with insidious growth. Adequate knowledge of cavernous sinus anatomy, microsurgical experience, intraoperative monitoring of cranial nerves and neuronavigation allows radical tumor removal with no additional neurological deficits.

scholarly journals Two-Stage Double Petrosal Approach for the Total Resection of Petroclival-Cavernous Meningioma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Emad Aboud ◽  
Walid Ibn Essayed ◽  
Ossama Al-Mefty
Keyword(s):  
Cavernous Sinus ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Transverse Sinus ◽  
Jugular Bulb ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Petroclival Meningiomas ◽  
Significant Extension ◽  
Anterior Petrosectomy

Abstract The utilization of skull base approaches has markedly facilitated the safe surgical removal of challenging petroclival meningiomas.1 The anterior petrosal approach has been utilized for tumors limited to the upper clivus, above the meatus, whereas the posterior petrosal approach has been the workhorse for the resection of larger tumors in the posterior fossa extending down the clivus.2 Giant cases with extension in the middle fossa, cavernous sinus, and ventral to the brain stem would benefit from a wider exposure than each of these approaches provide. This could be achieved by total petrosectomy. However, in patients with serviceable hearing anterior and posterior petrosals can be combined while preserving the hearing apparatus.2,3 This procedure is lengthy; hence, we tend to stage it in 2 subsequent days. The first stage is focused on the soft tissue and bone work including the mastoidectomy, sigmoid transverse sinus, and jugular bulb skeletonization, as well as anterior petrosectomy. The second stage is dedicated to tumor exposure through tentorial sectioning and microsurgical resection. We report the case of a 40-yr-old woman diagnosed with large left-sided petroclival meningioma with significant extension into the cavernous sinus and Meckel's cave. The patient had neurological deficits including cranial nerves, cerebellar dysfunction, and hydrocephalus, although her hearing was intact. Total tumor resection was achieved through the double petrosal approach in 2002. Extensive anatomic knowledge and thorough preoperative clinical and radiological evaluation, particularly the venous system, are key in the successful planning of this procedure. The patient consented for surgery and publication of their image.  Figures at 2:40 and 3:47, ©Ossama Al-Mefty, used with permission.

scholarly journals Extended Middle Fossa Approach for Trigeminal Schwannoma Resection

2021 ◽  
Author(s):  
Baha'eddin A. Muhsen ◽  
Edinson Najera ◽  
Hamid Borghei-Razavi ◽  
Badih Adada
Keyword(s):  
Cavernous Sinus ◽  
Brain Mri ◽  
Clinical Status ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Petrous Apex ◽  
Benign Tumors ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Trigeminal Schwannoma

AbstractTrigeminal schwannomas are rare benign tumors, it is second most common intracranial schwannomas after vestibular schwannomas. The management includes not limited to observation, stereotactic radiosurgery/radiotherapy, and/or surgical resection. Tumor size and patient clinical status are the most important factors in management.In this video, we describe the technical nuances of an extended middle fossa approach for large trigeminal schwannoma with cavernous sinus extension resection. A 44-year-old right-handed female with several months' history of progressive right facial paresthesia and pain in the distribution of V3 mainly. On physical examination, she had decreased sensation to light touch over the right V1 to V3 distribution with loss of cornel reflex. The brain MRI showed 3.5 cm bilobed mass extends from the pontine root entry zone to the cavernous sinus. Craniotomy was performed and followed by middle fossa dural peeling, peeling of temporal lobe dura away from the wall of the cavernous sinus, extradurally anterior clinoidectomy, drilling of the petrous apex, coagulation of superior petrosal sinus followed incision of the tentorium up to the tentorial notch with preservation the fourth cranial nerve, and tumor dissected away from V1 and then gradually removed from the superior wall of the cavernous sinus.The technique presented here allows for complete tumor resection, safe navigation through the relative cavernous sinus compartments, and minimizes the possibility of inadvertent injury to the cranial nerves.The postoperative course was uneventful except for right eye incomplete ptosis from the swelling. Her facial pain subsided after the surgery without any extra ocular movement impairment.The link to the video can be found at: https://youtu.be/zxi2XK2R9QU.

scholarly journals Large hibernoma of the neck: A case report

2019 ◽  
Vol 76 (3) ◽  
pp. 341-344
Author(s):  
Anton Mikic ◽  
Miljan Folic ◽  
Ivan Boricic ◽  
Nenad Arsovic
Keyword(s):  
Case Report ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
The Body ◽  
Preoperative Embolization ◽  
Surgical Removal ◽  
Histopathological Analysis ◽  
Illustrative Case ◽  
Brown Adipose ◽  
Supraclavicular Fossa

Introduction. A hibernoma is a rare benign tumor derived from vestigial remnants of brown adipose tissue. In neonates this tissue makes up about 5% of the body mass and its amount greatly decreases after birth, persisting only in scattered subcutaneous areas. In rare cases, brown fat continues to grow leading to a hibernoma that may be located in the head and neck. We present an illustrative case of a large hibernoma of the neck with infraclavicular extension and discuss about diagnostic and treatment difficulties. Case report. A 29-year-old male presented with large, slowly progressive, painless neck mass that was noticed 6 months earlier. Computed tomography (CT) and magnetic resonance (MR) showed a well-vascularized, soft tissue tumor of the lateral region of the neck and supraclavicular fossa with extension below clavicle. Treatment included arterial embolization followed by challenging surgical removal of the tumor. Dissection was performed at III, IV and V levels of the neck, making complete resection possible without the tumor fragmentation or major blood vessels and cranial nerves injuries. The final diagnosis of the hibernoma was made by histopathological analysis. The patient had no signs of recurrence during three-year follow-up. Conclusion. Although the CT scan and MR may raise the suspicion, hibernoma is definitely diagnosed by a pathologist. It is very important to exclude the malignant processes, foremost liposarcoma. The tumor fragmentation during surgery should be avoided because the high vascularity of the tumor tissue carries a substantial risk for hemorrhage. Our experience with preoperative embolization and complete tumor resection in this case showed positive impact on the final outcome.

Gamma Knife Radiosurgery for the Treatment of Cavernous Sinus Meningiomas

Neurosurgery ◽  
2003 ◽  
Vol 52 (3) ◽  
pp. 517-524 ◽  
Author(s):  
Yoshiyasu Iwai ◽  
Kazuhiro Yamanaka ◽  
Tomoya Ishiguro
Keyword(s):  
Tumor Growth ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Tumor Regression ◽  
Gamma Knife Radiosurgery ◽  
Growth Control ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Tumor Diameter

Abstract OBJECTIVE We report on the efficacy of gamma knife radiosurgery for cavernous sinus meningiomas. METHODS Between January 1994 and December 1999, we used gamma knife radiosurgery for the treatment of 43 patients with cavernous sinus meningiomas. Forty-two patients were followed up for a mean of 49.4 months (range, 18–84 mo). The patients' average age was 55 years (range, 18–81 yr). Twenty-two patients (52%) underwent operations before radiosurgery, and 20 patients (48%) underwent radiosurgery after the diagnosis was made by magnetic resonance imaging. The tumor volumes ranged from 1.2 to 101.5 cm3 (mean, 14.7 cm3). The tumors either compressed or were attached to the optic apparatus in 17 patients (40.5%). The marginal radiation dose was 8 to 15 Gy (mean, 11 Gy), and the optic apparatus was irradiated with 2 to 12 Gy (mean, 6.2 Gy). Three patients with a mean tumor diameter greater than 4 cm were treated by two-stage radiosurgery. RESULTS Thirty-eight patients (90.5%) demonstrated tumor growth control during the follow-up period after radiosurgery. Tumor regression was observed in 25 patients (59.5%), and growth was unchanged in 13 patients (31%). Regrowth or recurrence occurred in four patients (9.5%). The actual tumor growth control rate at 5 years was 92%. Only one patient (2.4%) experienced regrowth within the treatment field; in other patients, regrowth occurred at sites peripheral to or outside the treatment field. Twelve patients (28.6%) had improved clinically by the time of the follow-up examination. None of the patients experienced optic neuropathy caused by radiation injury or any new neurological deficits after radiosurgery. CONCLUSION Gamma knife radiosurgery may be a useful option for the treatment of cavernous sinus meningiomas not only as an adjuvant to surgery but also as an alternative to surgical removal. We have shown it to be safe and effective even in tumors that adhere to or are in close proximity to the optic apparatus.

Microsurgical Resection of Recurrent Cavernous Sinus Hemangioma by Superior and Lateral Approach: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E165-E166
Author(s):  
Qazi Zeeshan ◽  
Juan P Carrasco Hernandez ◽  
Michael K Moore ◽  
Laligam N Sekhar
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Cavernous Sinus ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Brain Magnetic Resonance Imaging ◽  
Mass Effect ◽  
Lateral Approach ◽  
Microsurgical Resection ◽  
The Right

Abstract This video shows the technical nuances of microsurgical resection of recurrent cavernous sinus (CS) hemangioma by superior and lateral approach.  A 77-yr-old woman presented with headache and difficulty in vision in right eye for 6 mo. She had previously undergone attempted resection of a right CS tumor in another hospital with partial removal, and the tumor had grown significantly. Neurological examination revealed proptosis, cranial nerve 3 palsy, and loss of vision in right eye (20/200). Left side visual acuity was 20/20.  Brain magnetic resonance imaging (MRI) demonstrated a large CS mass with homogeneous enhancement, measuring 3.3 × 3.3 × 2.6 cm, extending into the suprasellar cistern with mass effect on the right optic nerve. It extended anteriorly to the region of the right orbital apex and abuted the basilar artery posteriorly.  She underwent right frontotemporal craniotomy, posterolateral orbitotomy and anterior clinoidectomy as well as optic nerve decompression, and the CS tumor was removed by superior and lateral approach. An incision was made into the superior wall of the CS medial to the third nerve. On lateral aspect the tumor had extended outside the CS through the Parkinson's triangle. Posteriorly it extended through the clival dura. Anteriorly tumor encased the carotid artery and it was gradually dissected away. At the end of the operation, all of the cranial nerves were intact.  Postoperative MRI showed near complete tumor resection with preservation of the internal carotid artery. At 6 mo follow-up her modified Rankin Scale was 1 and vision in left eye was normal.  Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

Extended transsphenoidal approach for pituitary adenomas invading the anterior cranial base, cavernous sinus, and clivus: a single-center experience with 126 consecutive cases

2010 ◽  
Vol 112 (1) ◽  
pp. 108-117 ◽  
Author(s):  
Bing Zhao ◽  
Yu-Kui Wei ◽  
Gui-Lin Li ◽  
Yong-Ning Li ◽  
Yong Yao ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Tumor Resection ◽  
Cranial Base ◽  
Transsphenoidal Approach ◽  
Preoperative Imaging ◽  
Surgical Removal ◽  
Extended Transsphenoidal Approach ◽  
Anterior Cranial Base

Object The standard transsphenoidal approach has been successfully used to resect most pituitary adenomas. However, as a result of the limited exposure provided by this procedure, complete surgical removal of pituitary adenomas with parasellar or retrosellar extension remains problematic. By additional bone removal of the cranial base, the extended transsphenoidal approach provides better exposure to the parasellar and clival region compared with the standard approach. The authors describe their surgical experience with the extended transsphenoidal approach to remove pituitary adenomas invading the anterior cranial base, cavernous sinus (CS), and clivus. Methods Retrospective analysis was performed in 126 patients with pituitary adenomas that were surgically treated via the extended transsphenoidal approach between September 1999 and March 2008. There were 55 male and 71 female patients with a mean age of 43.4 years (range 12–75 years). There were 82 cases of macroadenoma and 44 cases of giant adenoma. Results Gross-total resection was achieved in 78 patients (61.9%), subtotal resection in 43 (34.1%), and partial resection in 5 (4%). Postoperative complications included transient cerebrospinal rhinorrhea (7 cases), incomplete cranial nerve palsy (5), panhypopituitarism (5), internal carotid artery injury (2), monocular blindness (2), permanent diabetes insipidus (1), and perforation of the nasal septum (2). No intraoperative or postoperative death was observed. Conclusions The extended transsphenoidal approach provides excellent exposure to pituitary adenomas invading the anterior cranial base, CS, and clivus. This approach enhances the degree of tumor resection and keeps postoperative complications relatively low. However, radical resection of tumors that are firm, highly invasive to the CS, or invading multidirectionally remains a big challenge. This procedure not only allows better visualization of the tumor and the neurovascular structures but also provides significant working space under the microscope, which facilitates intraoperative manipulation. Preoperative imaging studies and new techniques such as the neuronavigation system and the endoscope improve the efficacy and safety of tumor resection.

scholarly journals Surgery of petroclival meningiomas. Recent surgical results and outcomes

2015 ◽  
Vol 22 (1) ◽  
pp. 27-37
Author(s):  
Mugurel Radoi ◽  
Florin Stefanescu ◽  
Ram Vakilnejad ◽  
Lidia Gheorghitescu ◽  
Daniela Rosu
Keyword(s):  
Tumor Resection ◽  
Cranial Nerves ◽  
Surgical Approaches ◽  
Subtotal Resection ◽  
Recent Experience ◽  
Surgical Results ◽  
Petroclival Meningiomas ◽  
Microsurgical Techniques ◽  
Postoperative Hydrocephalus ◽  
Loss Of Hearing

Abstract Petroclival meningiomas represent only 10% of all meningiomas located in the posterior fossa, but are some of the most formidable challenges in skull base surgery. We described our recent experience (2005-September2014) regarding the surgery of these tumors. We retrospectively analyzed surgical results and outcome in 11 cases of petroclival meningiomas. Most common symptoms in our series were headache and gait disturbance, while cranial nerves palsies represented the most common presenting signs. There were 8 females and 3 males, and the mean age was 52 years. Surgical approaches chosen for petroclival meningiomas in our series were retrosigmoid (9 patients) and subtemporal transtentorial (2 patients). We achieved total tumor resection in 5 cases (45%) and subtotal resection in 6 cases (55%). Overall outcome (total/subtotal resection) was good in 6 cases, fair in 3 cases and poor in one case. One postoperative death occurred due to hemorrhagic midbrain infarction (9%). Complications were usually related to cranial nerve deficits: loss of hearing (2 patients), paresis of trochlear nerve (1 patient), trigeminal nerve (3 patients) and facial nerve (1 patient). In 4 patients these cranial nerves deficits were transient. In one case, a patient developed postoperative hydrocephalus and needed shunt placement. Despite the fact that complications can be disastrous, we considered that an appropriate approach, combined with microsurgical techniques and a better understanding of the anatomy, greatly decrease the incidence and severity of complications and make feasible a total tumor resection.

Neurinoma in the Cavernous Sinus: Report of Two Cases

Neurosurgery ◽  
1990 ◽  
Vol 27 (6) ◽  
pp. 986-990 ◽  
Author(s):  
Tooru Inoue ◽  
Masashi Fukui ◽  
Toshio Matsushima ◽  
Kanehiro Hasuo ◽  
Masayuki Matsunaga
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cavernous Sinus ◽  
Lateral Approach ◽  
Neurological Deficits ◽  
Surgical Approaches ◽  
Resonance Imaging ◽  
Accurate Localization ◽  
Trigeminal Neurinoma ◽  
Superior Approach

Abstract Two cases of trigeminal neurinoma located solely in the cavernous sinus are reported. Preoperatively, magnetic resonance imaging provided the accurate localization of the lesions, allowing precise planning of the surgical approach, that is, a subtemporal lateral approach and a pterional superior approach, respectively. The neurinomas inside the cavernous sinus were removed successfully, and the patients developed no new neurological deficits except for anesthesia in the 1st division of the trigeminal nerve. The characteristic magnetic resonance imaging findings of trigeminal neurinoma in the cavernous sinus are presented, and the different surgical approaches are discussed.

scholarly journals Surgery in tumors of the lateral ventricles – last 8 years experience

2014 ◽  
Vol 21 (1) ◽  
pp. 61-73
Author(s):  
Mugurel Radoi ◽  
Leon Danaila ◽  
Florin Stefanescu ◽  
Daniel Petrescu ◽  
Ram Vakilnejad
Keyword(s):  
Lateral Ventricle ◽  
Clinical Symptoms ◽  
Postoperative Radiotherapy ◽  
Tumor Resection ◽  
Choroid Plexus Papilloma ◽  
Neurological Deficits ◽  
Subtotal Resection ◽  
Transcallosal Approach ◽  
Ventriculoperitoneal Shunting ◽  
Transcortical Approach

Abstract Introduction: Tumors of the lateral ventricle are rare lesions including a large variety of benign or malignant tumors. These tumors could originate in the ventricular wall or arising and expanding within the lateral ventricle from the surrounding neural structures. The purpose of this study is to discuss postoperative results and factors that affected the preference for transcallosal or transcortical approach. Material and methods : We performed a retrospective study, lasted between 2005- 2013, that comprised 26 consecutive patients who underwent operation for lateral ventricle tumors. The main clinical symptoms and signs were associated with the localization and size of the tumors. Cerebral computed tomography and magnetic resonance imaging were used to determine the location and expansion of each tumor. The transcortical approach was used in 17 patients and the transcallosal approach was used in 9 patients. Results : Total tumor resection was achieved in 73% of cases (19 patients). Most frequent histological tumor’s type was glioblastoma, choroid plexus papilloma, ependymoma and meningioma. Signs of increased intracranial pressure were most dominant. One patient died because of postoperative intraventricular hemorrhage. Additional neurological deficits were seen in 3 patients and postoperative seizure occurred in three patients. One patient with preoperative hydrocephalus required ventriculoperitoneal shunting after tumor’s resection. Two patients developed postoperative epidural hematoma and one required reoperation. 15 of 26 patients received postoperative radiotherapy and 6 of them received adjuvant chemotherapy. The mean duration of postoperative evaluation was 24,32 (range 5-92). Excepting the cases with subtotal resection, two patients were reoperated for recurrences. Conclusions : The nature, size, location and vascularization of intraventricular tumors are the most important elements influencing the choice of surgical approach. Surgeons must evaluate all these factors and prefer the short and safe way to remove the tumor.

scholarly journals Endoscopic endonasal transcavernous approach for invasive corticotroph pituitary adenoma

2020 ◽  
Vol 2 (2) ◽  
pp. V2
Author(s):  
Ming-Ying Lan ◽  
Wei-Hsin Wang
Keyword(s):  
Cavernous Sinus ◽  
Diagnostic Tests ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Surgical Anatomy ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Cavernous Sinus Invasion ◽  
The Right

This is a 37-year-old woman who presented with weight gain, a moon-shaped face, and muscle weakness for 4 months. Cushing’s disease was confirmed after a series of diagnostic tests. MRI demonstrated a pituitary macroadenoma with right cavernous sinus invasion and encasement of the right ICA. An endoscopic endonasal approach was performed, and gross-total resection could be achieved without injury of the cranial nerves. The Cushing’s syndrome improved gradually after the surgery. Histopathology revealed a corticotroph adenoma. In this surgical video, we demonstrate the strategies of tumor resection according to a surgical anatomy-based classification of the cavernous sinus from an endonasal perspective.The video can be found here: https://youtu.be/aNXFRdGfjpI.

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