Infiltration of the carotid artery by cavernous sinus meningioma

Abstract

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.

PET/CT of Skull Base Meningiomas Using 2-18F-Fluoro-L-Tyrosine: Initial Report

“…One possible explanation for the larger tumor volume obtained with PET than with MRI may nonetheless stem from pathologic considerations. Indeed, careful histopathologic analyses have shown that, despite the benign nature of World Health Organization grade 1 meningiomas, tumoral cells may microscopically infiltrate surrounding tissue, such as vascular structures and cranial nerves (37,38). It is possible that the density of this infiltration is too low to be visualized on MR images but is sufficient to represent a focus of increased activity on PET images, thanks to the low background uptake.…”

Meningioma Manifesting as Cerebral Infarction -Case Report-

“…1,6,7,10) Intracranial arterial obstructions (narrowing or occlusion) associated with meningioma have been increasingly recognized in recent years, 9) and encasement and obstructions of the ICA at the level of the skull base are well known. 8,15) The ICA at the level of the skull base is adjacent to the bony structures and fixed with the dura Neurol Med Chir (Tokyo) 50, July, 2010…”

The treatment of cavernous sinus meningiomas: evolution of a modern approach

“…Histological studies of invasive CSMs that were resected within the cavernous sinus proper have demonstrated that these tumors may invade cranial nerves and the ICA wall itself. 25,26,43 These findings call into question the utility of microsurgically exploring the cavernous sinus proper if tumor control may be achieved with less invasive and less morbid means.…”