Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management

Shrivastava, Raj; Sen, Chandranath; Costantino, Peter D.; Rocca, Robert Della

doi:10.3171/jns.2005.103.3.0491

Cited by 194 publications

(203 citation statements)

References 34 publications

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“…27,36,40,46 In a modern series of large (> 3 cm diameter) sphenocavernous meningiomas, Abdel-Aziz et al detailed a surgical strategy that involved tumor debulking with removal of tumor within the interdural lateral compartment of the cavernous sinus, with tumor remnant treated with adjunctive linear accelerator radiosurgery or fractionated radiotherapy, and found a 90% tumor control rate in those tumors treated with adjuvant radiation. 1 They also noted that the rate of recurrence was similar (at 6% in both patient subgroups) in subtotally resected tumors and those believed to be a microscopic GTR.…”

Section: Modern Multimodality Therapymentioning

confidence: 99%

“…However, many modern series of CSMs include meningiomas that likely arise from the dura of the sphenoid ridge, clinoid processes, petroclival region, or anterior skull base, and extend into, or infiltrate, the cavernous sinus. 1,46 Cavernous sinus meningiomas also may vary significantly in their degree of involvement, or invasion, of the sinus. Cavernous sinus meningiomas may grow within the plane of the "intradural" space, between the layers of cavernous sinus dura, without invading the cavernous sinus proper.…”

Section: Anatomymentioning

confidence: 99%

“…1,8,46 They classically arise from the dura of the cavernous sinus itself. However, many modern series of CSMs include meningiomas that likely arise from the dura of the sphenoid ridge, clinoid processes, petroclival region, or anterior skull base, and extend into, or infiltrate, the cavernous sinus.…”

Section: Anatomymentioning

confidence: 99%

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

Klinger

Flores

Lewis

et al. 2013

FOC

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Cavernous sinus meningiomas (CSMs) are challenging lesions for the skull base neurosurgeon to manage given their close association with cranial nerves II–VI and the internal carotid artery. In the 1980s and early 1990s, with advancements in microsurgical techniques, increasing knowledge of the relevant microsurgical neuroanatomy, and the advent of advanced skull base surgical approaches, the treatment of CSMs involved attempts at gross-total resection (GTR). Initial fervor for a surgical cure waned, however, as skull base neurosurgeons demonstrated the limits of complete resection in this region, the ongoing issue of potential tumor recurrences, and the unacceptably high cranial nerve and vascular morbidity associated with this strategy. The advent of radiosurgery and its documented success for tumor growth control and limited morbidity in cavernous lesions has helped to shift the treatment goals for CSMs from GTR to tumor control and symptom relief while minimizing treatment- and lesion-associated morbidity. The authors review the relevant microanatomy of the cavernous sinus with anatomical and radiographic correlates, as well as the various treatment options. A modernized, multimodality treatment algorithm to guide management of these lesions is proposed.

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Section: Modern Multimodality Therapymentioning

confidence: 99%

Section: Anatomymentioning

confidence: 99%

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

Klinger

Flores

Lewis

et al. 2013

FOC

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“…The development of complex neurosurgical approaches to the skull base and orbit as well as interdisciplinary operation teams including ophthalmic, otorhinolaryngological, and craniomaxillofacial surgeons led to a drop in morbidity rates while extent of resection increased. 12,27,28,31 However, even in these series, postoperative morbidity was reported to occur at least transiently in 30% 27 to 69% of patients. 28 Because extended skull base tumors involving bone, dura mater, and the orbital system are hard to adequately resect, recurrence rates are high.…”

Section: Discussionmentioning

confidence: 98%

Orbit-associated tumors: navigation and control of resection using intraoperative computed tomography

Terpolilli¹,

Rachinger²,

Kunz³

et al. 2016

JNS

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S kull base tumors with close anatomical association to orbit, optic nerve, and the cavernous sinus often cause neurological symptoms like loss of visual function and exophthalmus. In most cases resection (complete or partial removal) is the most promising and most effective therapeutic approach with regard to preservation or restoration of visual function. Furthermore, operative tumor removal or reduction is a crucial step in multidisciplinary operative as well as medical or radiotherapeutic treatment concepts, because it allows exact histological diagnosis and safe decompression of anatomical structures at risk. However, resection of these tumors is associated with increased perioperative morbidity due to the proximity of highly sensitive structures-e.g., cranial nerves abbreviatioNs CN = cranial nerve; iCT = intraoperative CT; iMRI = intraoperative MRI; NNS = neuronavigational system. obJective Treatment of skull base lesions is complex and usually requires a multidisciplinary approach. In meningioma, which is the most common tumor entity in this region, resection is considered to be the most important therapeutic step to avoid tumor recurrence. However, resection of skull base lesions with orbital or optic nerve involvement poses a challenge due to their anatomical structure and their proximity to eloquent areas. Therefore the main goal of surgery should be to achieve the maximum extent of resection while preserving neurological function. In the postoperative course, medical and radiotherapeutic strategies may then be successfully used to treat possible tumor residues. Methods to safely improve the extent of resection in skull base lesions therefore are desirable. The current study reports the authors' experience with the use of intraoperative CT (iCT) combined with neuronavigation with regard to feasibility and possible benefits of the method. methods Those patients with tumorous lesions in relationship to the orbit, sphenoid wing, or cavernous sinus who were surgically treated between October 2008 and December 2013 using iCT-based neuronavigation and in whom an intraoperative scan was obtained for control of resection were included. In all cases a second iCT scan was performed under sterile conditions after completion of navigation-guided microsurgical tumor resection. The surgical strategy was adapted accordingly; if necessary, resection was continued. results Twenty-three patients (19 with WHO Grade I meningioma and 4 with other lesions) were included. The most common clinical symptoms were loss of visual acuity and exophthalmus. Intraoperative control of resection by iCT was successfully obtained in all cases. Intraoperative imaging changed the surgical approach in more than half (52.2%) of these patients, either because iCT demonstrated unexpected residual tumor masses or because the second scan revealed additional tumor tissue that was not detected in the first scan due to overlay by osseous tumor parts; in these cases resection was continued. In the remaining cases resection was concluded as planned ...

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“…Orbital and frontoparietal regions are the most common locations of intradiploic meningioma [3]. Sphenoorbital meningiomas are intraosseous meningiomas at the base of the anterior and middle cranial fossa, involving the sphenoid wing and orbit associated with a intracranial carpet-like, soft tissue component [5,6]. In our case, the tumor located only in lateral orbital wall.…”

mentioning

confidence: 94%

Intradiploic Meningioma in the Lateral Orbital Wall: A Case Report

Shibata¹,

Osuka²,

Matsumura³

2012

J Cancer Ther Res

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Orbital wall tumor and intradiploic meningioma are rare tumors. Magnetic resonance imaging and nuclear medicine findings in the cases of orbital intradiploic meningioma have rarely been reported. A 46-year-old man presented with gradually appearing exophthalmos. MR and nuclear medicine findings revealed intradiploic tumor on the lateral orbital wall. The patient underwent total tumor resection and final pathological diagnosis was benign meningioma. This case highlights the importance of pathological conformation before performing extensive surgery. Thallium single-photon emission computed tomography is a valuable technique for distinguishing intradiploic benign meningioma from other malignant tumors.

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Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management

Cited by 194 publications

References 34 publications

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

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

Orbit-associated tumors: navigation and control of resection using intraoperative computed tomography

Intradiploic Meningioma in the Lateral Orbital Wall: A Case Report

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