Strategy and Technique of Endonasal Endoscopic Bony Decompression and Selective Tumor Removal in Symptomatic Skull Base Meningiomas of the Cavernous Sinus and Meckel's Cave

Sivakumar, Walavan; Barkhoudarian, Garni; Lobo, Bjorn; Zhang, Xin; Zhao, Fan; Eisenberg, Amy; Kesari, Santosh; Krauss, H; Griffiths, Chester F; Wollman, Robert C.; Chaiken, Lisa; Kelly, Daniel F.

doi:10.1016/j.wneu.2019.06.073

Cited by 13 publications

(20 citation statements)

References 27 publications

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“…A more recent publication of the same group ( 11 ) demonstrated the results of endonasal bony decompression and partial tumor removal in 20 patients with parasellar and petroclival meningiomas. The authors divided their patient population in subgroups based on prior treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Different conservative surgical approaches with the goal of safe tumor debulking or simply CS decompression reported promising results in recovery and preservation of CSCN function (8)(9)(10)(11). Hence, the combination of a functional surgical decompression with adjuvant radiation therapy for tumor growth control appears to be an optimal management strategy for CS meningiomas (5,7).…”

Section: Introductionmentioning

confidence: 99%

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Improving Function in Cavernous Sinus Meningiomas: A Modern Treatment Algorithm

et al. 2020

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Background: The efficacy and safety of radiosurgery led to paradigm shift in the management of cavernous sinus meningiomas. Nevertheless, patients are still significantly affected by cranial nerve deficits related to the mass effect of these tumors. Our management strategy involves the combination of a functional surgical decompression followed by radiation therapy. Methods: We reviewed a single institution's cohort of patients who underwent endoscopic endonasal decompression (EED) for symptomatic meningiomas primarily involving the cavernous sinus (CS) from 2010 to 2016. The preoperative neuro-ophthalmological exam was compared to the 1- and 6-month postoperative exams. The patient's length of hospital stay, complications, and radiological and clinical follow-up were noted. Results: A total of 17 patients underwent EED for CS meningiomas that fit our radiological criteria. The final outcome at the 6-month visit showed five patients (62.5%) with normalization of deficit and three patients (37.5%) with partial improvement of the CNII deficit. Out of the 12 patients who had cavernous sinus cranial nerves (CSCN) deficits, the final outcome at the 6-month visit showed four patients (33.33%) with normalization of deficit, seven patients (58.3%) with partial improvement, and one patient (8.33%) with no improvement. There were no intraoperative complications. Conclusion: The EED for CS meningiomas is a valuable technique when addressing acute/subacute CNII and CSCN deficits. This conservative surgical approach showed good functional outcomes, low morbidity, and low complication rates. However, it does not exempt the need for radiosurgery/radiation therapy for control of tumor growth.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving Function in Cavernous Sinus Meningiomas: A Modern Treatment Algorithm

et al. 2020

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“…In summary, from these studies, we can conclude that a biopsy or planned partial tumor removal may be safely performed, coupled with bony decompression, to improve the visual symptoms and obtain a decompression of the cavernous sinus. Better results in terms of symptomatic improvement were obtained in the cohort of previously untreated patients [28] .…”

Section: Review Of Reported Surgical Seriesmentioning

confidence: 96%

“…This permits the performance of a precise bony decompression around the sella, the medial cavernous sinus, the optic canal, and, if necessary, of the clivus and Meckel's cave [17] . Furthermore, this approach allows the positioning of autograft fat between the tumor and radiosensitive structures for further treatments [28] .…”

Section: Surgical Techniquementioning

confidence: 99%

“…Table 2 shows in detail the surgical results and the final outcome. Nine series published between 2009 and 2020 gathered 106 patients in whom an endoscopic endonasal approach was performed for CS meningiomas [18,28,[30][31][32][33][34][35][36] . In most of cases, the aim was to perform a tissue biopsy and decompression of cranial nerves in the CS or optic nerve.…”

Section: Review Of Reported Surgical Seriesmentioning

confidence: 99%

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The role of endoscopy and radiosurgery in the management of cavernous sinus meningiomas

Cossu¹,

Abarca²,

Levivier³

et al. 2020

Mini-invasive Surg

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Cavernous sinus (CS) meningiomas represent a formidable neurosurgical pathology. The desired treatment depends on tumor size and extensions apart from the presenting clinical symptoms of the patient. The last few decades have shown a paradigm shift in the management towards a multimodal treatment. For patients with tumors presenting with a medial extension or when the meningioma occupies the antero-inferior portion of the CS, an endoscopic biopsy can be safely performed through the endonasal route. The boundaries of endoscopic endonasal approaches have been pushed during the last decade, and a direct access to the CS may now be performed. At the same time, an extensive bony decompression to decompress the optic canal and the pituitary gland may be performed. Autologous fat may be interposed between the residual tumor and radiosensitive structures to safely perform adjuvant radiation therapy. The aim of this manuscript is to describe the role of endoscopic surgery in the management of cavernous sinus meningiomas along with the complementary role of radiotherapy. We describe the endoscopic anatomy and the surgical technique to safely perform the procedure and we review the surgical series reported in the literature dealing with the endoscopic approach for CS meningiomas with or without complementary radiation therapy. Endoscopic endonasal approaches have shown promising results in terms of improvement or stabilization of cranial neuropathy and hypopituitarism. Furthermore, the endoscopic approach may enhance the efficacy and safety of stereotactic radiosurgery through the performance of an hypophysopexy and/or chiasmopexy.

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