1
|
Baucher G, Troude L, Olory-Togbe R, Roche PH. Extradural disconnection of the cavernous sinus with preservation of the internal carotid artery: indication and technique. Acta Neurochir (Wien) 2023; 165:2951-2956. [PMID: 36971846 DOI: 10.1007/s00701-023-05562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Extradural disconnection of the cavernous sinus (CS) with preservation of the internal carotid artery (ICA) is indicated for aggressive and recurrent tumors, in patients presenting loss of oculomotor function and non-functional circle of Willis. METHOD Extradural resection of the anterior clinoid process disconnects the CS anteriorly. The ICA is dissected in the foramen lacerum via extradural subtemporal approach. The intracavernous tumor is split and removed following the ICA. Bleeding control of the inferior and superior petrosal and intercavernous sinuses completes posterior CS disconnection. CONCLUSION This technique can be proposed for recurrent CS tumors and need of ICA preservation.
Collapse
Affiliation(s)
- Guillaume Baucher
- AP-HM, Hôpital Universitaire Nord, Neurochirurgie adulte, Chemin des Bourrely , 13015, Marseille, France.
| | - Lucas Troude
- AP-HM, Hôpital Universitaire Nord, Neurochirurgie adulte, Chemin des Bourrely , 13015, Marseille, France
| | - Régis Olory-Togbe
- AP-HM, Hôpital Universitaire Nord, Neurochirurgie adulte, Chemin des Bourrely , 13015, Marseille, France
| | - Pierre-Hugues Roche
- AP-HM, Hôpital Universitaire Nord, Neurochirurgie adulte, Chemin des Bourrely , 13015, Marseille, France
| |
Collapse
|
2
|
Basak AT, Ozbek MA. Single-Fraction Gamma-Knife Radiosurgery with or without Previous Surgery for Cavernous Sinus Meningiomas: A Single-Center Experience and Systematic Literature Review. Niger J Clin Pract 2023; 26:545-551. [PMID: 37357468 DOI: 10.4103/njcp.njcp_2033_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Background The most effective treatment method for meningiomas is surgical treatment. However, complete resection of cavernous sinus meningiomas is quite difficult. The biggest reasons for this are; narrow surgical corridor, the optic chiasm is the close relationship between the cranial nerves and anterior cerebral and internal carotid arteries. Gamma knife radiosurgery (GKRS) may be a good option in these lesions with high mortality and morbidity. Aim This study aimed to evaluate and compare the early effects at a mean of 6 months and 3 years and outcomes between surgery followed by gamma knife radiosurgery (GKRS) and GKRS alone for cavernous sinus meningiomas. Methods We included 20 patients with cavernous sinus meningioma treated via single fraction Leksell Gamma Knife Perfexion (Elekta Instruments; Stockholm, Sweden) between 2015 and 2018. The mean age of the patients was 54.95 (range: 32-77) years. Nine patients underwent primary surgery (for the resection of extracavernous components of the tumor) followed by GKRS (for the resection of intracavernous components of the tumor) (group A). Meanwhile, 11 patients were managed with GKRS alone (group B). The tumor volume ranged from 2.8 to 32.8 (mean: 14.76) cm3 and the isodose to the tumor margin from 10 to 13.5 (mean: 11.65) Gy. Results In total, 20 patients were followed up at a mean time of 18.95 (range: 6-36) months. The mean Karnofsky Performance Score of the patients was 95.2%. The mean follow up times of groups A and B were 23.6 and 15 months, respectively. Meanwhile, only patients with a follow up time of at least 6 months were included in the study. The mean follow up time after GKRS in group A was 17.6 months. There was no change in the tumor volume in 15% of patients. In the remaining cases, the tumor volume decreased. The mean tumor regression rates were 82.2% in Group A and 17.7% in Group B. The tumor volume did not decrease in three patients (n = 1, group A and n = 2, group B). Cranial nerve deficits improved, worsened, and remained stable in 46.6%, 26.6%, and 26.6% of cases, respectively. The temporary morbidity rate was 10%. In group A, transient postoperative diabetes insipidus was observed in one patient and atelectasis in another. None of these complications affected the final status of patients. The mortality rate after treatment was 0%. Conclusion Volume staged GKRS is safe and effective for cavernous sinus meningioma. GKRS is effective for long term tumor growth control and has a low complication rate. Hence, it is the preferred management strategy for tumors with a suitable volume (average tumor diameter: 3 cm or volume: 10 cm3 ). In tumors with a volume of more than 10 mL and/or without a 3 mm safety margin with the optical system, it is recommended to prepare for radiosurgery by cytoreducing the tumor volume surgically. Based on our opinion, the best results were obtained by GKRS to the intracavernous.
Collapse
Affiliation(s)
- A T Basak
- Department of Neurosurgery, American Hospital, Istanbul, Turkey
| | - M A Ozbek
- Department of Neurosurgery, Istanbul Medipol University, Istanbul, Turkey
| |
Collapse
|
3
|
Westphal M, Saladino A, Tatagiba M. Skull Base Meningiomas. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1416:47-68. [PMID: 37432619 DOI: 10.1007/978-3-031-29750-2_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Skull base meningiomas are among the most challenging meningiomas to treat clinically due to their deep location, involvement or encasement of adjacent essential neurovascular structures (such as key arteries, cranial nerves, veins, and venous sinuses), and their often-large size prior to diagnosis. Although multimodal treatment strategies continue to evolve with advances in stereotactic and fractionated radiotherapy, surgical resection remains the mainstay of treatment for these tumors. Resection of these tumors however is challenging from a technical standpoint, and requires expertise in several skull-base surgical approaches that rely on adequate bony removal, minimization of brain retraction, and respect for nearby neurovascular structures. These skull base meningiomas originate from a variety of different structures including, but are not limited to: the clinoid processes, tuberculum sellae, dorsum sellae, sphenoid wing, petrous/petroclival area, falcotentorial region, cerebellopontine angle, and foramen magnum. In this chapter, we will cover the common anatomical areas in the skull base from which these tumors arise, and the specific or optimal surgical approaches and other treatment modalities for meningiomas in these such locations.
Collapse
Affiliation(s)
- Manfred Westphal
- Department of Neurological Surgery, UK Eppendorf, Hamburg, Germany.
| | - Andrea Saladino
- Department of Neurological Surgery, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| |
Collapse
|
4
|
González-Darder JM, Capilla-Guasch P. Microsurgical technique for en bloc anatomical exenteration of cavernous sinus compartment to treat invasive meningioma. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
5
|
Corniola MV, Roche PH, Bruneau M, Cavallo LM, Daniel RT, Messerer M, Froelich S, Gardner PA, Gentili F, Kawase T, Paraskevopoulos D, Régis J, Schroeder HW, Schwartz TH, Sindou M, Cornelius JF, Tatagiba M, Meling TR. Management of cavernous sinus meningiomas: Consensus statement on behalf of the EANS skull base section. BRAIN AND SPINE 2022; 2:100864. [PMID: 36248124 PMCID: PMC9560706 DOI: 10.1016/j.bas.2022.100864] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/08/2022] [Accepted: 01/16/2022] [Indexed: 01/04/2023]
Abstract
Introduction The evolution of cavernous sinus meningiomas (CSMs) might be unpredictable and the efficacy of their treatments is challenging due to their indolent evolution, variations and fluctuations of symptoms, heterogeneity of classifications and lack of randomized controlled trials. Here, a dedicated task force provides a consensus statement on the overall management of CSMs. Research question To determine the best overall management of CSMs, depending on their clinical presentation, size, and evolution as well as patient characteristics. Material and methods Using the PRISMA 2020 guidelines, we included literature from January 2000 to December 2020. A total of 400 abstracts and 77 titles were kept for full-paper screening. Results The task force formulated 8 recommendations (Level C evidence). CSMs should be managed by a highly specialized multidisciplinary team. The initial evaluation of patients includes clinical, ophthalmological, endocrinological and radiological assessment. Treatment of CSM should involve experienced skull-base neurosurgeons or neuro-radiosurgeons, radiation oncologists, radiologists, ophthalmologists, and endocrinologists. Discussion and conclusion Radiosurgery is preferred as first-line treatment in small, enclosed, pauci-symptomatic lesions/in elderly patients, while large CSMs not amenable to resection or WHO grade II-III are candidates for radiotherapy. Microsurgery is an option in aggressive/rapidly progressing lesions in young patients presenting with oculomotor/visual/endocrinological impairment. Whenever surgery is offered, open cranial approaches are the current standard. There is limited experience reported about endoscopic endonasal approach for CSMs and the main indication is decompression of the cavernous sinus to improve symptoms. Whenever surgery is indicated, the current trend is to offer decompression followed by radiosurgery. A thorough evaluation of cavernous sinus meningiomas by a multidisciplinary team is mandatory. Microsurgery should be considered for aggressive lesions in young patients. Extended endoscopic approaches can be effective when combined with radiotherapy. Stereotaxic radiotherapy and stereotaxic radiosurgery offer excellent tumour control in small/asymptomatic lesions .
Collapse
|
6
|
Yong M, Wu YQ, Su S, Hanna E, Prisman E, Thamboo A, Walgama E. The effect of prior radiation on the success of ventral skull base reconstruction: A systematic review and meta-analysis. Head Neck 2021; 43:2795-2806. [PMID: 33973680 DOI: 10.1002/hed.26709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/07/2021] [Indexed: 11/08/2022] Open
Abstract
The incidence of cerebrospinal fluid leak after ventral skull base reconstruction is a primary outcome of interest to skull base surgeons. Exposure to pre-operative radiation may put patients at an increased risk of skull base reconstructive failure. A systematic search identified studies which included patients receiving ventral skull base reconstruction in the setting of pre-operative radiation. A meta-analysis using a random effects model was conducted to estimate an odds ratio of cerebrospinal fluid (CSF) leak in patients exposed to pre-operative radiation. A meta-analysis of 13 studies demonstrated that the odds ratio of CSF leak was 1.73 (95% CI 0.98-3.05). The majority of studies (77%) used vascularized tissue grafts for reconstruction. We identified an increased incidence of CSF leak among patients undergoing ventral skull base reconstruction after prior radiation therapy, although not of statistical significance. Skull base surgeons should exercise caution when planning reconstruction in this population.
Collapse
Affiliation(s)
- Michael Yong
- Division of Otolaryngology - Head and Neck Surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Yu Qi Wu
- Division of Otolaryngology - Head and Neck Surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Shirley Su
- Department of Otolaryngology - Head & Neck Surgery, M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ehab Hanna
- Department of Otolaryngology - Head & Neck Surgery, M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Eitan Prisman
- Division of Otolaryngology - Head and Neck Surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Andrew Thamboo
- Division of Otolaryngology - Head and Neck Surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Evan Walgama
- Department of Otolaryngology - Head & Neck Surgery, M. D. Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
7
|
Raheja A, Couldwell WT. Cavernous Sinus Meningioma with Orbital Involvement: Algorithmic Decision-Making and Treatment Strategy. Skull Base Surg 2020; 81:348-356. [PMID: 33072476 DOI: 10.1055/s-0040-1715471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cavernous sinus meningioma (CSM) with orbital involvement presents a unique challenge to modern-day neurosurgeons. In the modern era of preventive medicine with enhanced screening tools, physicians encounter CSM more frequently. An indolent natural history, late clinical presentation, close proximity to vital neurovascular structures, poor tumor-to-normal tissue interface, and high risk of iatrogenic morbidity and mortality with aggressive resection add to the complexity of decision-making and optimal management of these lesions. The clinical dilemma of deciding whether to observe or intervene first for asymptomatic lesions remains an enigma in current practice. The concepts of management for CSM with orbital involvement have gradually evolved from radical resection to a more conservative surgical approach with maximal safe resection, with the specific goals of preserving function and reducing proptosis. This change in surgical attitude has enabled better long-term functional outcomes with conservative approaches as compared with functionally disabled outcomes resulting from the pursuit of anatomical cure from disease with radical resection. The advent of stereotactic radiosurgery as an adjunct tool to treat residual CSM has greatly shaped our resection principles and planning. Interdisciplinary collaboration for multimodality management is key to successful management of these difficult to treat lesions and tailor management as per individual's requirement.
Collapse
Affiliation(s)
- Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
| |
Collapse
|
8
|
Abstract
Cavernous sinus meningioma (CSM) presents a management challenge to present-day neurosurgeons. Lack of adequate understanding of the natural history of these lesions, the early involvement of vital neurovascular structures, the absence of clear tissue planes with normal surrounding structures, and a high rate of aggressive surgery-related morbidity each pose management dilemmas for neurosurgeons. Over the past few decades, the enthusiasm of the neurosurgical community has shifted from aggressive microsurgical resection to maximal safe resection and institution of adjuvant radiotherapy, if necessary. This paradigm shift has ensured better functional outcome in treated patients. This chapter has been designed to discuss the current treatment algorithm and the importance of multimodality management for optimal outcome in patients with CSM. The technical aspects of this approach to management are presented, and the various treatment options are compared.
Collapse
Affiliation(s)
- Amol Raheja
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States.
| |
Collapse
|
9
|
Fukuhara N, Tsuruta W, Hosoo H, Sato M, Matsumaru Y, Yamaguchi-Okada M, Yoshino M, Hara T, Yamada S, Nishioka H. Magnetic Resonance Angiography-based Prediction of the Results of Balloon Test Occlusion. Neurol Med Chir (Tokyo) 2019; 59:384-391. [PMID: 31353325 PMCID: PMC6796060 DOI: 10.2176/nmc.oa.2019-0070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Precautious balloon test occlusion (BTO) is sometimes performed in cases of high-risk intraoperative internal carotid artery injury. We investigated whether magnetic resonance angiography (MRA) findings could predict BTO results to thus avoid the use of precautious BTO. This retrospective study, included 96 patients who underwent BTO, eight of whom underwent bilateral BTO. The relationship between the BTO results for 104 internal carotid arteries and the MRA findings obtained in 96 patients were retrospectively evaluated. On MRA, anterior cerebral artery (A1)–anterior communicating artery–A1 was defined as anterior collateral circulation (ACC), and posterior cerebral artery–posterior communicating artery was defined as posterior collateral circulation (PCC). BTO was tolerated in all 27 sides with thick ACC regardless of PCC thickness. In 31 of 44 cases with a thin ACC, the tested sides were BTO-tolerant (70.5%). Of these 44 tested sides, all five with a thick PCC were BTO-tolerant, but eight with a thin PCC and 31 with an invisible PCC showed results other than tolerance. Among cases with an invisible ACC, 10 of 33 tested sides were BTO-tolerant (30.3%). Among these 33 tested sides, outcomes other than tolerance were observed regardless of PCC thickness. Thick, thin, and invisible ACCs were assigned 3, 1, and 0 points, respectively; and thick, thin, and invisible PCCs were assigned 2, 1, and 0 points, respectively. A sum of 3 points in the ACC and PCC indicated that all sides were BTO-tolerant. In conclusion, a thick ACC or a thin ACC with a thick PCC indicates BTO-tolerance. The BTO prediction score is useful for predicting results of BTO.
Collapse
Affiliation(s)
- Noriaki Fukuhara
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital.,Department of Comprehensive Pathology, Tokyo Medical and Dental University.,Okinaka Memorial Institute for Medical Research
| | - Wataro Tsuruta
- Okinaka Memorial Institute for Medical Research.,Department of Neuro-Endovascular Therapy, Toranomon Hospital
| | - Hisayuki Hosoo
- Department of Neuro-Endovascular Therapy, Toranomon Hospital
| | - Masayuki Sato
- Division of Stroke, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Yuji Matsumaru
- Division of Stroke, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | | | - Masanori Yoshino
- Okinaka Memorial Institute for Medical Research.,Department of Neurosurgery, Tokyo Metropolitan Police Hospital
| | - Takayuki Hara
- Okinaka Memorial Institute for Medical Research.,Department of Neurosurgery, Toranomon Hospital
| | - Shozo Yamada
- Okinaka Memorial Institute for Medical Research.,Department of Neurosurgery, Tokyo Neurological Center
| | - Hiroshi Nishioka
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital.,Okinaka Memorial Institute for Medical Research
| |
Collapse
|
10
|
Koutourousiou M, Vaz Guimaraes Filho F, Fernandez-Miranda JC, Wang EW, Stefko ST, Snyderman CH, Gardner PA. Endoscopic Endonasal Surgery for Tumors of the Cavernous Sinus: A Series of 234 Patients. World Neurosurg 2017; 103:713-732. [PMID: 28450229 DOI: 10.1016/j.wneu.2017.04.096] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/13/2017] [Accepted: 04/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cavernous sinus (CS) tumors often are considered inoperable. We present our experience with endoscopic endonasal surgery (EES) and compare the outcomes for different tumor. METHODS EES (medial or lateral approach) was used in 234 patients with CS tumors. The cohort included 175 (75%) pituitary adenomas and 59 (25%) nonadenomatous lesions. RESULTS Presenting symptoms were significantly different between the 2 groups, with cranial neuropathies occurring mainly in nonadenomas (P < 0.0001). The overall gross total tumor resection rate from the CS was 37.3% (37.1% in adenomas, 38.1% in non-adenomas). In total, preexisting cranial nerve (CN) dysfunction improved in 56.4% of the patients. After treatment completion (including radiation of residual tumor), 83.3% of acromegalic patients, 50% of prolactinomas and 33.3% of Cushing's disease, were in remission. Visual loss improved in 86.8% of adenomas and in 70.8% of nonadenomas. Intracavernous CN palsies improved in 77.3% of adenomas and 42.4% of nonadenomas. New permanent CN palsies occurred in 7 nonadenomas, which is significantly greater than in adenomas (P = 0.007). The leak rate of cerebrospinal fluid was 6.3% for adenomas and 11.9% for nonadenomas. Four patients suffered an internal carotid artery injury with no neurologic sequelae in 3 cases and 1 death (0.4%). CONCLUSIONS EES provides an easily accessible midline corridor to the CS with equivalent or superior results to transcranial approaches in the management of select tumors. Symptomatology due to CS invasion is more likely to improve in pituitary adenomas and the rate of surgical complications is greater in nonadenomas. Using a team approach, the overall mortality due to vascular injury is low.
Collapse
Affiliation(s)
- Maria Koutourousiou
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | | | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Susan Tonya Stefko
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
| |
Collapse
|
11
|
Patrona A, Patel KS, Bander ED, Mehta A, Tsiouris AJ, Anand VK, Schwartz TH. Endoscopic endonasal surgery for nonadenomatous, nonmeningeal pathology involving the cavernous sinus. J Neurosurg 2016; 126:880-888. [PMID: 27128582 DOI: 10.3171/2015.8.jns15275] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgery within the cavernous sinus (CS) remains a controversial topic because of the delicate and complex anatomy. The risk also varies with tumor consistency. Softer tumors such as pituitary adenomas are more likely to be surgically treated, while firm tumors such as meningiomas are often treated with radiosurgery. However, a wide range of pathologies that can involve the CS are amenable to surgery. The authors describe and analyze their results using endonasal endoscopic "medial-to-lateral" approaches for nonadenomatous, nonmeningeal tumors, in relation to the degree of invasion within the CS. METHODS A prospectively acquired database of consecutive endoscopic approaches for tumors with verified intraoperative CS invasion was reviewed. Pituitary adenomas and meningiomas were excluded. Degree of invasion of the CS was classified using the Knosp-Steiner (KS) grading system as well as the percentage of cavernous carotid artery (CCA) encasement. Extent of resection of the entire tumor and of the CS component was assessed by independent neuroradiologists using volumetric measurements of the pre- and postoperative MRI studies. Demographic data and complications were noted. RESULTS Fifteen patients (mean age 51.1 years who received endoscopic surgery between 2007 and 2013 met the selection criteria. There were 11 malignant tumors, including chordoma, chondrosarcoma, hemangiopericytoma, lymphoma, and metastatic cancer, and 4 benign tumors, including 3 cavernous hemangiomas and 1 dermoid. All cases were discussed before treatment in a tumor board. Adjuvant treatment options included chemotherapy and radiotherapy. The mean pre- and postoperative tumor volumes were 12.74 ml and 3.86 ml. Gross-total resection (GTR; ie, resection greater than 95%) was the goal in 13 cases and was achieved in 6 patients (46%) while in addition 5 patients had a greater than 80% resection. Gross-total resection in the CS was accomplished in 55% of the tumors with KS Grades 1-2 and in 16.6% of the tumors with KS grades 3-4, respectively. Likewise, GTR was accomplished in 55% of the tumors with CCA encasement under 75% and in 14.3% of the lesions with CCA encasement over 75%, irrespective of tumor volume and underlying pathology. There were 18 preexisting cranial neuropathies involving cranial nerves III-VI, of which 9 fully resolved, 4 improved, and 3 remained unchanged; 2 of these worsened with tumor recurrence. Surgical complications included 1 transient new cranial nerve VI palsy associated with Horner's syndrome and 1 case of panhypopituitarism. There were no postoperative CSF leaks and no infections. The mean extended follow-up was 34.4 months. CONCLUSIONS Endonasal endoscopic approaches can play a role in the management of nonmeningeal, nonadenomatous tumors invading the CS, either through biopsy, debulking, or GTR. An advantage of this method is the relief of preexisting cranial neuropathies with low risk for new neurological deficit. Extent of resection within the CS varies with KS grade and degree of carotid encasement irrespective of the underlying pathology. The goals of surgery should be clearly established preoperatively in consultation with radiation and medical oncologists.
Collapse
Affiliation(s)
- Aikaterini Patrona
- Department of Neurosurgery, Medizinische Hochschule Brandenburg, Ruppiner Kliniken, Neuruppin, Germany; and
| | | | | | | | | | - Vijay K Anand
- Otolaryngology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | | |
Collapse
|
12
|
Bloch OG, Jian BJ, Yang I, Han SJ, Aranda D, Ahn BJ, Parsa AT. Cranial chondrosarcoma and recurrence. Skull Base 2011; 20:149-56. [PMID: 21318031 DOI: 10.1055/s-0029-1246218] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The literature regarding recurrences in patients with cranial chondrosarcoma is limited to small series performed at single institutions, raising the question if these data precisely reflect the true recurrence of this tumor for guiding the clinician in the management of these patients. An extensive systematic review of the English literature was performed. The patients were stratified according to treatment modality, treatment history, histological subtype, and histological grade, and the recurrence rates were analyzed. A total of 560 patients treated for cranial chondrosarcoma were included. Five-year recurrence rate among all patients was 22% with median follow-up of 60 months and median disease-free interval of 16 months. Tumor recurrence was more common in patients who only received surgery or had mesenchymal subtype tumors. Our systematic review closely reflects the actuarial recurrence rate and provides predictive factors in the recurrence of cranial chondrosarcoma.
Collapse
Affiliation(s)
- Orin G Bloch
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California
| | | | | | | | | | | | | |
Collapse
|
13
|
Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, McDermott MW, Parsa AT. Factors affecting outcome following treatment of patients with cavernous sinus meningiomas. J Neurosurg 2010; 113:1087-92. [DOI: 10.3171/2010.3.jns091807] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Object
Although there is a considerable volume of literature available on the treatment of patients with cavernous sinus meningiomas (CSMs), most of the data regarding tumor control and survival come from case studies or single-institution series. The authors performed a meta-analysis of reported tumor control and survival rates of patients described in the published literature, with an emphasis on specific prognostic factors.
Methods
The authors systematically analyzed the published literature and found more than 3000 patients treated for CSMs. Separate meta-analyses were performed to calculate pooled rates of recurrence and cranial neuropathy after 1) gross-total resection, 2) subtotal resection without adjuvant postoperative radiotherapy or radiosurgery, and 3) stereotactic radiosurgery (SRS) alone. Results were expressed as pooled proportions, and random-effects models were used to incorporate any heterogeneity present to generate a pooled proportion. Individual studies were weighted using the inverse variance method, and 95% CIs for each group were calculated from the pooled proportions.
Results
A total of 2065 nonduplicated patients treated for CSM met inclusion criteria for the analysis. Comparisons of the 95% CIs for recurrence of these 3 cohorts revealed that SRS-treated patients experienced improved rates of recurrence (3.2% [95% CI 1.9–4.5%]) compared with either gross-total resection (11.8% [95% CI 7.4–16.1%]) or subtotal resection alone (11.1% [95% CI 6.6–15.7%]) (p < 0.01). The authors found that the pooled mixed-effects rate of cranial neuropathy was markedly higher in patients undergoing resection (59.6% [95% CI 50.3–67.5%]) than for those undergoing SRS alone (25.7% [95% CI 11.5–38.9%]) (p < 0.05).
Conclusions
Radiosurgery provided improved rates of tumor control compared with surgery alone, regardless of the subjective extent of resection.
Collapse
Affiliation(s)
| | | | | | - Igor J. Barani
- 2Radiation Oncology, University of California at San Francisco, California
| | | | | |
Collapse
|
14
|
Demirkaya M, Sevinir B, Ozdemir O, Nazlioğlu HO, Okan M. Lymphoma of the cavernous sinus mimicking Tolosa-Hunt syndrome in a child. Pediatr Neurol 2010; 42:351-4. [PMID: 20399391 DOI: 10.1016/j.pediatrneurol.2009.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 12/14/2009] [Accepted: 12/21/2009] [Indexed: 11/16/2022]
Abstract
Some children with malignancies initially present with neurologic signs. Cavernous sinus syndrome is a rare manifestation of lymphomas, more commonly reported in adults. A patient presenting with third and fourth cranial nerve palsies was initially thought to manifest Tolosa-Hunt syndrome, but during follow-up a diagnosis of lymphoma without systemic involvement was established. This patient is the youngest, to our knowledge, to be diagnosed with primary cavernous sinus lymphoma. He remains in remission 5 years after chemotherapy. Malignancies (especially non-Hodgkin's lymphoma) should be considered in young children with cavernous sinus syndrome, even without systemic involvement.
Collapse
Affiliation(s)
- Metin Demirkaya
- Department of Pediatric Oncology, Faculty of Medicine, Uludag University, 16059 Görükle, Bursa, Turkey.
| | | | | | | | | |
Collapse
|
15
|
Nakamura M, Krauss J. Image-guided resection of small lesions in the cavernous sinus and Meckel's cave. Eur J Surg Oncol 2010; 36:208-13. [DOI: 10.1016/j.ejso.2009.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Revised: 06/27/2009] [Accepted: 07/02/2009] [Indexed: 11/25/2022] Open
|
16
|
A systematic review of intracranial chondrosarcoma and survival. J Clin Neurosci 2009; 16:1547-51. [PMID: 19796952 DOI: 10.1016/j.jocn.2009.05.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 05/02/2009] [Accepted: 05/06/2009] [Indexed: 11/20/2022]
Abstract
Most data regarding survival in patients with chondrosarcoma are limited to case studies and small series performed at single institutions. A systematic review was performed to study the relationship between potential prognostic factors and survival. The survival rates were analyzed according to modality of treatment, treatment history, histological subtype, and histological grade. A total of 560 patients with intracranial chondrosarcoma were analyzed. Median follow-up time was 60 months. The 5-year mortality among all patients was 11.5% with median survival of 24 months. Mortality at 5 years was significantly greater for patients with tumors of higher grade, or of the mesenchymal subtype, or who had received surgical resection alone. The results of our systematic review provide useful data in predicting survival among intracranial chondrosarcoma patients.
Collapse
|
17
|
Malignant trigeminal schwannoma extending into the anterior skull base. Acta Neurochir (Wien) 2008; 150:599-604. [PMID: 18473115 DOI: 10.1007/s00701-008-1563-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 02/10/2008] [Indexed: 10/22/2022]
Abstract
Malignant schwannomas are rare tumours that seldom grow in the head and neck and their occurrence is even rarer in patients not affected by neurofibromatosis. The authors report a 40 year old woman with a left trigeminal malignant schwannoma (arising from V2), involving the infratemporal fossa and subsequently extending into the maxillary, sphenoid and ethmoidal sinuses, the orbit, and the intracranial compartment. Given the complex location of this tumour, the patient initially underwent radiation treatment; however due to a poor response to this form of treatment as well as disease progression, surgical resection requiring a combined Neurosurgical, ENT and Plastic Surgery was recommended. The planned operation included sacrificing the internal carotid artery and cavernous sinus, ipsilateral orbit exenteration and reconstruction with a free flap from the latissimus dorsi muscle. In this report, we discuss the sporadic occurrence of these tumours, the histo-pathological features and the management strategy along with a review of the literature.
Collapse
|
18
|
Jacob M, Wydh E, Vighetto A, Sindou M. Visual outcome after surgery for cavernous sinus meningioma. Acta Neurochir (Wien) 2008; 150:421-9; discussion 429. [PMID: 18421411 DOI: 10.1007/s00701-008-1554-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 01/18/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Extension of cavernous sinus meningiomas can compromise vision by compressing the optic nerves and chiasm. Surgical tumour removal aims to protect vision in the long-term. However, the risks of surgery include transient or permanent damage to the anterior visual pathways. This study aims to 1) analyse the visual status in unilateral cavernous sinus meningioma with extra-cavernous extension, before and after removal of the extra-cavernous portion, without any adjuvant treatment with radiotherapy, 2) identify pre-surgical and early post-surgical prognostic factors for long-term visual outcome and 3) compare these results to previous studies. METHODS This is a retrospective study of 30 consecutive patients who underwent surgery between 1989 and 2004. Visual acuity, visual fields, and fundi were evaluated before surgery and during the mean follow-up period of 2 years. FINDINGS Total visual loss occurred in the ipsilateral eye following surgery in 10% of patients. There was improvement in vision in 23%, no significant change in 27% and worsening in 50% of patients. Pre-surgical visual acuity was not predictive of final visual outcome, but initial optic disc pallor was a poor prognostic factor. In pre-operatively normal contralateral eyes, 10% developed a mild visual deficit (visual acuity = 20/32 or better, and visual field defect <or=4 dB) post-operatively. Where vision in the contralateral eye was affected pre-operatively, 57% improved and 43% were unchanged. Overall, 93% of patients retained good visual function (mild or no visual deficit) in at least one eye, and 40% retained good visual function in both eyes after surgery. CONCLUSION Visual handicap is rare after conservative surgery for cavernous sinus meningioma with supra/laterosellar extension. Since surgery protects contralateral visual pathways from local compression, it may preserve long-term vision in the contralateral eye. Visual outcome in the ipsilateral eye is unpredictable, and may significantly worsen after surgery.
Collapse
Affiliation(s)
- M Jacob
- Consultation de Neuro-Opthalmologie, Hôpital Neurologique et Neurochirugical Pierre Wertheimer, Lyon, France.
| | | | | | | |
Collapse
|
19
|
Surgical management of anterior clinoidal meningiomas: a 26-case report. ACTA ACUST UNITED AC 2008; 68 Suppl 2:S6-S10; discussion S10. [PMID: 18037043 DOI: 10.1016/j.surneu.2007.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 09/15/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Resection of anterior clinoidal meningiomas remains a major neurosurgical challenge. We determine the surgical technique for removal of tumor and improvement of patient's outcome. METHODS A retrospective analysis was performed on 26 consecutive patients with anterior clinoidal meningiomas who underwent surgical resection at the Department of Neurosurgery, Renji Hospital, from January 1999 to August 2006. All patients had surgery through the pterional or extended pterional approach. Microvascular Doppler probe was used to protect the internal carotid artery and its branching arteries during dissection of the tumor. Twenty-two of them had severe visual deficits preoperatively. The follow-up period ranged from 3 to 36 months (22.3 +/- 8.8 months). RESULTS In this series, Simpson grade II resection in 16 cases (61.5%), Simpson grade III resection in 4 cases (15.4%), Simpson grade IV resection in 6 cases (23.1%) were achieved. Sixteen of the patients with preoperative visual impairment experienced significant improvement. No patients died. There was no evidence of tumor recurrence during follow-up. CONCLUSIONS In the majority of patients, surgery is still the first choice for total resection of the tumors without major complications. Protection of nerves and blood vessels must be a priority concern during removal of tumors.
Collapse
|
20
|
Abstract
Chordomas are rare, slow growing tumors of the axial skeleton, which derive from the remnants of the fetal notochord. They can be encountered anywhere along the axial skeleton, most commonly in the sacral area, skull base and less commonly in the spine. Chordomas have a benign histopathology but exhibit malignant clinical behavior with invasive, destructive and metastatic potential. Genetic and molecular pathology studies on oncogenesis of chordomas are very limited and there is little known on mechanisms governing the disease. Chordomas most commonly present with headaches and diplopia and can be readily diagnosed by current neuroradiological methods. There are 3 pathological subtypes of chordomas: classic, chondroid and dedifferentiated chordomas. Differential diagnosis from chondrosarcomas by radiology or pathology may at times be difficult. Skull base chordomas are very challenging to treat. Clinically there are at least two subsets of chordoma patients with distinct behaviors: some with a benign course and another group with an aggressive and rapidly progressive disease. There is no standard treatment for chordomas. Surgical resection and high dose radiation treatment are the mainstays of current treatment. Nevertheless, a significant percentage of skull base chordomas recur despite treatment. The outcome is dictated primarily by the intrinsic biology of the tumor and treatment seems only to have a secondary impact. To date we only have a limited understanding this biology; however better understanding is likely to improve treatment outcome. Hereby we present a review of the current knowledge and experience on the tumor biology, diagnosis and treatment of chordomas.
Collapse
|
21
|
Sindou M, Wydh E, Jouanneau E, Nebbal M, Lieutaud T. Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone. J Neurosurg 2007; 107:937-44. [DOI: 10.3171/jns-07/11/0937] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors report on the long-term outcome in 100 consecutive patients with meningiomas arising from the cavernous sinus (CS) with compressive extension outside the CS. The treatment in all cases was surgery alone without adjuvant radiosurgery or radiotherapy. The aim of this study was to evaluate the percentage of patients in whom surgery alone was able to produce long-term tumor control.
Methods
All 100 patients harbored meningiomas with supra- and/or laterocavernous extension, and 27 had petro-clival extension. Surgery was performed via frontopterionotemporal craniotomy associated with orbital and/or zygomatic osteotomy in 97 patients. Proximal control of the internal carotid artery at the foramen lacerum was undertaken in 65 patients; the paraclinoid carotid segment was exposed extradurally at the space made by the anterior clinoidectomy in 81 patients. For the petroclival tumor extension, a second-stage surgery was performed via a presigmoid–retro-labyrinthine or retrosigmoid approach in 13 and 14 patients, respectively.
Results
The mortality rate was 5% and two patients had severe hemiplegic or aphasic sequelae. The creation or aggravation of disorders in vision, ocular motility, or trigeminal function occurred in 19, 29, and 24% of patients respectively, with a significantly higher rate of complications when resection was performed inside the CS (p < 0.05).
Gross-total removal of both the extra- and intracavernous portions was achieved in 12 patients (Group 1), removal of the extracavernous portions with only a partial resection of the intracavernous portion in 28 patients (Group 2), and removal only of the extracavernous portions was performed in 60 patients (Group 3). The follow-up period ranged from 3 to 20 years (mean 8.3 years). There was no tumor recurrence in Group 1. In the 83 surviving patients in Groups 2 and 3 combined, the tumor remnant did not regrow in 72 patients (86.7%); regrowth was noted in 11 (13.3%).
Conclusions
The results suggest that there is no significant oncological benefit in performing surgery within the CS. Because entering the CS entails a significantly higher risk of complications, radiosurgical treatment should be reserved for remnants with secondary growth and clinical manifestations.
Collapse
Affiliation(s)
| | | | | | | | - Thomas Lieutaud
- 2Anesthesiology and Intensive Care, Hopital Neurologique Pierre Wertheimer, University Claude-Bernard of Lyon, France
| |
Collapse
|
22
|
Natarajan SK, Sekhar LN, Schessel D, Morita A. Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up. Neurosurgery 2007; 60:965-79; discussion 979-81. [PMID: 17538370 DOI: 10.1227/01.neu.0000255472.52882.d6] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate patients' clinical outcome, survival, and performance status, at the long-term follow-up evaluation after aggressive microsurgical resection of petroclival meningiomas. METHODS During a 13-year period (1991-2004), 150 patients underwent 207 operative procedures for resection of petroclival meningiomas. The tumor size was large in 79% of the patients, with a mean tumor diameter of 3.44 cm. Tumors extended into adjoining regions in 57% of the patients. Thirty patients (20%) previously underwent operation or irradiation. One hundred patients (66%) had a single operation, 43 patients (29%) had two operations, and seven patients (5%) had three operations. Gross tumor resection was accomplished in 48 patients (32%), subtotal resection in 65 patients (43%), and partial resection in 37 patients (25%). There were no operative deaths. Postoperative complications (cerebrospinal fluid leakage, quadriparesis, infections, cranial nerve palsies, etc.) were observed in 33 patients (22%). Postoperative radiation or radiosurgery was administered to 47 of the 102 patients who had residual tumors. The outcome and survival of patients were evaluated by questionnaires, telephone calls, and review of their recent radiological images. RESULTS At the conclusion of the study, 87 patients (58%) were alive with disease and 45 patients (30%) were alive without disease. The mean follow-up period was 102 months (range, 15-180 mo). Seven patients (5%; five of the subtotal and partially resected patients and two of the total resection patients) had recurrence; of these patients, two underwent repeat resection and four were treated with gamma knife radiosurgery. One of the patients died of tumor progression with no response to gamma knife radiosurgery. The recurrence-free survival rate was 100% at 3 years, 92.7% at 7 years, and 85% at 12 years; the progression-free survival rate was 96% at 3 years, 86.8% at 7 years, and 79.5% at 12 years. The Karnofsky Performance Scale score was 78 +/- 11 preoperatively, 76 +/- 11 at 1 year postoperatively, and 84 +/- 9 at the time of the latest follow-up evaluation. Common disabilities at the time of the follow-up evaluation included diplopia, loss of hearing, balance problems, and loss of sensation in the V1 and V2 cranial nerve distribution. Most patients developed coping mechanisms. CONCLUSION This series has the largest number of patients with the longest follow-up period, to our knowledge, reported in the literature to date. The excellent quality of life at the time of the long-term follow-up examination for these patients warrants aggressive but judicious tumor resection, with or without radiosurgical treatment of tumor remnants.
Collapse
Affiliation(s)
- Sabareesh K Natarajan
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | | | | |
Collapse
|
23
|
Cornelius JF, George B, Kolb F. Combined use of a radial fore arm free flap for extra-intracranial bypass and for antero-lateral skull base reconstruction--a new technique and review of literature. Acta Neurochir (Wien) 2006; 148:427-34. [PMID: 16475019 DOI: 10.1007/s00701-006-0732-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Accepted: 11/30/2005] [Indexed: 11/26/2022]
Abstract
This article describes a new surgical technique consisting of the combined use of a fascial radial fore arm free flap (RFFF) as vascular graft for extra-intracranial bypass and as dura mater plasty for reconstruction of the antero-lateral skull base. This new technique is illustrated by a case of a complex intracranial meningioma with extracranial extension necessitating resection of internal carotid artery. The technical issues of antero-lateral skull base reconstruction and extra-intracranial bypass are discussed and the literature is reviewed.
Collapse
Affiliation(s)
- J F Cornelius
- Department of Neurosurgery, Lariboisiere Hospital, University of Paris VII, Paris, France.
| | | | | |
Collapse
|
24
|
Amin-Hanjani S, Butler WE, Ogilvy CS, Carter BS, Barker FG. Extracranial—intracranial bypass in the treatment of occlusive cerebrovascular disease and intracranial aneurysms in the United States between 1992 and 2001: a population-based study. J Neurosurg 2005; 103:794-804. [PMID: 16304982 DOI: 10.3171/jns.2005.103.5.0794] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. The authors assessed the results of extracranial—intracranial (EC—IC) bypass surgery in the treatment of occlusive cerebrovascular disease and intracranial aneurysms in the US between 1992 and 2001 by using population-based methods.
Methods. This is a retrospective cohort study based on data from the Nationwide Inpatient Sample (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, Rockville, MD). Five hundred fifty-eight operations were performed at 158 hospitals by 115 identified surgeons. The indications for surgery were cerebral ischemia in 74% of the operations (2.4% mortality rate), unruptured aneurysms in 19% of the operations (7.7% mortality rate), and ruptured aneurysms in 7% of the operations (21% mortality rate). Overall, 4.6% of the patients died and 4.7% of the patients were discharged to long-term facilities, 16.4% to short-term facilities, and 74.2% to their homes. The annual number of admissions in the US increased from 190 per year (1992–1996) to 360 per year (1997–2001), whereas the mortality rates increased from 2.8% (1992–1996) to 5.7% (1997–2001).
The median annual number of procedures was three per hospital (range one–27 operations) or two per surgeon (range one–21 operations). For 29% of patients, their bypass procedure was the only one recorded at their particular hospital during that year; for these institutions the mean annual caseload was 0.4 admissions per year. For 42% of patients, their particular surgeon performed no other bypass procedure during that year. Older patient age (p < 0.001) and African-American race (p = 0.005) were risk factors for adverse outcome. In a multivariate analysis in which adjustments were made for age, sex, race, diagnosis, admission type, geographic region, medical comorbidity, and year of surgery, high-volume hospitals less frequently had an adverse discharge disposition (odds ratio 0.54, p = 0.03).
Conclusions. Most EC—IC bypasses performed in the US during the last decade were performed for occlusive cerebrovascular disease. Community mortality rates for aneurysm treatment including bypass procedures currently exceed published values from specialized centers and, during the period under study, the mortality rates increased with time for all diagnostic subgroups. This technically demanding procedure has become a very low-volume operation at most US centers.
Collapse
Affiliation(s)
- Sepideh Amin-Hanjani
- Neurosurgical Service, Massachusetts General Hospital, and Department of Surgery Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | |
Collapse
|
25
|
Pamir MN, Kiliç T, Bayrakli F, Peker S. Changing treatment strategy of cavernous sinus meningiomas: experience of a single institution. ACTA ACUST UNITED AC 2005; 64 Suppl 2:S58-66. [PMID: 16256845 DOI: 10.1016/j.surneu.2005.07.053] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Oncological treatment of a neoplasm is more than surgical removal of the tumor. Probably, this truth is the reason for the ongoing discussion on cavernous sinus meningiomas in the last decade. Debate on optimal management of cavernous sinus meningiomas aims to compare the different treatment strategies: (a) radical surgical resection and (b) conservative surgical resection complemented with radiosurgical treatment. MATERIALS AND METHODS Natural history of the change in the management strategy of cavernous sinus meningiomas in our department before and after GK facility became available in 1997 allowed us to compare the 2 aforementioned strategies. Before installation of a Leksell GK unit at the hospital in 1997, the neurosurgical team at Marmara University Institute of Neurological Sciences and Faculty of Medicine (Istanbul, Turkey) treated patients with cavernous sinus meningioma using radical resection (radical strategy, group A, 10 patients). After 1997, the same neurosurgical team used understanding of surgical removal of the extracavernous sinus tumor component with GK irradiation of the intracavernous part (conservative strategy, group B, 12 patients). Another group of patients, who were treated with GK as a first-step treatment, was analyzed (GK group, group C, 26 patients). RESULTS At the end of the third year, more stable tumor volume control was achieved in groups B and C; after the second year, an incline in the tumor volume-time graph was detected. Group B resulted in less cranial nerve-related complications; a certain degree of improvement in cranial nerve deficits was observed. CONCLUSION Comparing 2 different management strategies for cavernous sinus meningiomas in the same hospital setting using the same neurosurgical group, we conclude that extracavernous resection followed by GK is as effective as radical surgery. Considering cranial nerve complications and third-year tumor volume control achievement, conservative approach yielded better results. Longer follow-up with larger series is necessary.
Collapse
Affiliation(s)
- M Necmettin Pamir
- Institute of Neurological Sciences, Marmara University, PK 53 Maltepe, Istanbul 81532, Turkey
| | | | | | | |
Collapse
|
26
|
Abstract
We discuss revascularization techniques for complex skull base lesions utilizing high-flow arterial bypass. At present, the radial artery is the donor graft utilized in most circumstances at our institution. The knowledge of revascularization techniques is very important to achieve radical resection in lesions where arterial compromise is documented.
Collapse
Affiliation(s)
- Jorge Mura
- Department of Neurosurgery, Institute of Neurological Sciences, São Paulo, Brazil
| | | | | |
Collapse
|
27
|
Parkinson RJ, Bendok BR, O'Shaughnessy BA, Shaibani A, Russell EJ, Getch CC, Awad IA, Batjer HH. Temporary and permanent occlusion of cervical and cerebral arteries. Neurosurg Clin N Am 2005; 16:249-56, viii. [PMID: 15694157 DOI: 10.1016/j.nec.2004.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Richard J Parkinson
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 233 East Erie Street, Suite 614, Chicago, IL 60611, USA.
| | | | | | | | | | | | | | | |
Collapse
|