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Veldeman M, Rossmann T, Vartiainen N, Niemela M. Subtemporal approach for cavernous sinus meningiomas - Simple and effective. Surg Neurol Int 2023; 14:16. [PMID: 36751461 PMCID: PMC9899470 DOI: 10.25259/sni_1012_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
Background Over the past few decades, there has been a paradigm shift in treatment strategy for cavernous sinus meningiomas (CSMs). Preserving neurological function and cranial nerve (CN) decompression have become the primary goal of cases eligible for surgical treatment. Extensive skull base dissection and drilling can be avoided by approaching these lesions through a subtemporal route. Methods We describe the subtemporal approach in a step-by-step fashion illustrating its advantages and pitfalls through and illustrative case. Results The subtemporal approach to CSMs is a valuable alternative for CN decompression and maximal safe resection. We describe the technique in comparison to classical skull base approaches. Although rare, recurrence after adjuvant maximal radiation is possible leaving reoperation as the only treatment option. Conclusion The subtemporal approach offers a less invasive alternative for initial and redo CN decompression and successful symptom control in patients suffering from CSM.
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Affiliation(s)
- Michael Veldeman
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany,,Department of Neurosurgery, University of Helsinki and Helsinki University Hospital,,Corresponding author: Michael Veldeman, Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Tobias Rossmann
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital,,Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | - Nuutti Vartiainen
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital
| | - Mika Niemela
- Department of Neurosurgery, University Hospital Helsinki, Helsinki, Finland
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Dincer A, Sharma V, Madan N, Heilman C. Cavernous segment internal carotid artery stenosis specific to meningiomas compared to pituitary adenomas. J Neuroimaging 2023; 33:73-78. [PMID: 36117152 DOI: 10.1111/jon.13051] [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: 07/05/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Pituitary macroadenomas and meningiomas are common neoplasms arising within the cavernous sinus. Imaging characteristics on MRI can often distinguish these tumors from one another; however, some cases may be more difficult to differentiate. This study compares patterns of cavernous segment internal carotid artery (CS-ICA) stenosis between the two tumor types to establish a novel radiographic method of differentiation. METHODS A retrospective analysis of patients with pathology-confirmed meningioma and pituitary adenomas at Tufts Medical Center was performed. The diameter of the CS-ICA at the narrowest point within the cavernous sinus was measured and compared to the ipsilateral petrous segment ICA and contralateral CS-ICA. The mean and range of percent stenosis and frequency of cases of CS-ICA stenosis >15% were determined. Statistical analysis to compare the groups was conducted using the Chi-squared test, Fisher's exact test, and t-test. RESULTS There were a total of 78 out of 231 patients who were included in the study. The mean % ICA stenosis for all meningiomas was 9.3%, with increasing stenosis with increasing World Health Organization grade. Of all meningioma cases, 13 (33%) had greater than 15% ICA stenosis. Mean ICA stenosis for pituitary adenomas was -1.48%. There were no cases of pituitary adenomas causing ICA stenosis >15%. CONCLUSIONS Differentiating pituitary adenomas and intracavernous meningioma tumors can have important implications on surgical approach and outcome. Our study found that stenosis of the CS-ICA greater than 15% is highly specific to meningiomas and can serve as a radiologic sign to distinguish between these two tumors.
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Affiliation(s)
- Alper Dincer
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Vaishnavi Sharma
- Tufts University School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Neel Madan
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Carl Heilman
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
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Gambacciani C, Grimod G, Sameshima T, Santonocito OS. Surgical management of skull base meningiomas and vestibular schwannomas. Curr Opin Oncol 2022; 34:713-722. [PMID: 36093884 DOI: 10.1097/cco.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study is to discuss surgical management of meningiomas and schwannomas of skull base. RECENT FINDINGS Meningiomas and schwannomas are typically benign neoplasm with a good prognosis after surgery. Patients should be treated individually related to several features: size and localization of tumor and its proximity with deep critical neurovascular structures, neurological status, age and comorbidity. Also, the widespread use of neuroimaging and the progressive and constant aging of the populations inevitably result in the increase of detection rate of incidental (asymptomatic) neoplasm.Nowadays, there are still controversies about the correct management strategy. SUMMARY Surgery represents the gold standard treatment, with the objective of gross total resection; however, it is not always feasible due to localization, encasement of neuro-vascular structure, invasion of cranial nerve and brain parenchyma. Stereotactic radiosurgery and radiation therapy are important to achieve a satisfactory functional outcome and tumor control in case of residue or recurrence. A multidisciplinary approach is pivotal.
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Affiliation(s)
| | | | - Tetsuro Sameshima
- Department of Neurosurgery. Hamamatsu University School of Medicine, University Hospital, Hamamatsu, Japan
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Qian H, Ling Y, Wang C, Lenahan C, Zhang M, Zheng M, Shao A. A Correlative Study Between Personality Traits and the Preference of Site Selection in Cosmetic Treatment. Front Psychiatry 2021; 12:648751. [PMID: 34093268 PMCID: PMC8169958 DOI: 10.3389/fpsyt.2021.648751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cosmetic treatment was closely associated with beauty seekers' psychological well-being. Patients who seek cosmetic surgery often show anxiety. Nevertheless, not much is known regarding how personality traits relate to the selection of body parts that receive cosmetic treatment. Aims: This study aims to investigate the correlation between personality traits and various selection sites for cosmetic treatment via Eysenck Personality Questionnaire (EPQ). Methods: A cross-sectional approach was adopted to randomly recruited patients from a general hospital planning to undergo cosmetic treatments. All respondents completed the EPQ and provided their demographic information. The EPQ involves four scales: the extraversion (E), neuroticism (N), psychoticism (P), and lying scales (L). Psychological scales were evaluated to verify that people who selected different body sites for cosmetic intervention possessed different personality portraits. Results: A total of 426 patients with an average age of 32.14 ± 8.06 were enrolled. Among them, 384 were females, accounting for more than 90% of patients. Five treatment sites were analyzed, including the body, eye, face contour, nose, and skin. Comparatively, patients with neuroticism were more likely to undergo and demand rhinoplasty (OR 1.15, 95% CI 1.07-1.24, P < 0.001). Face contour treatment was commonly associated with extraversion (OR 1.05, 95% CI 1.00-1.11, P = 0.044), psychoticism (OR 1.13, CI 1.03-1.25, P = 0.013), and neuroticism (OR 1.05, CI 1.01-1.10, P = 0.019). Conclusions: This novel study attempted to determine the personality profiles of beauty seekers. The corresponding assessments may provide references for clinical treatment options and enhance postoperative satisfaction for both practitioners and patients.
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Affiliation(s)
- Huan Qian
- Department of Plastic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuxiao Ling
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Chen Wang
- Department of Plastic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Cameron Lenahan
- Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, CA, United States.,Burrell College of Osteopathic Medicine, Las Cruces, NM, United States
| | - Mengwen Zhang
- Department of Plastic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Min Zheng
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Anwen Shao
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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