Review article imaging lesions of the cavernous sinus a. Although microsurgical gross total removal remains the treatment of choice in intracranial meningiomas, numerous reports have shown that total resection of cavernous sinus cs meningiomas is not always feasible and whenever possible is. Evidence of cranial nerve infiltration by meningioma suggests that, in some circumstances, cavernous sinus dissection in the hope of total removal of a. What better way to show all available cavernous sinus connections than a highpressure cavernous sinus state, exemplified by the various complex and challenging fistulas which afflict it. Hello, i have recently been diagnosed with a right cavernous sinus meningioma that has wrapped around the carotid artery and is pressing on the optic nerve and 2 other cranial nerves. In fact, tb of the cavernous sinus is an uncommon disorder even in an immunocompetent patient.
Listing a study does not mean it has been evaluated by the u. It is located at the central base of the skull, on either side of the sella turcica. Imaging lesions of the cavernous sinus american journal. Review stereotactic radiosurgery for benign world health organization grade i cavernous sinus meningiomasinternational stereotactic radiosurgery society isrs practice guideline.
With increasing international expertise in cavernous sinus surgery, the results must be analyzed critically to search for accurate prognosticators of outcome. On the other hand, the improvement of the anatomical knowledge and the microsurgical techniques together with diffusion of radiosurgery are currently changing the. Cavernous sinus meningioma in radiological progress dr. The mass also compresses the left temporal lobe and left pons. The most common are neurogenic tumors and cavernoma. The cavernous sinus cs is a small but complex structure containing vital neurovascular structures that may be affected by a wide spectrum of infective, noninfectious inflammatory, neoplastic, vascular, and infiltrative lesions. Even though i live in a large city, i feel very limited by the physicians whom i have seen so far. In those patients with typical meningioma, the control rate was 93. Management of parasellar and cavernous sinus meningiomas neil r. Medially, the cavernous sinus is related to the pituitary gland and the sphenoid sinus. A large right paraselllar mass is noted measuring up to 18 mm thick, filling the cavernous sinus and moderately narrowing in the transverse portion of the cavernous carotid artery.
Original article gamma knife radiosurgery of cavernous. Venous relationships cavernous sinus venous plexus or venous channel. Tumors of the nasopharynx, skull base, and sphenoid sinus may extend to the cs as can perineural and. Baltimore, md objectives at the conclusion of this program, the attendee will be able to. These initial references were followed by ridleys first detailed description of the cs in 1695. It may also cause compression of the chiasma over a long period of time. Cavernous hemangiomas can be misdiagnosed as a meningioma, especially when localized in the cavernous sinus. Singlefraction radiosurgery of benign cavernous sinus. Risks are rooted primarily in tumor location, particularly with respect to the proximity of important neurovascular structures. Cavernous sinus definition of cavernous sinus by medical. Cavernous sinus surgery is considered neurosurgically feasible. The paired cavernous sinuses are thinwalled venous pockets below and behind the orbits or eye sockets that collect blood draining from the face, eye, and anterior brain. Cavernous sinus meningiomas can cause double vision, dizziness and facial pain.
Hitherto, the results of gamma knife radiosurgery of cavernous sinus meningioma have proved its safety and efficiency, although long term experience with a large group of patients is missing. Cavernous sinus meningioma radiosurgery request pdf. The veins that communicate with the cavernous sinus are. Meningioma meningiomas are the most common tumor arising from the lateral wall of the cavernous sinus.
As a venous channel, the cavernous sinus also receives multiple venous tributaries, including the superior and inferior petrosal sinuses, the. The veins of the face drain blood into the cavernous sinus via the superior ophthalmic vein. In the patients who had srs as the primary treatment, the fiveyear local control rate was 96. Six cases were lost and 9 had less than 1 year follow up. Cranial nerve vi occupies a more medial position in the cavernous sinus proper. Tumors involving the cavernous sinus clinical gate.
Fiftysix patients undergoing 57 cavernous sinus surgical procedures performed by a single senior neurosurgeon were. Owing to the fact that there are no valves in the sinus and its connected veins, the direction of blood flow is dependent on venous pressure. Meningioma near the cavernous sinus brain tumors inspire. Cavernous sinus meningiomas are rare tumors that affect the cavernous sinus, an area that controls eye movement and allows your face to feel sensations. Cavernous sinus meningioma nancy huynh ophthalmic medical technology uams, college of health professions little rock, ar the cavernous venous sinus is a small bloodfilled space on both sides of the base of the. The results of surgery for benign tumors of the cavernous. Laterally, it is related to the temporal lobe of the brain. Despite the advances in techniques and technologies, the management of cavernous sinus cs meningiomas still remains a challenge for both neurosurgeons and radiation oncologists. Cavernous sinus meningioma csm gradually compresses the above nerves and artery causing varied degrees of unilateral ophthalmoplegia.
Anteriorly, the tumor extends for 1 centimeter into the apex of the right orbit, medially into the upper right sphenoid sinus. Infection as an infrequent cause of cavernous sinus disease in hivinfected patients is likely because of poor reporting or lack of. As such, infections of the face particularly those involving the danger triangle orbits, nasal sinuses, and superior part of the face can cause a. A meningioma that originates in the cavernous sinus can invade the sella. The aim of this study was to evaluate longterm outcomes, including tumor control and neurological function, in patients with cavernous sinus meningiomas treated using gamma knife surgery gks. Cavernous sinus meningiomas that encase and narrow the carotid artery are difficult to resect surgically or completely non resectable. Evidencebased treatment of cavernous sinus meningioma. Cavernous sinus anatomy large venous space situated in the middle cranial fossa, on either side of body of the sphenoid bone. Diagnosing cavernous sinus ch preoperatively is very important, but its radiological differential diagnosis is quite difficult. Cavernous sinus connections demonstrated by cavernous sinus dural fistula. These features are suggestive of a cavernous sinus meningioma. The cavernous sinus cs is a venous plexus that lies between the periosteal and dural layers of the dura mater. Until 1965, when parkinsons landmark article describing the direct surgical approach to carotidcavernous fistulas was published, little reference was made in the neurosurgical literature to direct operative attack on lesions of the cavernous sinus. Department of neurosurgery, gamma knife center, komaki city hospital, komaki, japan.
Cavernous sinus dissection and bleeding in meningiomas ocs the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Cavernous sinus meningioma nocturnal owl monkey, obama bin laden bumper sticker, orange cat pictures, skillet wallpaper, blake lively red hair images, blake lively red hair 2011, micromax gc360 price in india, caveirao, blake lively red hair met gala, terrifying clown, funny osama bin laden dead pics, owl art, cavernous sinus contents, president obama in ireland. Meningiomas classically encase and narrow vessels while a pituitary adenoma would not. Objective meningiomas confined to the cavernous sinus mcss are benign tumors. Cavernous sinus dissection and bleeding in meningiomas. On ct or mr imaging, the diagnosis depends on morphologic changes such as exophthalmos and enlargement of the superior ophthalmic veins, cavernous sinus, or extraocular muscles. A cavernous sinus meningioma is a benign tumor arising from the cells that form the internal lining membrane of the brain, called the pia mater, which expands to fill the cavernous sinus. One hundred and seventeen patients with cavernous sinus meningiomas had linac radiosurgery at our institution in the period 19932007. Nothing demonstrates the limits of anatomical plasticity quite like pathology. Recognize the major presenting signs and symptoms of parasellar and cavernous sinus meningiomas 2. Cavernous sinus chs are usually misdiagnosed as a meningioma because meningioma is a common lesion. The oculomotor and trochlear nerves are embedded in its lateral. Clival meningiomas are located on the underside of the cerebrum within the posterior cranial fossa. I was told its in a very tricky part and the biopsy has to be surgery.
These lesions may arise in the cavernous sinus proper or may secondarily infiltrate the cavernous sinus. Meningiomas of the cavernous sinus cs are extremely difficult to treat surgically with acceptable morbidity and mortality. Due to the high risk of severe complications, the intracavernous surgical procedure was abandoned in favor of. Stereotactic radiotherapy for treatment of cavernous sinus. However, dural arteriovenous fistula of the cavernous sinus is most easily understood as simply a dural arteriovenous fistula in a specific location. I am in the beginning stages of being diagnosed with meningioma they are not 100% thats what it is yet. Potential causes of cavernous sinus syndrome include metastatic tumors, direct extension of nasopharyngeal tumours, meningioma, pituitary tumors or pituitary apoplexy, aneurysms of the intracavernous carotid artery, carotidcavernous fistula, bacterial infection causing cavernous sinus thrombosis, aseptic cavernous sinus thrombosis, idiopathic. The cavernous sinus has many vital structures passing through it, including the carotid artery and the third, fourth, fifth, and sixth cranial nerves. The cavernous sinus is an unconventional venous system in the sense that it does not have a unidirectional flow of blood. Review article imaging lesions of the cavernous sinus. Stereotactic radiosurgery srs is an important treatment option for patients with cavernous sinus meningiomas csm. On mr imaging, flow voids within the cavernous sinus and hyperintensity on arterial 3d tof suggest the diagnosis.
Management of parasellar and cavernous sinus meningiomas. And are a typical adult female tumors with peak incidence of 4060 y. Surgically proven as venous channel matter of debatea pair of cavernous sinus, on either side of sella turcica. The mass is t1 isotense and t2 hyperintense with vivid contrast enhancement. The remaining 102 patients were prospectively followed up at 1 y intervals with clinical, neuroophthalmological and mri examinations. Winslow, however, was the first to use the term cavernous sinus in 1734, as an analogy to the corpus cavernosum of the penis. Meningioma, neurofibroma secondary brain tumor metastsis. Imaging of the cavernous sinus lesions sciencedirect.
635 351 1292 1413 1580 1107 1461 282 1528 602 15 798 1383 1362 1480 370 573 1075 1439 33 1479 1328 117 466 1234 839 1572 1477 909 1543 1033 1053 1254 1154 728 1012 1040 641 1073 973 887 1246 361 606 761