Decompression of cavernous sinus meningioma for preservation and improvement of cranial nerve function: Technical note

William T. Couldwell, Peter Kan, James K. Liu, Ronald I. Apfelbaum

Research output: Contribution to journalArticle

Abstract

Meningiomas are the most common tumors affecting the cavernous sinus (CS). Despite advances in microsurgery and radiosurgery, treatment of CS meningiomas remains difficult and controversial. As in cases of other meningiomas, the goal of treatment for CS meningioma is long-term growth control and preservation of neural function. Gross-total resection, the ideal treatment for meningioma, is not always possible to obtain in patients with CS meningiomas with an acceptable level of morbidity. Therefore, microsurgery and radiosurgery have recently been advocated as a combined therapy to achieve good control of tumor growth and favorable functional outcome. The authors describe a technique in which tumor volume can be reduced to a minimal residual amount, while preserving cranial nerve function. This enables the smallest field to be treated radiosurgically. The optic nerve is decompressed, and the tumor mass is reduced to provide at least a 5-mm interpositional distance between the optic nerve and the residual lesion. Direct decompression of the CS, with opening of the lateral and superior sinus walls, and piecemeal removal of the tumor in "safe" locations are performed to facilitate an improvement in cranial nerve function. The authors describe the use of this technique in a series of patients and demonstrate improvement of cranial nerve function in a subset of these patients.

Original languageEnglish (US)
Pages (from-to)148-152
Number of pages5
JournalJournal of neurosurgery
Volume105
Issue number1
DOIs
StatePublished - 2006

Keywords

  • Cavernous sinus
  • Meningioma
  • Radiation therapy
  • Radiosurgery
  • Skull base neoplasm
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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