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Published on: January 17, 2018
[Surgical treatment of large or giant cavernous sinus hemangiomas via epidural approach]
Xin-guang Yu1, Yi-heng Yin, Ding-biao Zhou
1Department of Neurosurgery, People's Liberation Army General Hospital, Beijing 100853, China. xg_yu@yahoo.cn
Insights
Surgical treatment of large or giant cavernous sinus hemangiomas (CSH) using the epidural approach is effective. This method allows for acceptable preservation of cranial nerves while treating CSH symptoms.
Area of Science:
- Neurosurgery
- Skull Base Surgery
- Vascular Neurosurgery
Context:
- Large or giant cavernous sinus hemangiomas (CSH) present significant surgical challenges.
- The epidural approach offers a potential surgical corridor for CSH resection.
- Understanding the efficacy and outcomes of this approach is crucial for neurosurgical practice.
Purpose:
- To evaluate the curative effect of surgically treating large or giant CSH via the epidural approach.
- To assess the outcomes and complications associated with this surgical technique.
Summary:
- Retrospective review of 19 patients (15 female, 4 male) with CSH treated via epidural approach.
- Common presenting symptoms included ptosis, ocular motility disorders, headache, decreased visual acuity, and facial hyperesthesia.
- Gross total resection achieved in 13 cases; significant symptom relief observed, with one complication of vision and ocular motility impairment.
Impact:
- The epidural approach, combined with skilled skull base techniques, is an effective method for surgically treating large or giant CSH.
- Acceptable preservation of cranial nerves can be achieved.
- This study contributes to the understanding of surgical management for complex CSH cases.
Objective:
To summarize the curative effect of surgically treated large or giant cavernous sinus hemangiomas (CSH) via epidural approach.
Methods:
From June 1999 to June 2011, 19 cases of CSH including 15 female and 4 male patients, ranging from 26 to 70 years (mean 45.3 years) were retrospectively reviewed. Ptosis/ocular motility disorders (10 cases), headache/ophthalmalgia (7 cases), decreased visual acuity (7 cases) and facial hyperesthesia (4 cases) were the most common presenting complaints. The epidural approach was taken and the tumor dissection was performed at the interval between trochlear nerve and ophthalmic nerve and the interval between ophthalmic nerve and maxillary nerve. The curative effect was followed up regularly.
Results:
Gross total resection was attained in 13 cases, near-total resection in 4 cases, subtotal resection in 1 case and partial resection in 1 case. The follow-up period was between 6-144 months (mean 41.5 months). The results of last follow-up were as follows: among the 10 patients with ptosis/ocular motility disorders, complete remission was achieved in 5, improvement in 2, no change in 2 and lost follow-up in 1. Facial hypoesthesia symptom got complete remission in 2 patients and partial remission in the other 2 patients. The other symptoms mentioned above were all relieved. One patient got complication with impairment of vision and ocular motility disorders.
Conclusions:
Combined with skilled skull base techniques, surgical treatment of large or giant CSH via epidural approach is an effective method and the preservation of cranial nerves could be attained to an acceptable level.
