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Cavernous sinus meningiomas: imaging and surgical strategy
Marc Sindou1, Mustapha Nebbal, Bulent Guclu
1Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, University of Lyon 1, Lyon, France.
Advances and Technical Standards in Neurosurgery
|November 21, 2014
Summary
Preoperative neuroimaging is crucial for surgical planning of difficult cavernous sinus (CS) meningiomas. Detailed imaging guides strategies for tumor resection, preserving vital neurovascular structures.
Area of Science:
- Neurosurgery
- Skull Base Surgery
- Neuroradiology
Background:
- Cavernous sinus (CS) meningiomas are challenging skull base tumors originating from the parasellar region.
- Effective surgical management necessitates detailed preoperative assessment of tumor-neurovascular relationships.
Purpose of the Study:
- To highlight the importance of advanced neuroimaging in surgical strategy for CS meningiomas.
- To outline key imaging parameters influencing operative decisions.
Main Methods:
- Utilized thin-section CT, 3D spiral CT, MRI, MR angiography, and digital subtraction angiography (DSA) with selective arteriography.
- Evaluated tumor proximity to neurovascular structures, extension into cisterns, and vascular supply/drainage.
Main Results:
- Preoperative imaging informs craniotomy type, osteotomy, and potential need for extradural anterior clinoidectomy.
- Imaging data guides decisions on middle cranial fossa exposure, internal carotid artery (ICA) control, and Willis circle assessment for bypass.
Conclusions:
- The current accepted strategy involves operating on tumors with extracavernous extensions, resecting only these portions.
- Radiosurgery or radiotherapy can supplement surgery or manage tumor remnants.
