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Published on: January 17, 2018
Management of Cavernous Sinus Involvement in Sinonasal and Ventral Skull Base Malignancies
Amol Raheja1, William T Couldwell1
1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT 84132, USA.
Abstract:
Cavernous sinus (CS) involvement by sinonasal and ventral skull base malignancies is infrequently encountered in neurosurgical practice. Despite advancements in skull base microneurosurgery and endoscopic techniques, detailed knowledge and experience of the surgical management of these lesions are limited. This article elaborates on surgical strategies and approaches for CS involvement of malignant ventral skull base tumors. The article discusses the indications, techniques, nuances, advantages, limitations, and complications of minimally invasive CS biopsy, transcranial microscopic, and transfacial endoscopic approaches to the CS using illustrative diagrams and operative videos. The principles and nuances of a high-flow cerebral revascularization procedure are mentioned.
Insights
Surgical management of malignant tumors invading the cavernous sinus (CS) is complex. This review details minimally invasive biopsy, transcranial microscopic, and transfacial endoscopic approaches for these challenging ventral skull base lesions.
Area of Science:
- Neurosurgery
- Skull Base Surgery
- Oncology
Background:
- Cavernous sinus (CS) involvement by sinonasal and ventral skull base malignancies presents unique neurosurgical challenges.
- Limited experience and detailed knowledge exist regarding the surgical management of these rare lesions.
Purpose of the Study:
- To elaborate on surgical strategies and approaches for managing malignant ventral skull base tumors with CS involvement.
- To discuss indications, techniques, nuances, advantages, limitations, and complications of various surgical methods.
Main Methods:
- Review of surgical strategies for CS involvement by malignant ventral skull base tumors.
- Discussion of minimally invasive CS biopsy, transcranial microscopic, and transfacial endoscopic approaches.
- Inclusion of illustrative diagrams and operative videos.
Main Results:
- Detailed description of surgical techniques for accessing and managing CS tumors.
- Analysis of the benefits and drawbacks of different surgical modalities.
- Mention of principles for high-flow cerebral revascularization procedures.
Conclusions:
- Effective surgical management of CS malignancies requires a thorough understanding of various approaches.
- Minimally invasive techniques, alongside traditional microscopic and endoscopic methods, offer options for biopsy and resection.
- Cerebral revascularization may be a critical adjunct in select cases.
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