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Should meningiomas involving the cavernous sinus be totally resected?
M Suzuki1, K Mizoi, T Yoshimoto
1Department of Neurosurgery, Tohoku University School of Medicine, Japan.
Surgical Neurology
|July 1, 1995
Summary
Subtotal resection of cavernous sinus meningiomas after estrogen with 25% alcohol+polyvinyl acetate (Est+PVac) embolization is a safe and effective surgical strategy. This approach preserves cranial nerve function and reduces recurrence rates compared to estrogen-only embolization.
Area of Science:
- Neurosurgery
- Oncology
- Vascular Surgery
Background:
- Cavernous sinus meningiomas present surgical challenges due to complex anatomy and risk of neurovascular injury.
- Optimal surgical strategies for cavernous sinus meningiomas remain debated.
- Evaluating subtotal removal combined with chemical embolization for efficacy and functional preservation.
Observation:
- Nineteen patients with cavernous sinus meningiomas underwent subtotal removal and were followed for over 1 year.
- Preoperative embolization of feeding arteries was performed to minimize intraoperative bleeding.
- Embolization materials evolved from estrogen (Est) to a combination of estrogen with 25% alcohol and polyvinyl acetate (Est+PVac).
Findings:
- Fourteen patients remained recurrence-free for a mean of 6.5 years post-surgery.
- Five patients experienced recurrence, with a mean recurrence-free interval of 1.7 years.
- The Est+PVac embolization group demonstrated a lower recurrence rate compared to the Est-only group.
Implications:
- Subtotal resection following Est+PVac embolization is a safe and effective treatment for cavernous sinus meningiomas.
- This combined approach facilitates tumor removal while preserving cranial nerve function.
- The findings support the use of Est+PVac as an improved embolization agent for these tumors.