J Neurol Surg B Skull Base 2020; 81(04): 348-356
DOI: 10.1055/s-0040-1715471
Typical Orbital Pathologies
Review Article

Cavernous Sinus Meningioma with Orbital Involvement: Algorithmic Decision-Making and Treatment Strategy

Amol Raheja
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
William T. Couldwell
2   Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
› Institutsangaben

Abstract

Cavernous sinus meningioma (CSM) with orbital involvement presents a unique challenge to modern-day neurosurgeons. In the modern era of preventive medicine with enhanced screening tools, physicians encounter CSM more frequently. An indolent natural history, late clinical presentation, close proximity to vital neurovascular structures, poor tumor-to-normal tissue interface, and high risk of iatrogenic morbidity and mortality with aggressive resection add to the complexity of decision-making and optimal management of these lesions. The clinical dilemma of deciding whether to observe or intervene first for asymptomatic lesions remains an enigma in current practice. The concepts of management for CSM with orbital involvement have gradually evolved from radical resection to a more conservative surgical approach with maximal safe resection, with the specific goals of preserving function and reducing proptosis. This change in surgical attitude has enabled better long-term functional outcomes with conservative approaches as compared with functionally disabled outcomes resulting from the pursuit of anatomical cure from disease with radical resection. The advent of stereotactic radiosurgery as an adjunct tool to treat residual CSM has greatly shaped our resection principles and planning. Interdisciplinary collaboration for multimodality management is key to successful management of these difficult to treat lesions and tailor management as per individual's requirement.



Publikationsverlauf

Artikel online veröffentlicht:
17. September 2020

Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Radhakrishnan K, Mokri B, Parisi JE, O'Fallon WM, Sunku J, Kurland LT. The trends in incidence of primary brain tumors in the population of Rochester, Minnesota. Ann Neurol 1995; 37 (01) 67-73
  • 2 De Monte F. Current management of meningiomas. Oncology (Williston Park) 1995; 9 (01) 83-91 , 96, discussion 96, 99–101
  • 3 Dolenc V. Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg 1983; 58 (06) 824-831
  • 4 Hakuba A, Tanaka K, Suzuki T, Nishimura S. A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus. J Neurosurg 1989; 71 (5 Pt 1): 699-704
  • 5 Kawase T, van Loveren H, Keller JT, Tew JM. Meningeal architecture of the cavernous sinus: clinical and surgical implications. Neurosurgery 1996; 39 (03) 527-534 , discussion 534–536
  • 6 Parkinson D. A surgical approach to the cavernous portion of the carotid artery. Anatomical studies and case report. J Neurosurg 1965; 23 (05) 474-483
  • 7 Parkinson D, Ramsay RM. Carotid cavernous fistula with pulsating exophthalmus: a fortuitous cure. Can J Surg 1963; 6: 191-195
  • 8 Taptas JN. The so-called cavernous sinus: a review of the controversy and its implications for neurosurgeons. Neurosurgery 1982; 11 (05) 712-717
  • 9 Umansky F, Nathan H. The lateral wall of the cavernous sinus. With special reference to the nerves related to it. J Neurosurg 1982; 56 (02) 228-234
  • 10 Klinger DR, Flores BC, Lewis JJ, Barnett SL. The treatment of cavernous sinus meningiomas: evolution of a modern approach. Neurosurg Focus 2013; 35 (06) E8 Doi: 10.3171/2013.9.FOCUS13345
  • 11 Walsh MT, Couldwell WT. Management options for cavernous sinus meningiomas. J Neurooncol 2009; 92 (03) 307-316
  • 12 Vernooij MW, Ikram MA, Tanghe HL. et al. Incidental findings on brain MRI in the general population. N Engl J Med 2007; 357 (18) 1821-1828
  • 13 Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neurooncol 2010; 99 (03) 307-314
  • 14 Hashimoto N, Rabo CS, Okita Y. et al. Slower growth of skull base meningiomas compared with non-skull base meningiomas based on volumetric and biological studies. J Neurosurg 2012; 116 (03) 574-580
  • 15 Chamoun R, Krisht KM, Couldwell WT. Incidental meningiomas. Neurosurg Focus 2011; 31 (06) E19 Doi: 10.3171/2011.9.FOCUS11220
  • 16 Nakasu S, Fukami T, Nakajima M, Watanabe K, Ichikawa M, Matsuda M. Growth pattern changes of meningiomas: long-term analysis. Neurosurgery 2005; 56 (05) 946-955 , discussion 946–955
  • 17 Nakamura M, Roser F, Michel J, Jacobs C, Samii M. The natural history of incidental meningiomas. Neurosurgery 2003; 53 (01) 62-70 , discussion 70–71
  • 18 Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, McDermott MW, Parsa AT. Treatment decision making based on the published natural history and growth rate of small meningiomas. J Neurosurg 2010; 113 (05) 1036-1042
  • 19 Cophignon J, Lucena J, Clay C, Marchac D. Limits to radical treatment of spheno-orbital meningiomas. Acta Neurochir Suppl (Wien) 1979; 28 (02) 375-380
  • 20 Larson JJ, van Loveren HR, Balko MG, Tew Jr JM. Evidence of meningioma infiltration into cranial nerves: clinical implications for cavernous sinus meningiomas. J Neurosurg 1995; 83 (04) 596-599
  • 21 Sen C, Hague K. Meningiomas involving the cavernous sinus: histological factors affecting the degree of resection. J Neurosurg 1997; 87 (04) 535-543
  • 22 Pichierri A, Santoro A, Raco A, Paolini S, Cantore G, Delfini R. Cavernous sinus meningiomas: retrospective analysis and proposal of a treatment algorithm. Neurosurgery 2009; 64 (06) 1090-1099 , discussion 1099–1101
  • 23 Hasegawa T, Kida Y, Yoshimoto M, Koike J, Iizuka H, Ishii D. Long-term outcomes of Gamma Knife surgery for cavernous sinus meningioma. J Neurosurg 2007; 107 (04) 745-751
  • 24 Kano H, Park KJ, Kondziolka D. et al. Does prior microsurgery improve or worsen the outcomes of stereotactic radiosurgery for cavernous sinus meningiomas?. Neurosurgery 2013; 73 (03) 401-410
  • 25 Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, McDermott MW, Parsa AT. Factors affecting outcome following treatment of patients with cavernous sinus meningiomas. J Neurosurg 2010; 113 (05) 1087-1092
  • 26 Gozal YM, Alzhrani G, Abou-Al-Shaar H, Azab MA, Walsh MT, Couldwell WT. Outcomes of decompressive surgery for cavernous sinus meningiomas: long-term follow-up in 50 patients. J Neurosurg 2019; 132 (02) 380-387
  • 27 Altay T, Patel BC, Couldwell WT. Lateral orbital wall approach to the cavernous sinus. J Neurosurg 2012; 116 (04) 755-763
  • 28 Messerer M, Dubourg J, Saint-Pierre G, Jouanneau E, Sindou M. Percutaneous biopsy of lesions in the cavernous sinus region through the foramen ovale: diagnostic accuracy and limits in 50 patients. J Neurosurg 2012; 116 (02) 390-398
  • 29 Raithatha R, McCoul ED, Woodworth GF, Schwartz TH, Anand VK. Endoscopic endonasal approaches to the cavernous sinus. Int Forum Allergy Rhinol 2012; 2 (01) 9-15
  • 30 Schwartz TH, Fraser JF, Brown S, Tabaee A, Kacker A, Anand VK. Endoscopic cranial base surgery: classification of operative approaches. Neurosurgery 2008; 62 (05) 991-1002 , discussion 1002–1005
  • 31 Cohen MA, Couldwell WT. Resection of cavernous sinus meningioma via lateral orbitotomy approach: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 2019; DOI: 10.1093/ons/opz174.
  • 32 Couldwell WT, Kan P, Liu JK, Apfelbaum RI. Decompression of cavernous sinus meningioma for preservation and improvement of cranial nerve function. Technical note. J Neurosurg 2006; 105 (01) 148-152
  • 33 Dolenc VV. Frontotemporal epidural approach to trigeminal neurinomas. Acta Neurochir (Wien) 1994; 130 (1-4): 55-65
  • 34 Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery 1991; 28 (06) 869-875 , discussion 875–876
  • 35 Couldwell WT, Sabit I, Weiss MH, Giannotta SL, Rice D. Transmaxillary approach to the anterior cavernous sinus: a microanatomic study. Neurosurgery 1997; 40 (06) 1307-1311
  • 36 Bowers CA, Sorour M, Patel BC, Couldwell WT. Outcomes after surgical treatment of meningioma-associated proptosis. J Neurosurg 2016; 125 (03) 544-550
  • 37 Al-Mefty O, Smith RR. Surgery of tumors invading the cavernous sinus. Surg Neurol 1988; 30 (05) 370-381
  • 38 Black PM. Meningiomas. Neurosurgery 1993; 32 (04) 643-657
  • 39 DeMonte F, Smith HK, al-Mefty O. Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 1994; 81 (02) 245-251
  • 40 Kim DK, Grieve J, Archer DJ, Uttley D. Meningiomas in the region of the cavernous sinus: a review of 21 patients. Br J Neurosurg 1996; 10 (05) 439-444
  • 41 Landeiro JA, Ribeiro CH, Lapenta MA, Flores MS, Lopes CA, Marins J. [Meningiomas of the cavernous sinus: the surgical resectability and complications]. Arq Neuropsiquiatr 2001; 59 (3-B): 746-753
  • 42 Sindou M, Wydh E, Jouanneau E, Nebbal M, Lieutaud T. Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone. J Neurosurg 2007; 107 (05) 937-944
  • 43 Couldwell WT, MacDonald JD, Taussky P. Complete resection of the cavernous sinus-indications and technique. World Neurosurg 2014; 82 (06) 1264-1270
  • 44 George B, Ferrario CA, Blanquet A, Kolb F. Cavernous sinus exenteration for invasive cranial base tumors. Neurosurgery 2003; 52 (04) 772-780 , discussion 780–782