Cavernous sinus exenteration for invasive cranial base tumors

Bernard George, Cristina Anastasia Ferrario, Alexandre Blanquet, Frédéric Kolb, Takeshi Kawase, Ossama Al-Mefty, Felix Umansky, Sergei Spektor, Vinko V. Dolenc, Laligam N. Sekhar, John Diaz Day

    Research output: Contribution to journalArticlepeer-review

    33 Scopus citations

    Abstract

    OBJECTIVE: Invasive tumors involving the cavernous sinus, such as recurrent benign meningiomas or sarcomas, raise therapeutic problems that may be resolved by cavernous sinus exenteration (CSE). METHODS: Our series comprises 18 patients (9 women and 9 men ranging in age from 14 to 64 yr) who underwent CSE during the past 8 years. The tumors in these patients included 12 meningiomas, 3 chondrosarcomas, 1 rhabdomyosarcoma, 1 lipomyosarcoma, and 1 epidermoid carcinoma. Preoperative occlusion of the internal carotid artery was confirmed in 15 cases by a balloon occlusion test. Three patients had a negative balloon occlusion test, and their internal carotid arteries were preserved (n = 1) or revascularized (n = 2) through an external carotid artery-to-middle cerebral artery bypass. RESULTS: CSE was performed as a primary treatment in 5 patients and after one to five recurrences in 13 patients. In all patients, CSE included the internal carotid artery and Cranial Nerves III, IV, and VI and one to three branches of Cranial Nerve V. Orbital exenteration was performed in eight patients, and partial hypophysectomy was performed in five patients. Ten patients had received radiotherapy before CSE, and five patients underwent irradiation after CSE. The operative mortality includes two patients. Cerebrospinal fluid leakage was the main complication in four patients, with three patients having meningitis. Follow-up ranged from 6 months to 5 years, with three deaths from new recurrences at 2, 3, and 4 years after CSE. As compared with their clinical courses before CSE, all patients except the two who died postoperatively benefited from CSE. CONCLUSION: CSE has useful indications in invasive and rapidly growing tumors, including apparently benign meningiomas. A better understanding of the biological behavior of these tumors is necessary for appropriate selection of patients for CSE.

    Original languageEnglish
    Pages (from-to)772-782
    Number of pages11
    JournalNeurosurgery
    Volume52
    Issue number4
    DOIs
    StatePublished - 1 Apr 2003

    Keywords

    • Cavernous sinus
    • Exenteration
    • Internal carotid artery
    • Meningioma

    ASJC Scopus subject areas

    • Surgery
    • Clinical Neurology

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